Post a description of the focus of your scenario. Describe the data that could be used and how the data might be collected and accessed.

In the modern era, there are few professions that do not to some extent rely on data. Stockbrokers rely on market data to advise clients on financial matters. Meteorologists rely on weather data to forecast weather conditions, while realtors rely on data to advise on the purchase and sale of property. In these and other cases, data not only helps solve problems, but adds to the practitioner’s and the discipline’s body of knowledge.

Of course, the nursing profession also relies heavily on data. The field of nursing informatics aims to make sure nurses have access to the appropriate date to solve healthcare problems, make decisions in the interest of patients, and add to knowledge.

In this Discussion, you will consider a scenario that would benefit from access to data and how such access could facilitate both problem-solving and knowledge formation.

Question

Post a description of the focus of your scenario. Describe the data that could be used and how the data might be collected and accessed. What knowledge might be derived from that data? How would a nurse leader use clinical reasoning and judgment in the formation of knowledge from this experience?

 
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Examine the advanced nursing practice role for which you are being prepared (Nurse Practitioner) and briefly describe the role including the history of the role, education and certification, and major functions of this role.

  1. Examine the advanced nursing practice role for which you are being prepared (Nurse Practitioner) and briefly describe the role including the history of the role, education and certification, and major functions of this role.
  2. Create a marketing plan to support your value to the healthcare team. You will need to look at the literature beyond nursing. Address each of the 4Ps to market your advanced nursing practice role.
  3. Investigate at least two of the Central and Core Competencies (i.e., Direct Clinical Practice, Guidance and Coaching, Consultation, Evidence-based Practice, Leadership, Collaboration, Ethical Decision Making) described in Hamric’s Integrative Model of Advanced Practice Nursing and how these competencies can influence and advance healthcare.

Your presentation must be presented in a single PowerPoint presentation. The presentation must be between 7 and 10 slides in length, not including the title and reference list slides. The presentation must use proper APA formatting as directed in the APA Publication Manual, 6th edition formatting, including title slide and reference list with properly formatted citations in the body of the presentation. You will record this as a voice-over PowerPoint. This must be at least 10 minutes in length.

 
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Discussion, you shared your experiences with health care practice problems as a consumer and/or as a practitioner. Now, consider your current practice setting and think about something specific and relevant to your practice setting that you would like to see improved or changed.

In this week’s Discussion, you shared your experiences with health care practice problems as a consumer and/or as a practitioner. Now,  consider your current practice setting and think about something specific and relevant to your practice setting that you would like to see improved or changed. Interview a key leader in your practice setting who can confirm that your practice problem is one that should be addressed to enhance delivery or performance in the field. It is important to remember from the beginning that your practice problem must be measurable and that you identify data that suggest a problem exists, and although this comes up more specifically in Week 2, it is important to consider this from the start.

This will be the problem discussed in your Practice Experience Project, Capstone Paper, and Storyboard.

By Day 4

Identify a measurable patient-centered practice problem related to quality or safety and relevant to your practice setting that you will also focus on in your Capstone Paper, and post a brief description of the problem and an explanation of why you selected it. Explain how the conversation you had with the key leader in your practice setting impacted your decision to address this particular practice problem. Be sure to support your practice problem with the literature that indicates the relevance of this problem for nursing practice. Provide evidence from your practice area and describe the data that is available.

You will not be collecting any data during the practice experience project; you will use data already available to you in your workplace or another practice setting. Think about the different kinds of data that is shared with you in your work area. For example, data may include patient satisfaction scores, medication error rates, falls, CLABSI, or  CAUTI rates. Analyzing the data available to you is how you will identify that a quality problem exists. Data identifies potential areas for improvement and monitors the effectiveness of any changes. It is important to obtain baseline data before beginning a quality improvement project and to analyze results during and at the end of a  project.

 
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Case Study Chief complaint: “I’m here for a medication refill because I ran out of my medicines”. HPI: Mrs. Allen is a 68-year-old African American who presents to the clinic for prescription refills.

Case Study

Chief complaint: “I’m here for a medication refill because I ran out of my medicines”.

HPI:  Mrs. Allen is a 68-year-old African American who presents to the clinic for prescription refills. The patient indicates that she has noticed shortness of breath which started about 3 months ago. The SOB gets worse with exertion, especially when she is walking fast, and it is resolved when she is resting. She reports that she is also bothered by shortness of breath that wakes her up intermittently during her sleep. Her symptoms of shortness of breath resolve after sitting upright on 3 pillows. She also has lower leg edema pitting 1+ which started 2 weeks ago. She indicates that she often feels light headed at times with intermittent syncope episodes while going up a flight of stairs, but it resolves after sitting down to rest. She has not tried any over the counter medications at home.

