Describe the influence “levels of evidence” have on practice changes. Identify the most reliable level of evidence and provide an example of the type of practice change that could result from this level of evidence.

Initial discussion question posts should be a minimum of 200 words and include at least two references cited using APA format. Responses to peers or faculty should be 100-150 words and include one reference. Refer to “RN-BSN Discussion Question Rubric” and “RN-BSN Participation Rubric,” located in Class Resources, to understand the expectations for initial discussion question posts and participation posts, respectively.

Select one of the following discussion questions below.  Post a substantive initial response with references. 

Discussion Post #3

Option 1

M.C. is a 69-year-old man who presents to the outpatient office with a hacking, raspy cough.

Subjective Data

PMH: HTN, DM

Cough is productive, bringing up green phlegm

Runny nose, sore throat

Denies fever

Sore throat pain when swallowing

No history of smoking or seasonal allergies

Complains of fatigue

Objective Data

Vital signs: T 37 P 72 R 14 BP 134/64

Lungs: + Rhonchi bilateral upper lobes, wheeze

O2 Sat = 98%

Ears = TM bulging

Nose = + erythema, yellow discharge

Throat = + erythema, – pustules

Medications: Metoprolol 12.5 mg per day, Glucophage 500 mg twice a day

Questions

1. What other questions should the nurse ask about the cough?
2. Develop a problem list from the objective and subjective data.
3. What nursing diagnoses can be derived from the problems list?
4. What should be included in the plan of care?
5. What risk factors are associated with this age group?
6. Based on the readings, what is the most likely cause of this patient’s cough?

(Image: Female Holding Head in Discomfort)

Option 2

S.P. is a 75-year-old woman who presents to the provider’s office with fatigue.

Subjective Data

PMH: HTN, hyperlipidemia, MI 3 years ago

Fatigue started about a month ago, getting worse

Relieved with rest, exacerbated with activity

Denies chest pain

Ankles swollen

Objective Data

Vital signs: T 37 P 112 R 18 BP 110/54

Lungs: bilateral lower lobe crackles

O2 Sat = 94%

Skin = cool to touch

CV = heart rate regular, positive peripheral pulses, ECG = no changes

+2 edema bilateral ankles

Medications: Metoprolol 20 mg per day, 325 mg of aspirin per day

Questions

1. What other questions should the nurse ask about the fatigue?
2. What other assessments are necessary for this patient?
3. What are some causes of fatigue?
4. Develop a problem list from the objective and subjective data.
5. What should be included in the plan of care?
6. Based on the readings, what is this patient’s most likely cause of fatigue?

 Information literacy is critically important for all nurses, especially APNs. APNs must be able to determine what information is needed, find the information, critique the information, provide care based on this information, and evaluate the outcomes of the process. Sound challenging? Continue to reflect upon strategies to facilitate this process. Provide a brief response (100 words or less)

Respond to two (2) of the following prompts:

1. Consider the social stratification of your family tree. Compare your social standing to that of your parents and grandparents. If you are unfamiliar with these people, feel free to substitute other family members or acquaintances from other generations. (USLO 3.1)
2. What social traits did your forebears pass down to you? Is there consistency or inconsistency in your family’s status? Which theoretical approach best describes your family’s social stratification? What changes do you anticipate for your family’s future generation? (USLO 3.1)
3. Consider your own experiences with social mobility. How do rules, laws, and societal structures promote wealth and poverty? Do you believe that rules, laws, and societal structure have a greater impact on social mobility than individual traits such as a strong work ethic? Do you believe social mobility has decreased or risen in recent years? How could rules, laws, and societal structures impact your future social mobility? What are some strategies for dealing with this future possibility? (USLO 3.2)
4. What is the relationship between subjective, absolute, and relative poverty and inequality/inequity? Who benefits from poverty, inequality, and inequity? Can policies be enacted to eliminate various forms of poverty and break the cycle of poverty? What are the advantages and disadvantages of enacting such policies? What role does the cycle of poverty play in maintaining social stratification, especially for women through the global feminization of poverty? (USLO 3.3)
5. Which of the three theoretical approaches (functionalist, conflict, or symbolic interactionist) would you use to explain why healthcare injustice and inequity occurs and what to do about it? (USLO 3.4)
6. What role does healthcare injustice play in perpetuating the system of stratification? How does the healthcare system maintain social stratification? Is healthcare injustice harming our society as a whole? (USLO 3.4)