Response 1

TC presents to urgent care with a right-shoulder pain 8/10 due to a work injury. The patient has no ROM in the effected shoulder and reports no neck pain. As a healthcare provider there are several things that need to be asked to understand this patient’s pain and pain management. How the injury occurred, if the pain gets better or worse with anything, how long has this pain been occurring for, and what type of pain is TC experiencing should be asked (Woo & Robinson, 2020). The patient should also be assessed for any depression or anxiety via a mental health screen for a history as well as to see if the pain is causing any changes in affect. A past medical history as well as a full physical exam should also be completed prior to making recommendations for pain management. Asking the patient if he is currently on any medications, specifically pain medications will be a useful tool to help decide what treatment will work best for this patient. In addition, allergies need to be considered.
The goal of pain management is to treat the pain but with the least adverse reactions possible (Woo & Robinson, 2020). The best way to accomplish this is to start with non-pharmaceutical management. Ice would be my first recommendation when the patient arrives. If upon assessment this patient has an injury that is affecting the muscle or tendon as most shoulder pain from work occurs from than ice can be put on the patient (Workers Injury Law and Advocacy Group, 2020). The patient’s pain being an 8 out of a 10 on the 0-10 scale however would alert me to give him at least an anti-inflammatory medication as well if not contradicted by information gathered during the history intake and physical examination. I would give TC 1,000mg of acetaminophen due to his high pain scale every 4 to 6 hours (Harvard Health, 2020). This patient may be asked for a urine sample as well for a tox screen to ensure there will be no medication contradictions as well as to assess if this patient is a drug seeker. If this were not sufficient for pain control and there were no other contradictions noted I would try a low dose of hydrocodone.
Instructions for TC would include to rest the shoulder and to ice the shoulder for 10-15 minutes at a time for the first day or two of the injury (Michigan Medicine, 2018). Instructions for acetaminophen include taking with some food to avoid GI upset as well as to not mix with alcohol or loop diuretics, beta-adrenergic blockers, or zidovudine medications (Woo & Robinson, 2020). If the patient were on one or more of these medications I would consider using a non-steroidal anti-inflammatory (NSAID) medication instead of acetaminophen such as Naprosyn. Also, the patient should not exceed the total daily maximum of 4,000mg per day as acetaminophen poisoning is common and dangerous (Woo & Robinson, 2020). Instructions for hydrocodone include not to take with alcohol or other opioid medication. Hydrocodone can cause respiratory distress, low blood pressure, altered mental status, nausea, vomiting, hallucinations, incoordination, constipation, and lethargy (Woo & Robinson, 2020). TC should be instructed not to drive while taking this medication. All opioid medications can become addictive as well so screening and education on this topic is also vital for TC. Lastly I would inform TC to follow-up with his provider and return to urgent care if symptoms get worse or new ones arise.
The DEA Drug Classification Schedule has five categories. Schedule one includes substances that are not for medical purposes or have not been legally endorsed for medical purposes and are highly abused when used such as heroin (DEA, 2020). Schedule two are also high risk for abuse however are used in a medical setting for example hydromorphone. Schedule three includes medications like Tylenol/Codeine which have a less risk of addictive abuse but still could be abused (DEA, 2020). Schedule four medications have a low risk for abuse and addiction as consequence of consumption and they include medications such as Ambien (DEA, 2020). And lastly, are schedule five drugs which do not contain the same narcotic properties as the other categories of drugs. This would include cough syrup and Lyrica (DEA, 2020).

Response 2

 

The treatment plan for pain has been a much-discussed topic with different opinions that may have pharmacological companies and government agencies at odds of how to treat pain in this country. The one thing everyone agrees is that pain is “real” and affects millions of people worldwide with ineffective treatment for different reasons. According to Woo (2020), pain can be defined as the duration of the pain is either acute or chronic and the source of the pain. The attempt by large corporations in the late 1990’s to treat pain resulted in millions of people dying of an overdose or with addiction that has cost millions of dollars in healthcare treatments (CDC, 2020). In this case study, there are a few things to consider.