She started taking her medications, but failed to refill the prescriptions because she cannot afford the medications as she only works part-time and lives alone. In addition, she reports that she does not think taking all these medications would help her condition anyway.

PMH: Primary Hypertension, Previous history of MI 1 year ago

Surgeries:

1 year ago-Left Anterior Descending (LAD) cardiac stent placement

Allergies: Penicillin

Vaccination History:  Up-to-date

Social history:

High school graduate married and no children. Drinks one 4-ounce glass of red wine daily. She is a former smoker and stopped 5 years ago.

Family history:

Both parents are alive. Father has history of MI and valvular heart disease; mother alive and cardiac history is unknown. He has one brother who is alive and has history of MI 5 years ago at age 52.

ROS:

Constitutional: Lightheaded and faint with exertion. Respiratory: Shortness of breath with exertion. + Orthopnea. Cardiovascular: + 2 pitting leg edema for 3 weeks.

Psychiatric: Non-contributory.

Physical examination:

Vital Signs: Height: 5 feet 1 inches Weight: 175 pounds BMI: 32, Obese, BP 160/92, T 98.0, P 111,  R 22 and non-labored

HEENT: Normocephalic/Atraumatic, Bilateral cataracts; PERRLA, EOMI; Teeth intact. Negative for gum disease. NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement. LUNGS: + Mild Crackles on inspiratory phase not clearing with cough. Equal breath sounds. Symmetrical respiration. No respiratory distress. HEART: Normal S1 with S2 during expiration. An S4 is noted at the apex; + systolic murmur noted at the right upper sternal border without radiation to the carotids. Pulses are 2+ in upper extremities and 2+ in pedal pulses bilaterally. 2+ pitting edema to her knees noted bilaterally. ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses. GENITOURINARY: No CVA tenderness bilaterally. GU exam deferred. MUSCULOSKELETAL: + Heberden’s nodes at the DIP joints, hands. + Crepitus, bilateral knees. Slow gait but steady. No Kyphosis. PSYCH: Normal affect. Cooperative. SKIN: No rashes. Positive for dry skin.

Labs: Hgb 13.2, Hct 38%, K+ 4.0, Na+137, Cholesterol 228, Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98.

A:

Primary Diagnosis: Congestive Heart Failure (CHF)

Secondary Diagnoses: Primary Hypertension, Obesity, Osteoarthritis (OA)

Differential Diagnosis: Peripheral Vascular Disease (PVD)

Plan: 

Medications: Tylenol 650 mg PO Q4 hours as needed for arthritis pain

Labs: UA; Brain natriuretic peptide (BNP); LFTs and TSH; 12-lead EKG, Chest X-ray; Initial 2D echo with Doppler; Ankle-brachial index.

Additional lab results: Echo results 1 week ago: Left ventricular EJ Fraction decreased to 35 %

BNP – not available.

As a future FNP, you need to determine the medications for CHF/ASCVD. (Arteriosclerotic Cardiovascular Disease).

Questions:

1.     According to the ACC/AHA guidelines, what medications should this patient be prescribed?

2.     Does he need medication(s) given his history of MI? 

 
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Transcultural Perspectives in the care of Older Adults. Review the attached PowerPoint presentation. Once done, read the following clinical case below and answer the questions.

Transcultural Perspectives in the care of Older Adults.

Review the attached PowerPoint presentation.  Once done, read the following clinical case below and answer the questions;

Diabetes has been emerging as a major public health concern among Native American communities in the United States for the past 40 years. The Pima Indians in Arizona currently have the highest recorded prevalence of diabetes in the world. On average, American Indian and Alaska Native adults are 2.6 times more likely to have diabetes than non-Hispanic Whites of similar age. Diet is a key factor in controlling blood glucose levels and preventing serious cardiac, renal, peripheral vascular, and retinal complications such as heart attacks, renal failure, limb amputations, and blindness.

An Indian Health Service (IHS) nurse visits a patient in her mobile home, located on an Arizona Indian reservation. The patient is a 72-year-old, obese, female Pima Indian with a blood glucose level of 280. She is at risk for serious complications of type 2, or non–insulin-dependent, diabetes mellitus. With type 2 diabetes, the body either resists the effects of insulin or doesn’t produce enough insulin to maintain a normal blood glucose level. The patient lives with her adult daughter, two grandchildren, and five great-grandchildren. The nurse’s goals are to use culturally appropriate diet education to repattern the patient’s eating habits for the purpose of reducing the blood glucose level to normal (between 70 and 110 mg/dL); promoting steady sustained weight loss (5 pounds per week); encouraging increased exercise and activity. The nurse also asks the patient to participate in group sessions at the Pima Community Center focused on healthy food preparation and eating a balanced meal.

