outpatient

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Alma Faulkenberger is an 85-year-old female outpatient sitting in the waiting room awaiting an invasive pelvic procedure. The health care professional who will assist in her procedure enters the room and calls “Alma.” There is no reply so the professional retreats to the work area. Fifteen minutes later the professional returns and calls “Alma Frankenberg.” Still no reply, so he leaves again. Another 15 minutes pass and the professional approaches Alma and shouts in her ear, “Are you Alma Frankenberg?” She replies, “No I am not, and I am not deaf either, and when you get my name correct, I will answer you.”

How would you use collaboration to assist in compliance with a patient as difficult as Alma?

 

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Nursing homework help

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Explain the role of health education in health promotion. How is the nursing process used in developing health education? Describe a contemporary issue, local or global, that a family may experience today. What steps would the nurse take to address these as part of a health education plan?

Due Date: august 4

Second Post

What characteristics would lead a provider to suspect domestic violence, child abuse, or elder abuse is taking place within a family? Discuss your facility’s procedure for reporting these types of abuse.

Due Date August 6

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Health Promotion

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Assignment: Preventative Guidelines – One Guideline and Two Scenarios

Throughout this course, we have looked at health promotion and disease prevention and focused on various vulnerable populations. This week’s discussion will focus on applying one guideline to two patients. Please select ONE of the following scenarios and then answer the questions in your initial post.

Please include at least three scholarly sources within your initial post.

Scenario A: Focus on Preventative Guidelines for Childhood Immunizations

You are working as an APRN in your local primary care office. The rural town of Maynard has 300 people, a post office, doctor’s office, and a gas station. The primary source of income is farming or driving 45 minutes to a somewhat larger town. With the blizzard coming, all your patients except two have cancelled for the morning. Jose is scheduled at 0900; he is a nine-year-old Hispanic male born in Mexico. He and his family (Mom, Dad, and six siblings, ages six months to 14 years) moved into the area just a few months ago. Jose’s mother reported that he had nearly died at two months after contracting pertussis.

Your final patient of the morning is Irena, a 15-year-old teenage female who lives with her aunt in Maynard. Irena is Romanian and barely speaks any English. Her aunt has been your patient for the past few years, and she told you that Irena had been abducted in Romania at the age of 10. Irena’s parents found her quite by accident when a sex trafficking ring dumped all their “product” in a refugee camp in Serbia just a few months ago. Irena’s parents are still in Romania, but they sent Irena here to live with her aunt.

Scenario B: Focus on Preventative Guidelines for Colorectal Cancer Screening

On a busy Thursday morning, you note on your schedule a couple of patients who routinely “take a long time” no matter what their complaint. Jimmy is a 62-year-old male who is mentally challenged and lives in a local group home. Both his parents passed away last year, and his sister has never really been in the picture. She lives at least eight hours away. Jimmy has a “genetic disorder” but actually his symptoms are more like autism that we are familiar with today. Jimmy’s caregiver states he has been having some problems with constipation but otherwise he seems okay. Jimmy is nonverbal and hates to be touched. Approaching Jimmy can be difficult, and he has taken a swing at staff a couple of times because he doesn’t understand what is going on – especially if they try to touch him to check his pulse or blood pressure.

Having finished up with Jimmy, you move on to Marvin. Marvin is a 67-year-old male here for his annual physical. Marvin is pretty healthy despite a scare with colon cancer when he was 50. He is obsessed with his bowels and even brings charts to each of his appointments as he is always concerned that the cancer will return.

Scenario C: Focus on Preventative Guidelines for Breast Cancer Screening

Volunteering once a month for a mobile clinic, you head out this Saturday morning with two other providers and staff. The mobile RV is a large motorhome retrofitted as a primary care clinic. Headed downtown where there is a large homeless population, everyone is excited to see what the day brings.