        TC comes to the clinic due to a work-injury with an 8 out of 10 pain and is unable to do ROM to the shoulder. The first action that this clinician would take is to assess the patient’s shoulder, his skin, and also take a detailed history of medications, and allergies. After identifying TC’S home medications, if any, and allergies, this prescriber prescribes a fast-acting opioid medication to help with the pain such as morphine. The next step would be sending TC to do an X-Ray and possible follow-up with orthopedic.

        While treating TC for acute pain with opioid morphine is important to understand that this treatment option would be just until his pain is controlled and the necessary X-rays and other tests are obtained. Understanding that the inflammatory process has started the moment the injury occurred as a body’s defense mechanism and healing process (Roma et al., 2020). In this situation, an anti-inflammatory, NSAIDs such as Ibuprofen could be prescribed to control his pain, if there were no fracture noted. The use of an NSAID would decrease the need to use an opioid which is associated with chemical dependency (Woo, 2020). Also, a topical agent could be prescribed in adjunction with the NSAID to help in the treatment of the pain. By prescribing the Lidocaine patch to be applied to the site would help in the control of pain with continuous therapy.

        The teaching to TC would include following the instructions from the orthopedics. Take medications as prescribed. When taking NSAIDS make sure to take with food and a full glass of water and stay up for at least 30 minutes to prevent any GI disturbance, do not take any other medication that is not approved by the clinician, and report to the clinician if the pain is at a comfortable level. Educate TC to report to the clinician if the pain is increasing and the injury is not getting any better to contact the clinician and not to initiate any home remedies without first consulting a prescriber.

        The classification of medication according to the US Drug Enforcement Administration (DEA) drug classification scheduled is to guide prescribers into prescribing drugs. It is designed to regulate the manufacturing, distribution, and dispensing of medications classified as “controlled” (Woo, 2020). The schedule is bound to follow those rules. It is divided into five categories. Scheduled I is drugs that are not prescribed for medical use and have a high potential for abuse, for example, heroin, LSD, marijuana, ecstasy, methaqualone, and peyote (DEA, 2020). In the scheduled II are drugs with high potential for abuse, and may lead to psychological or physical dependency, some examples are Vicodin, Dilaudid, Demerol, OxyContin, Fentanyl, Dexedrine, Adderall, and Ritalin (DEA, 2020). In the scheduled III comes drugs with moderate potential for abuse which are Tylenol with codeine, ketamine, anabolic steroids, and testosterone (DEA, 2020). In Scheduled IV are drugs with low potential for abuse or dependence, some are Xanax, Soma, Darvon, Darvocet, Valium, Talwin, Ambien, and Tramadol (DEA, 2020). Lastly, comes the schedule V which are drugs with low potential for abuse, and contains preparations with a limited quantity of certain narcotics. It is mostly used as an antidiarrheal, antitussive, and analgesic needs, some examples are Robitussin AC, Lomotil, Motofen, Lyrica, and Parepectolin (DEA, 2020). This classification is an important tool for the prescriber to follow and understand how each medication is used and the level of addiction that it can have in patients.

 Respond with a  well-developed paragraph (300–350 words to each peer), integrating an evidence-based resource that is different than the one used for the initial post.

Respectfully agree and disagree with your peers’ responses and explain your reasoning by including your rationales in your explanation.
 

   

Responses 1 JITop of Form

The top five strengths theme results of my StrenghtsFinder assessment are as follows (CliftonStrengths for Students, 2020): 

Achiever: Hard worker with the stamina to keep working. They like to keep themselves busy and make their time useful (Schubring, 2017). 

Learner: Like learning new things and continuously want to improve things. They get satisfaction in learning new things.

Futuristic: Dreamers, perceivers, and inspired by what could be in the future. They have a clear vision of what they would like in the future and go towards that goal.

Focus: They prioritize their tasks before acting on it. Make corrections as needed but stay on track.  

Analytical: Are thinkers, they like to think of possible causes and reasons that might be causing a problem in the situation. 

Your personal values are things that are important to you. It is what guides us to make our decisions (What Are Your Values?, 2020). My two core values that guide my decisions are being persistent and being dependable. Being dependable comes with being honest and reliable. If I am given a task, I have been known to work hard and long hours to get it done. I believe in this, whether I am doing something at home or at the workplace. My previous manager once said, she likes putting me in the team lead position because she knows I will make sure everything will get done even if my shift is over. Working hard leads to me having perseverance. I will not give up until I have figured out or completed what I am working on. I do not like leaving work I have started for others. 

