Rate yourself using the results from the “Nurse Manager Skills Inventory”:

Write a reflection of 750-1,000 words in which you identify your strengths and weaknesses related to the four content areas below:

1. Personal and professional accountability
2. Career planning
3. Personal journey disciplines
4. Reflective practice reference behaviors/tenets

Discuss how you will use your current leadership skill set to advocate for change in your workplace.

Identify one personal goal for your leadership growth and discuss your implementation plan to achieve that goal.

While APA format is not required for the body of this assignment, solid academic writing is expected and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

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

There are various considerations that must be taken into account when initiating drug therapies in a geriatric, pediatric, or pregnancy patient. In a well-developed essay, discuss one to two key factors/elements that must be taken into consideration when initiating a particular drug (your selection) in a geriatric, pediatric, or pregnant patient.

Include the following elements in your essay:

 An introduction with an argumentative thesis statement

 The description and considerations of the first key factor

 The description and considerations of the second key factor

 A conclusion

 At least two outside sources. One can be your textbook, but the other must be from the CSU Online Library.

Your essay should be approximately one page in length (not including the cover and reference page.) Follow APA format and be sure to cite, and reference all outside sources that you used.

Information about accessing the Blackboard Grading Rubric for this assignment is provided below.

A 58-year-old female is admitted for a work up for a complaint of neck and low back pain. During admission, you discover that she underwent a renal transplant six years ago. The patient also had blood work collected. When you review the findings, you notice that her serum calcium is elevated at 13.9 (Normal values range from 8.5 to 10.2 mg/dl), her CBC shows a hematocrit of 33%, and hemoglobin of 11.1 g/dl (normal adult female hematocrit Range: 37-47%, normal adult female hemoglobin range: 12-16 g/dl). What does this mean and what could be the underlying cause of her pain and her abnormal lab values? What other assessments would be helpful?

The first thing that I would address is how she is doing with her anti-rejection medications and when the last time she followed up with her transplant team. Although the rate of rejection decreases every year after a transplant, the long term success of a kidney transplant significantly depends on regular follow up care with the transplant team, taking anti-rejection medications, and following the advice/care plan that is set in place for you (Kimberley, 2017). The fact that she is having that lower back pain concerns me of some type of kidney issue that can be as minor as a kidney stone or as severe as possible rejection. The elevated calcium can be attributed to many different things. It can be from overactive parathyroid glands, cancer, and a whole list of other things. I am suspecting that this patient could possibly be dehydrated because hypercalcemia can also be attributed to severe dehydration, which is also why my main concern is what is going on with her kidneys (Lumachi, 2010). Having a low hematocrit means that the percentage of red blood cells is lower what is expected. The patient can have some kind of internal bleeding, or possibly even cancer. She has been on the anti-rejection medications for 6 years. A side effect of those anti-rejection medications is a secondary cancer. It wouldn’t hurt to have that evaluated. A lower hemoglobin can also be indicative of chronic kidney disease, and/or cancer (Kimberley, 2017).

I would recommend that an entire kidney workup be completed for this patient. That would incredude a complete metabolic panel, a UA, Renal US. It is possible that this is just a kidney stone, but that is where I would start. If all those prove to be normal then I would do a cancer workup to see if it is possible the patient has developed a secondary cancer from the anti-rejection medications. If that proves not to be the problem then I would consider maybe with the patients age that this could be indicative to osteoporosis.

 A PICOT starts with a designated patient population in a particular clinical area and identifies clinical problems or issues that arise from clinical care. The intervention should be an independent, specified nursing change intervention. The intervention cannot require a provider prescription. Include a comparison to a patient population not currently receiving the intervention, and specify the time-frame needed to implement the change process.

Formulate a PICOT statement using the PICOT format provided in the assigned readings. The PICOT statement will provide a framework for your capstone project.

In a paper of 500-750 words APA, clearly identify the clinical problem and how it can result in a positive patient outcome.

Make sure to address the following on the PICOT statement:

1. Evidence-Based Solution
2. Nursing Intervention
3. Patient Care
4. Health Care Agency
5. Nursing Practice