Miss Eleanor is a 72-year-old African American female who you have seen many times. Today she is complaining of some breast tenderness due to a fall she took with her grocery cart a couple of weeks ago. While examining Eleanor’s breast, you took the opportunity to do a manual breast exam. Eleanor said it had been at least 30 years since she’d had a breast exam and that she had never had a mammogram.

Finishing up your day on the mobile clinic, Sally, a 48-year-old female, is concerned that she has an STI. During Sally’s pelvic exam, you learn that she has been living in a tent under a bridge downtown for about a year. Sally is eager to talk to someone and tells you that she used to work in a medical office as a receptionist but that was a long time ago, before she was diagnosed with bipolar disorder. You are concerned that Sally does have an STI and you ask about her medical history. After quite a story, Sally tells you she had a mammogram about two years ago before she left Texas and there was a place the doctor wanted to evaluate further but she never went back for the ultrasound.

Scenario D: Focus on Cervical Cancer Guidelines

Working near a naval base, you see a lot of patients who are somehow connected with the military. Today, Shelesha, a 21-year-old African American female, is requesting to be seen for her annual exam before she leaves for deployment. Shelesha seems really anxious today. She is usually so excited about being on board her ship, but today she is different. You complete her annual exam, but she refuses her cervical and breast exam. After leaving the room so she can get dressed, you return to find Shelesha crying. She finally tells you that she was attacked – sexually assaulted on board her ship six months ago – and she has these “bumps” that keep getting bigger around her vagina and she is worried.

Virginia arrives for her annual well woman exam. Virginia is a 67-year-old female who has been married for 42 years. Virginia and Harrold are still sexually active with the use of medications, and like clockwork Virginia comes every year for her pelvic exam requesting a Pap smear. Virginia had breast cancer with a mastectomy when she was 52, but otherwise she is healthy, only taking medication for her cholesterol.

Scenario E: Focus on Prostate Cancer Guidelines

Ivan is a 59-year-old Caucasian male in your office today for his annual exam. He has been reading about prostate cancer and the need to have some lab work done. His wife really wants him to get his PSA drawn, but he’s not so sure. Your physical exam of Ivan is “all normal.” When reviewing Ivan’s health assessment form, you see he smokes two packs of cigarettes a day and his only complaint is a chronic cough.

Chen is 76-year-old gentleman of Chinese descent. He is here today for an annual exam and a recheck of his blood pressure. Chen tells you he just heard from his brother that his PSA (Prostate Specific Antigen) is really high, and they are concerned he may have prostate cancer. Chen’s brother is from his father’s second marriage and he is only 59 years old. Chen is asking to have his PSA drawn to make sure he doesn’t have prostate cancer.

Initial Post

Having discussed many guidelines throughout this term, consider the content you have explored. Using this knowledge, answer the following questions related to your chosen scenario. Note: please try to choose a topic for your initial post that you did not choose previously during the semester or aren’t as familiar with so you can gain additional knowledge as we finish up this course

  1. Discuss the guidelines assigned with your scenario.
  2. Will both patients be treated in the same manner? Why or why not?
  3. What would your treatment plan be for each of the individuals in your scenario?

INSTRUCTIONS

– Please include at least 3 scholarly sources within your initial post.

– APA style.

– Turnitin Assignment (No plagiarism)

Note: My background for you to have as a reference: I am currently enrolled in the Psych Mental Health Nurse Practitioner Program, I am a Registered Nurse. I work in a Psychiatric Hospital.

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GENITALIA ASSESSMENT

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Subjective:

  • CC: “I have bumps on my bottom that I want to have checked out.”
  • HPI: AB, a 21-year-old WF college student reports to your clinic with external
    bumps on her genital area. She states the bumps are painless and feel rough. She states she is sexually active and has had more than one partner during the past year. Her initial sexual contact occurred at age 18. She reports no abnormal vaginal discharge. She is unsure how long the bumps have been there but noticed them about a week ago. Her last Pap smear exam was 3 years ago, and no dysplasia was found; the exam results were normal. She reports one sexually transmitted infection (chlamydia) about 2 years ago. She completed the treatment for chlamydia as prescribed.
  • PMH: Asthma
  • Medications: Symbicort 160/4.5mcg
  • Allergies: NKDA
  • FH: No hx of breast or cervical cancer, Father hx HTN, Mother hx HTN, GERD
  • Social: Denies tobacco use; occasional etoh, married, 3 children (1 girl, 2 boys)
    Objective:
  • VS: Temp 98.6; BP 120/86; RR 16; P 92; HT 5’10”; WT 169lbs
  • Heart: RRR, no murmurs
  • Lungs: CTA, chest wall symmetrical
  • Genital: Normal female hair pattern distribution; no masses or swelling. Urethral
    meatus intact without erythema or discharge. Perineum intact. Vaginal mucosa pink and moist with rugae present, pos for firm, round, small, painless ulcer noted on external labia
  • Abd: soft, normoactive bowel sounds, neg rebound, neg murphy’s, negMcBurney
  • Diagnostics: HSV specimen obtained
    Assessment:
    • Chancre
  • Review the Episodic note case study provided you for this week’s Assignment.
  • Based on the Episodic note case study:
    • Review this week’s Learning Resources and consider the insights they provide about the case study. Refer to Chapter 3 of the Sullivan resource to guide you as you complete your Lab Assignment.
    • Search the Walden library or the Internet for evidence-based resources to support your answers to the questions provided.
    • Consider what history would be necessary to collect from the patient in the case study.
    • Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
    • Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.

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discussion

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Discuss the process of Advanced Practice Nurse (APN) business planning from a system approach.

APN Planning

The Institute of Medicine (IOM) (2010), advocates for Advanced Practice Nurse (APN) have an eye towards independence and innovation in building a healthcare system that meets the demands of safety, affordability, accessibility, quality, and patient-centred care. With the ageing of the baby boomer population, there is a substantially increased demand for primary care providers amid a growing shortage of primary care physicians. This also increases the probability of independent clinical practice. The systematic approach of translating the business plan into an actual running business requires a process (Johnson & Garvin, 2017). This discussion analyzes the process that APNs who wish to set up entrepreneurial endeavours follow.
The business process that an APN wishing to join independent venture must follow should incorporate research, deriving the purpose of the plan and objectives, development of a business profile, mission, and vision, execution of the project, and evaluation of the plan (Hahn & Cook, 2018). Other than understanding the process, the APN must have a clear understanding of other private practice requirements such as regulation, operational requirements, and financial aspect of the business (Johnson & Garvin, 2017). The APN can utilize the nursing education to come up with the business plan, ensuring that the intervention put in place is viable and well implemented and evaluated.
The first step of the process is research and developing a plan and objectives. Factors to consider while developing the business plan include; the purpose, the target group, type of services to be provided to the identified group, location of practice, operational hours of practice, and a clearly stated gap in the market.
The second, step the APN will consider the business plan is the business profile. In this stage, the APN should derive a vision statement, mission statement, clearly state services offered, and identify the registrations needed for the business. The third stage of the process will require that the APN propose how the services will be delivered. This should be clarified in terms of staff, equipment, and facility. Additionally, the marketing plan and the management plan will fall under this category.
Putting together all the above consideration in the planning process calls for the implementation of the plan and the later the evaluation. Private venture helps the APN, practice to the full extent of their skills and license (Hahn & Cook, 2018).
In the US, regulation and full authority practice differ from state to state. Currently, there 45 states where the APN can prescribe medication, of those 22 of them and the district of Columbia offer authority for full practice with only governance from the state nursing board (Conover & Richards, 2015). An APN aspiring for private practice must put into consideration the US state they plan to practice in and the specific regulation in place. States with full practice authority allow for their APN to fully take responsibility and liability of evaluation and management of the patient (Conover & Richards, 2015).
A business plan is essential in laying down the important strategies of the business. With a business plan in place, the APN establishes a focus, purpose, and a future plan. It also enables him or her secure the required funding in setting up the private practice.