My two strengths of being an achiever and focus go hand in hand with being dependable and persistent. I am able to work hard and long hours on something is because I am able to stay focused on not get sidetracked. I do like making a list of things to do as it states in behavioral examples of the StrengthsFinder Theme of Achiever (Schubring, 2017). I am task-oriented and will keep going down on the list of things to do until it is completed. 

This is actually also my weakness. I am so focused on getting things done, that I forget to ask for help and delegate tasks to others. I have a hard time delegating because I feel like I will get things done faster if I just do it myself. This causes me to work harder and end up doing a lot more work than others in the same position as I am. 

 
 

References

CliftonStrengths for Students. (2020). Gallup.com. Retrieved September 27, 2020, from https://walden.gallup.com/application/strengthsquest

Schubring, L. (2017). Exploring the StrengthsFinder Theme of Achiever. Leadership Vision. Retrieved September 28, 2020, from https://www.leadershipvisionconsulting.com/exploring-the-strengthsfinder-theme-of-achiever/

What are your values? (2020). MindTools. Retrieved September 28, 2020, from https://www.mindtools.com/pages/article/newTED_85.htm

Responses 2 Al

Top of Form

According to Rath (2007), a person is six times less likely to be engaged in their job when they are not in the “strengths zone,” and that person is quite different than they usually are. (p. 12). I find this to be true. If a person has a purpose and knows their strengths, they are more likely to try to achieve things using them and attempt harder to succeed. When I took my StrengthsFinder assessment, it found my top 5 strengths to be as follows: 

Achiever- “You relish on the feeling of being busy, but you also need to know when you are done.” (Rath, 2017, p. 38). This is true for me. On my days off, I am thinking about what in the heck I am going to do today. I cannot ever sit and be still.  

Communication- I did not think this would be a strength for me, although I am ok with communication. What I have done in the past, if I need to present something, is practice alone first, which the book guides us to do.

Input- “Schedule a time to read books or articles that stimulate you.” (Rath, 2017, p. 127).

Command-This is the one that fits me the best. “Your take-charge attitude steadies and reassures others in times of crisis.” (Rath, 2017, p. 63). There have been many codes on the unit where this has happened with my team.  My family would agree with this one also. Our book said a “command” is to partner with a “woo”.

Woo- “You are drawn to strangers.” (Rath, 2017, p. 169). A course of action here is finding a job where I interact with many different people, and I do this in psych, which I love.

“Although people certainly do change over time and our personalities adapt, scientists have discovered that core personalities adapt, scientists have discovered that core personality traits are relatively stable throughout adulthood, as are our passions and interests.” (Rath, 2007, p. 18).

I have always had core values of compassion and advocacy. Compassion for all the different situations people are in and where they have come from, along with their current situation. At times, my advocacy has gotten me into trouble. I try just to dive right in and solve problems.  I would like to strengthen here by getting all the facts and understanding all the history before trying to solve any problems for patients I may have ideas for. Working in psych, all kinds of issues come into the hospital frequently and my mind seems to be always going to give these people ideas on how to solve this when they get out.  I need to sit back with the patient and not just be the problem solver on my own. I do this with friends too. If there is an issue, I will not rest until its solved. I would like to work on handing the reins over and trusting the job will get done. At times I take on too much and do nothing but stress out. This would be part of the achiever piece; learning to let some go.

A strength I have is always being a team player. We, as nurses, take care of people. This is a huge job and it takes different members to produce the best outcome for these people, especially in psych when there is so much follow up to be done to ensure success. When it comes to being a leader, it is important to know your strengths, so your drive of the mission continues and you know your worth. “You have to have a lot of energy, a lot of direction, and be focused on the mission.” (Laureate Education, Producer, 2014, 2:04).

                                                                    References                         

Laureate Education (Producer). (2014). Leadership [Video file]. Baltimore, MD: Author.

Marshall, E., & Broome, M. (2017). Transformational leadership in nursing: From expert   

    clinician to influential leader (2nd ed.). New York, NY: Springer.