  1. If you were a nurse who just began doing home health care on the Pima Reservation, how would you learn about the specific cultural beliefs and practices related to nutrition and diet for this patient as a member of the Pima Indian Nation, versus stereotypes about the diet of Native Americans in general?
  2. Given that the patient’s family doesn’t own a vehicle, how will you encourage her to shop for healthy foods, prepare them, and actively participate in weight loss and exercise programs held free of charge at the Pima Community Center?
  3. How would you assess the patient’s eating habits, for example, type of food, method of preparation, amount eaten, etc.?
  4. Each of the patient’s children, grandchildren, and great-grandchildren is obese. How would you involve the patient’s family in the plan of care and motive them to lose weight as well?
 
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When selecting drugs and determining dosages for patients, it is essential to consider individual patient factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.

As an advanced practice nurse assisting physicians in the diagnosis and treatment of disorders, it is important to not only understand the impact of disorders on the body, but also the impact of drug treatments on the body. The relationships between drugs and the body can be described by pharmacokinetics and pharmacodynamics.

Pharmacokinetics describes what the body does to the drug through absorption, distribution, metabolism, and excretion, whereas pharmacodynamics describes what the drug does to the body.

Photo Credit: Getty Images/Ingram Publishing

When selecting drugs and determining dosages for patients, it is essential to consider individual patient factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes. These patient factors include genetics, gender, ethnicity, age, behavior (i.e., diet, nutrition, smoking, alcohol, illicit drug abuse), and/or pathophysiological changes due to disease.

For this Discussion, you reflect on a case from your past clinical experiences and consider how a patient’s pharmacokinetic and pharmacodynamic processes may alter his or her response to a drug.

To Prepare
  • Review the Resources for this module and consider the principles of pharmacokinetics and pharmacodynamics.
  • Reflect on your experiences, observations, and/or clinical practices from the last 5 years and think about how pharmacokinetic and pharmacodynamic factors altered his or her anticipated response to a drug.
  • Consider factors that might have influenced the patient’s pharmacokinetic and pharmacodynamic processes, such as genetics (including pharmacogenetics), gender, ethnicity, age, behavior, and/or possible pathophysiological changes due to disease.
  • Think about a personalized plan of care based on these influencing factors and patient history in your case study.
 
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describe the health problem HYPERTENSION Include a discussion of morbidity, mortality, epidemiology and pathophysiology related to this health problem

describe the health problem HYPERTENSION

Include a discussion of morbidity, mortality, epidemiology and pathophysiology related to this health problem

PRACTICE GUIDELINE: Describe the clinical practice guideline used for hypertension . Reflect on the questions included. Expand on your answer using support from evidence

·  Does the clinical practice guideline adequately address the health problem? Describe.

·  Is this practice guideline based on current evidence (within 5 years)? What is the strength of this evidence?

·  Does this clinical practice guideline adequately direct the healthcare provider in the management of a patient with this problem?

·  How effective is this clinical guideline in the management of patients with this healthcare problem? Think about how you would assess the effectiveness of patient management.

ANALYSIS: Think about future healthcare needs of patients with this problem, changing demographics, and changes in healthcare policies. Address these questions.

·  Does this clinical practice guideline need revision(s)? Please explain your answer in detail.

·  If you were going to revise this clinical practice guideline, what would you change? What evidence would you use to base your changes on?

·  How might changes in US demographics and healthcare reform affect this clinical practice guideline?

·  What strategies would you use to increase the likelihood that a new or modified clinical practice guideline would be adopted and used in clinical practice?

EVALUATION How would you determine its effectiveness of this revised clinical practice guideline in directing care for patients with the identified health problem?

Outline the steps you might employ.

LEARNING POINTS (3-5 bullet points outlining key learning in this case.)

REFERENCES (APA formatting, current within past 5 years.)

Expectations

·  Length: 8 pages not including the title page, abstract, and reference pages

·  Format: APA formatted paper

·  Research: APA formatting, current within past 5 years.

 
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Create a 5- to 6-slide PowerPoint presentation that can be used in a staff development meeting on presenting different approaches for implementing the stepwise approach for asthma treatment. Be sure to address the following:

Asthma is a respiratory disorder that affects children and adults. Advanced practice nurses often provide treatment to patients with these disorders. Sometimes patients require immediate treatment, making it essential that you recognize and distinguish minor asthma symptoms from serious, life-threatening ones. Since symptoms and attacks are often induced by a trigger, advanced practice nurses must also help patients identify their triggers and recommend appropriate management options. Like many other disorders, there are various approaches to treating and managing care for asthmatic patients depending on individual patient factors

One method that supports the clinical decision making of drug therapy plans for asthmatic patients is the stepwise approach.