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Healthcare: Interview and Interdisciplinary Issue Identification

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Assessment 2 Instructions: Interview and Interdisciplinary Issue Identification

  • For this assessment, you will create a 2-4 page report on an interview you have conducted with a health care professional. You will identify an issue from the interview that could be improved with an interdisciplinary approach, and review best practices and evidence to address the issue.
    As a baccalaureate-prepared nurse, your participation and leadership in interdisciplinary teams will be vital to the health outcomes for your patients and organization. One way to approach designing an improvement project is to use the Plan-Do-Study-Act (PDSA) cycle. The Institute for Healthcare Improvement describes it thus:
    The Plan-Do-Study-Act (PDSA) cycle is shorthand for testing a change in the real work setting—by planning it, trying it, observing the results, and acting on what is learned. This is the scientific method adapted for action-oriented learning…Essentially, the PDSA cycle helps you test out change ideas on a smaller scale before evaluating the results and making adjustments before potentially launching into a somewhat larger scale project (n.d.).
    You might also recognize that the PDSA cycle resembles the nursing process. The benefit of gaining experience with this model of project design is that it provides nurses with an opportunity to ideate and lead improvements. For this assessment, you will not be implementing all of the PDSA cycle. Instead, you are being asked to interview a health care professional of your choice to determine what kind of interdisciplinary problem he or she is experiencing or has experienced in the workplace. This interview, in Assessment 2, will inform the research that you will conduct to propose a plan for interdisciplinary collaboration in Assessment 3.
    It would be an excellent choice to complete the PDSA Cycle activity prior to developing the report. The activity consists of four questions that create the opportunity to check your understanding of best-practices related to each stage of the PDSA cycle. The information gained from completing this formative will promote your success with the Interview and Interdisciplinary Issue Identification report. This will take just a few minutes of your time and is not graded.
    Reference
    Institute for Healthcare Improvement. (n.d.). How to improve. Retrieved from http://www.ihi.org/resources/Pages/HowtoImprove/default.aspx
    Demonstration of Proficiency