Rath, T. (2007). Strengths Finder 2.0

REPLY QUOTE EMAIL AUTHOR

Bottom of Form

 

• PowerPoint Presentation Template.

Note: Review the PowerPoint Presentation Template available through the Walden Writing Center (http://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-2774362). While this template provides a general outline that may be used to help inform your presentation, you are urged to use individual creativity in the development of your presentation to the hospital administrator.

To complete the assessment, read the following instructions. Then, create a 12-to-15 slide presentation (excluding the cover and reference slide) that presents performance comparisons of two healthcare facilities.

Scenario:

The administrator for your healthcare organization is asking nurse leaders to understand how quality of care is measured as well as determine what each nurse can do to make an impact on areas that need improvement in healthcare organizations. Each nurse leader is asked to gather pertinent data from two organizations and to compare this data to assess performance. State and national averages should be identified when using the benchmark data from the Compare sites and should be used to compile a presentation to the hospital administrator.

In response to your administrator’s request, you will brainstorm and create a presentation that will highlight performance comparisons for two healthcare organizations. Note, you should compare two of the same healthcare organization type (example: if you select a hospital, you will need to select an additional hospital for the comparison; if you select a home health agency, you will need to select an additional home health agency for the comparison).

Be sure to base the information for your presentation on your clinical experience. Review the data from the Compare sites and brainstorm on what the data may be highlighting and indicating relative to each healthcare organization’s performance. Your presentation should contain the following sections:

1. Cover slide with name and title (1 slide)
2. Identify and describe any potential factors that may account for differences in performance measures. (2-3 slides)
3. Explain how these differences in performance measures might impact nursing practice. (2-3 slides)
4. Describe the publicly reported data on the quality and safety of care for TWO of the following organizations. Select hospitals, nursing homes, OR home health agencies, and describe the data listed under the organizations in your comparison: (6 slides)
   1. Hospitals
      (Choose one of the following to compare two hospitals)
      1. Patient Survey Results
      2. Timely and Effective Care
      3. Readmissions, Complications, and Deaths
      4. Linking Quality to Payment
      5. Medicare Volume
   2. Nursing Homes
      (Choose one of the following to compare two nursing homes)
      1. Overall Rating
      2. Health Inspections
      3. Staffing
      4. Quality Measures
   3. Home Health Agencies
      (Choose one of the following to compare two home health agencies)
      1. Quality of Patient Care
      2. Patient Survey Results
5. Provide recommendations that are supported by the research literature for clinical decisions systems that may potentially explain why the healthcare organizations are performing well, including an explanation of what you, as a nurse leader might continue doing to sustain a high level of performance OR why the healthcare organizations are not meeting standards, including an explanation of what you, as a nurse leader might do to help reach standards in the selected healthcare organizations. Be sure to cite at least 3 scholarly resources to support your recommendations. (2-3 slides)
6. Reference slide that cites all resources consulted and used to support the development of your presentation (1 slide)

 

1) Minimum 9 full pages (Follow the 3 x 3 rule: minimum three paragraphs per part)

              Part 1: Minimum 1 page

              Part 2: minimum 1 page

              Part 3: minimum 1 page

              Part 4: minimum 1 page 

              Part 5: Minimum 1 page

              Part 6: minimum 1 page

              Part 7: minimum 1 page

              Part 8: minimum 1 page

              Part 9: minimum 1 page

Submit 1 document per part

2)¨******APA norms, please use headers

          All paragraphs must be narrative and cited in the text- each paragraphs

          Bulleted responses are not accepted

          Dont write in the first person 

          Dont copy and pase the questions.

          Answer the question objectively, do not make introductions to your answers, answer it when you start the paragraph

         Submit 1 document per part

3)****************************** It will be verified by Turnitin (Identify the percentage of exact match of writing with any other resource on the internet and academic sources, including universities and data banks) 

********************************It will be verified by SafeAssign (Identify the percentage of similarity of writing with any other resource on the internet and academic sources, including universities and data banks)

4) Minimum 3 references per part not older than 5 years

5) Identify your answer with the numbers, according to the question.