  • Reflect on drugs used to treat asthmatic patients, including long-term control and quick-relief treatment options for patients. Think about the impact these drugs might have on patients, including adults and children.
  • Consider how you might apply the stepwise approach to address the health needs of a patient in your practice.
  • Reflect on how stepwise management assists health care providers and patients in gaining and maintaining control of the disease.

Create a 5- to 6-slide PowerPoint presentation that can be used in a staff development meeting on presenting different approaches for implementing the stepwise approach for asthma treatment. Be sure to address the following:

  • Describe long-term control and quick-relief treatment options for the asthma patient from your practice as well as the impact these drugs might have on your patient.
  • Explain the stepwise approach to asthma treatment and management for your patient.
  • Explain how stepwise management assists health care providers and patients in gaining and maintaining control of the disease. Be specific.
  • APA citation 4 to 5 References with 5 years
 
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Reflect on a case from your past clinical experiences and consider how a patient’s pharmacokinetic and pharmacodynamic processes may alter his or her response to a drug.

Reflect on a case from your past clinical experiences and consider how a patient’s pharmacokinetic and pharmacodynamic processes may alter his or her response to a drug.

  •  Consider the principles of pharmacokinetics and pharmacodynamics.
  • Reflect on your experiences, observations, and/or clinical practices from the last 5 years and think about how pharmacokinetic and pharmacodynamic factors altered his or her anticipated response to a drug.
  • Consider factors that might have influenced the patient’s pharmacokinetic and pharmacodynamic processes, such as genetics (including pharmacogenetics), gender, ethnicity, age, behavior, and/or possible pathophysiological changes due to disease.
  • Think about a personalized plan of care based on these influencing factors and patient history in your case study.

Post a description of the patient case from your experiences, observations, and/or clinical practice from the last 5 years. Then, describe factors that might have influenced the pharmacokinetic and pharmacodynamic processes of the patient you identified. Finally, explain the details of the personalized plan of care that you would develop based on influencing factors and patient history in your case. Be specific and provide examples.

 
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Write a summary of the significance and background of a healthcare problem by doing the following: 1. Describe a healthcare problem that can be used to develop a PICO question.

A.  Write a summary of the significance and background of a healthcare problem by doing the following:

1.  Describe a healthcare problem that can be used to develop a PICO question.

Note: You may use the same topic and the same research articles that were used in Task 1 provided they support the proposed intervention. Or you may choose a different topic and select articles focusing on one of the following topics: falls and fall prevention, pain management in children, opioid abuse, hepatitis C, catheter-associated urinary tract infections, and hand hygiene and infections in hospitals.

2.  Explain the significance of the problem from part A1.

3.  Describe the current healthcare practices related to the problem from part A1.

4.  Discuss how the problem affects the organization and patients’ cultural background (i.e., values, health behavior, and preferences).

B.  Complete a literature review by searching for a total of seven articles consisting of five research articles and two non-research articles related to the healthcare problem from part A1, and describe the search strategy you used to conduct the literature review by doing the following:

1.  Discuss two research evidence sources and two nonresearch evidence sources that you considered.

Note: Please do not use the same primary author for more than two articles. Articles must not be more than five years old.

C.  Use your research articles to develop a PICO (patient/population, intervention/indicator, comparison/control, and outcome) question based on the topic.

D.  Complete the attached “Evidence Matrix,” using the five research evidence sources from scholarly journal sources you located during the literature review in part B. For each article, address the following points:

Note: You may submit your completed matrix as a separate attachment to the task, or you may include the matrix within your paper, aligned to APA formatting standards.

Note: Upload a copy of the full text of the articles with your submission.

•  author, journal name, and year of publication

•  research design (e.g., quantitative, qualitative, mixed design, systematic review)

•  sample size (e.g., numbers of study participants, number of articles, number of control group participants)

•  outcome variables measured (e.g., identify what the research is measuring)

•  quality (using the following scale: A, B, C)

•  results/author’s conclusions (e.g., briefly summarize the outcome)

E.  Recommend a practice change that addresses the PICO question, using the evidence collected in the attached “Evidence Matrix.” You must use all five research articles from the “Evidence Matrix” attachment to support this recommendation via in-text citations.

F.  Describe a process for implementing the practice change from part E in which you do the following:

1.  Explain how you would involve three key stakeholders in the decision to implement the recommendation from part E.

2.  Describe two specific barriers you may encounter when implementing the practice change from part E in the nursing practice setting.

3.  Identify two strategies that could be used to overcome the barriers described in part F2.

4.  Identify one indicator to measure the outcome (the O in PICO question) of the recommended change practice from part E.

G.  Acknowledge sources, using APA-formatted in-text citations and references, for content that is quoted, paraphrased, or summarized.

H.  Demonstrate professional communication in the content and presentation of your submission.

 
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