    • Competency 2: Explain how interdisciplinary collaboration can be used to achieve desired patient and systems outcomes.
      • Summarize an interview focused on past or current issues at a health care organization.
      • Describe collaboration approaches from the literature that could be relevant in establishing or improving an interdisciplinary team to address an organizational issue.
    • Competency 3: Describe ways to incorporate evidence-based practice within an interdisciplinary team.
      • Identify an issue from an interview for which an evidence-based interdisciplinary approach would be appropriate.
    • Competency 4: Explain how change management theories and leadership strategies can enable interdisciplinary teams to achieve specific organizational goals.
      • Describe change theories and a leadership strategy that could help develop an interdisciplinary solution to an organizational issue.
    • Competency 5: Apply professional, scholarly, evidence-based communication strategies to impact patient, interdisciplinary team, and systems outcomes.
      • Communicate with writing that is clear, logically organized, and professional, with correct grammar and spelling, using current APA style.
    • Professional Context
      This assessment will introduce the Plan-Do-Study-Act (PDSA) Model to create change in an organization. By interviewing a colleague of your choice, you will begin gathering information about an interprofessional collaboration problem that your colleague is experiencing or has experienced. You will identify a change theory and leadership strategies to help solve this problem.
      Scenario
      This assessment is the first of three related assessments in which you will gather interview information (Assessment 2);  design a proposal for interdisciplinary problem-solving, (Assessment 3); and report on how an interdisciplinary improvement plan could be implemented in a place of practice (Assessment 4). At the end of the course, your interviewee will have a proposal plan based on the PDSA cycle that he or she could present to stakeholders to address an interdisciplinary problem in the workplace.
      For this assessment, you will need to interview a health care professional such as a fellow learner, nursing colleague, administrator, business partner, or another appropriate person who could provide you with sufficient information regarding an organizational problem that he or she is experiencing or has experienced, or an area where they are seeking improvements. Consult the Interview Guide [DOCX] for an outline of how to prepare and the types of information you will need to complete this project successfully.
      Remember: this is just the first in a series of three assessments.
      Instructions
      For this assessment, you will report on the information that you collected in your interview, analyzing the interview data and identifying a past or current issue that would benefit from an interdisciplinary approach. This could be an issue that has not been addressed by an interdisciplinary approach or one that could benefit from improvements related to the interdisciplinary approach currently being used. You will discuss the interview strategy that you used to collect information. Your interview strategy should be supported by citations from the literature. Additionally, you will start laying the foundation for your Interdisciplinary Plan Proposal (Assessment 3) by researching potential change theories, leadership strategies, and collaboration approaches that could be relevant to issue you have identified. Please be certain to review the scoring guide to confirm specific required elements of this assessment. Note that there are differences between basic, proficient and distinguished scores.
      When submitting your plan, use the Interview and Issue Identification Template [DOCX], which will help you to stay organized and concise. As you complete the template, make sure you use APA format for in-text citations for the evidence and best practices that are informing your plan, as well as for the reference list at the end.
      Additionally, be sure to address the following, which corresponds to the grading criteria in the scoring guide. Please study the scoring guide carefully so you understand what is needed for a distinguished score.
    • Summarize an interview focused on past or current issues at a health care organization.
    • Identify an issue from an interview for which an evidence-based interdisciplinary approach would be appropriate.
    • Describe potential change theories and a leadership strategies that could inform an interdisciplinary solution to an organizational issue.
    • Describe collaboration approaches from the literature that could facilitate establishing or improving an interdisciplinary team to address an organizational issue.
    • Communicate with writing that is clear, logically organized, and professional, with correct grammar and spelling, and using current APA style.
    • Additional Requirements
    • Length of submission: Use the provided template. Most submissions will be 2 to 4 pages in length. Be sure to include a reference page at the end of the plan.
    • Number of references: Cite a minimum of 3 sources of scholarly or professional evidence that support your central ideas. Resources should be no more than 5 years old.
    • APA formatting: Make sure that in-text citations and reference list follow current APA style.
    • Portfolio Prompt: Remember to save the final assessment to your ePortfolio so that you may refer to it as you complete the final Capstone course.

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Should We Withhold Life Support?

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Assessment 3 Instructions: Should We Withhold Life Support? The Mr. Martinez Case

    • Write a 2-3 page paper that examines the moral and ethical issues involved in making a decision regarding limiting life support.
      End-of-Life Issues
      With our framework of ethical theories and principles in hand, we begin our look at some of the critical ethical issues in our contemporary world, starting with end-of-life issues. This assessment covers ethical questions related to end-of-life care. Passive euthanasia is the removal or refusal of life-sustaining treatment. Examples of passive euthanasia include removal of a feeding tube or a ventilator, or forgoing a life-prolonging surgery. Passive euthanasia is legal in all 50 states, and the principle of autonomy gives informed patients the right to refuse any and all treatments. Patients who are unable to make such decisions in the moment (because they are unconscious, for example) might have made their intentions clear beforehand with an advance directive or similar document. Things become more complicated, however, when a patient who is unable to make treatment choices has not made his or her wishes clear, either formally in a written document, or informally in conversations with family members or friends. Another problem concerns cases in which there is disagreement about whether the treatment is sustaining the life of a person in the full sense or merely as a body that, because of severe and irreversible brain trauma, is no longer truly a living person.
      Active euthanasia, or assisted suicide, introduces further difficult moral questions. A patient who has a terminal illness and who has refused treatments that would merely prolong a potentially very painful and debilitating death might want the process of dying to be hastened and made less painful. The patient might want to take his or her own life before the disease reaches its horrible final stages. Should patients be legally allowed to have help in this endeavor? If suicide itself is not morally wrong, at least in cases like these, is it wrong for another person to directly help bring about the patient’s death? Is it wrong for doctors, a role we naturally associate with healing and the promotion of life, to use their medical expertise to deliberately end a patient’s life if the patient wants this?
      Demonstration of Proficiency
      By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