Example:

Q 1. Nursing is XXXXX

Q 2. Health is XXXX

6) You must name the files according to the part you are answering: 

Example:

Part 1.doc 

Part 2.doc 

__________________________________________________________________________________

Part 1:

1. Explain the planning process of community health improvement. 

2. Choose one of the models / tools for community health planning discussed in your book and explain it. (Please, mention which model / tool you chose).  (See chapter 1 and 2).

Part 2:  

1. Mention at least three benefits of massage physical level and explain them

2. Mention at least 3 contraindications of massage and explain them

2. Have you ever had a massage? 

a. What type of massage? Please, tell about your experience. 

Part 3:  

 

1. To best understand the concepts of ethics, define the following terms:

• Utilitarianism
• Egoism
• Relativism
• Absolutism

2.List two of the functions of a gerontological nurse regardless of practice setting.

Part 4:  

Case Study, Chapter 9, Diversity in the Nursing Workforce

A group of nurse educators are having a discussion about the minority student nurses. The nurse educators believe that there are numerous barriers to minority student success in nursing education. The nurse educators want to develop strategies to increase the success rate in graduation of these students.

1. The nurse educators make a list of the barriers that exist for minority student success. What are common barriers for minority student success?

2. The group of nurse educators is acutely aware that different generations are represented in nursing today. These different generations have different attitudes and value systems, which greatly affect the settings in which they work. What are the key characteristics of the four generational groups that are present in today’s workforce?

3. Analyze and describe how the different generations present in nursing today affect nursing care and the nursing workplace. 

Part 5: Florida

Go to the following website by clicking on the provided link, http://www.countyhealthrankings.org/ , and select a county and a state (this may be the county/state in which you reside, attend school, or plan to live and work as an APRN). After reviewing the website and the health outcomes in the County Health Rankings for the area, answer the following questions in a few short sentences as part of your discussion.

1. Briefly list the general statistics pertaining to a specific health concern that is on the rise in selected the city/county. 
2. How can the creation of a community health center program help to address this public health problem?
3. What can you as a nurse practitioner and/or nurse leader do to influence policy innovation to resolve the problem?

Part 6: California

Go to the following website by clicking on the provided link, http://www.countyhealthrankings.org/ , and select a county and a state (this may be the county/state in which you reside, attend school, or plan to live and work as an APRN). After reviewing the website and the health outcomes in the County Health Rankings for the area, answer the following questions in a few short sentences as part of your discussion.

1. Briefly list the general statistics pertaining to a specific health concern that is on the rise in selected the city/county. 

2. How can the creation of a community health center program help to address this public health problem?

3. What can you as a nurse practitioner and/or nurse leader do to influence policy innovation to resolve the problem?

Part 7: Colorado

 

Go to the following website by clicking on the provided link, http://www.countyhealthrankings.org/ , and select a county and a state (this may be the county/state in which you reside, attend school, or plan to live and work as an APRN). After reviewing the website and the health outcomes in the County Health Rankings for the area, answer the following questions in a few short sentences as part of your discussion.

1. Briefly list the general statistics pertaining to a specific health concern that is on the rise in selected the city/county. 

2. How can the creation of a community health center program help to address this public health problem?

3. What can you as a nurse practitioner and/or nurse leader do to influence policy innovation to resolve the problem?

Part 8:

Issue: Infection Control and Prevention 

Topics: Cleaning and disinfection; Standards precaution and Cross-contamination

Place:  University Plaza Nursing and Rehabilitation center 

After discussion with your preceptor:

1. Name one financial aspect, one quality aspect, and one clinical aspect that need to be taken into account for developing the evidence-based change proposal. 

2. Explain how your proposal will directly and indirectly impact each of the aspects.

Part 9:

Issue: Infection Control and Prevention 

Topics: Cleaning and disinfection; Standards precaution and Cross-contamination

Place:  University Plaza Nursing and Rehabilitation center  

Now that you have completed a series of assignments that have led you into the active project planning and development stage for your project, 

1. Briefly describe your proposed solution to address the problem, issue, suggestion, initiative, or educational need 

2. how it has changed since you first envisioned it. 

3. What led to your current perspective and direction?

discuss the article attached 1 to 2 pages.