      • Competency 1: Articulate ethical issues in health care.
        • Articulate the moral issues associated with limiting life support.
      • Competency 2: Apply sound ethical thinking related to a health care issue.
        • Demonstrate sound ethical thinking and relevant ethical principles when considering limiting life support.
        • Explain important considerations that arise when contemplating limiting life support.
      • Competency 5: Communicate in a manner that is scholarly, professional, and respectful of the diversity, dignity, and integrity of others and is consistent with health care professionals.
        • Exhibit proficiency in clear and effective academic writing skills.
      • Preparation
      • Case Study: Mr. Martinez.
      • This media piece provides the context for this assessment; make sure you have reviewed the case study thoroughly.
        Additionally, it may be useful to think through the following issues as they relate to Mr. Martinez’s case:
      • Should Mr. Martinez be transferred to intensive care, where his respiratory failure can be treated by a ventilator, and by CPR if necessary, and his oxygen level can be monitored?
        • What are the key ethical issues or models at play in this case study?
        • What are the key end-of-life issues at play in this case study?
        • How can an understanding of models and best-practice help to guide health care practitioners to make ethical and legal decisions?
      • Instructions
        In a 2–3 page analysis of the case study, address the following:
      • The patient’s directives.
      • The patient’s quality of life.
      • The family’s stated preferences.
      • The moral issues associated with limiting life support.
      • The ethical principles most relevant to reaching an ethically sound decision.
      • Important considerations such as implications, justifications, and any conflicts of interest that might arise because of the patient’s respiratory failure.
      • When writing your assessment submission assume that doctors cannot contact Mrs. Martinez and must make this choice on their own. To help you reach an objective, ethically sound decision, draw upon concepts and arguments from the suggested resources or your independent research. Support your response with clear, concise, and correct examples, weaving and citing the readings and media throughout your answer.
        Submission Requirements
      • Written communication: Written communication is free of errors that detract from the overall message.
      • APA formatting: Resources and citations are formatted according to current APA style and formatting guidelines.
      • Length: 2–3 typed, double-spaced pages.
      • Font and font size: Times New Roman, 12 point.

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Week 2 Assignment: Analysis of Personal Beliefs and Biases

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I just need this revised and edit please. Don’t change my words in my personal beliefs. Just want it revised as if there are any run-ons, fragments, and punctuation in my paper. Before turning it in. Thanks!

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SBAR

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Choose an experience from your nursing practice. Using the “SBAR” template, explain the situation in detail, followed with background information. Then explain your immediate assessment and recommendations you have for the provider.

Include the following in the “SBAR” template:

  1. Be sure to include three or four evidence-based references, not older than 5 years.
  2. When giving your recommendation discuss how you would educate the client using evidence-based research and guidelines. How would you deliver your recommendation in various learning environments?

APA style is not required, but solid academic writing is expected.

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

You are not required to submit this assignment to LopesWrite.

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nursing

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  • Identify and describe any      risks and consider what further information you would need to gain a full      understanding of the child’s health. Think about how you could gather this      information in a sensitive fashion.
  • Taking into account the      parents’ and caregivers’ potential sensitivities, list at least three      specific questions you would ask about the child to gather more      information.
  • Provide at least two      strategies you could employ to encourage the parents or caregivers to be      proactive about their child’s health and weight.
  • For this Assignment, you      will consider the validity and reliability of different assessment tools      and diagnostic tests. You will explore issues such as sensitivity, specificity,      and positive and negative predictive values. You will also consider      examples of children with various weight issues. You will explore how you      could effectively gather information and encourage parents and caregivers      to be proactive about their children’s health and weight.
  • CHILD HEALTH CASE

Overweight 5-year-old black boy with overweight parents who work full-time and the boy spends his time after school with his grandmother.

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