Exploring the use of evidence-based practice

Exploring the use of evidence-based practice

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You will be exploring the use of evidence-based practice and how it is incorporated into case management patient care guidelines, and pathways based on your chosen chronic illness from assignment one(Hypertension).

You will identify and discuss current best practices, recommended published guidelines for treating or addressing the illness, and describe how clinical pathways help to address the importance of basing case management on current practice.

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You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
I encourage you to incorporate the readings from the week (as applicable) into your responses.

Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

APA Format and Writing Quality

Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
I highly recommend using the APA Publication Manual, 6th edition.

Use of Direct Quotes

I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
It is best to paraphrase content and cite your source.

LopesWrite Policy

For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
I do not accept assignments that are two or more weeks late unless we have worked out an extension.
As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

Communication is so very important. There are multiple ways to communicate with me:
Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

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Discussion: Technology and reimbursement patterns have increased the amount of surgery performed on an ambulatory basis.

Discussion: Technology and reimbursement patterns have increased the amount of surgery performed on an ambulatory basis.

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Technology and reimbursement patterns have increased the amount of surgery performed on an ambulatory basis. Hospitals all over the country are experiencing a rise in the number of surgical patients who come into the hospital and go home on the same day; cases that previously required at least an overnight stay in the hospital. The move to outpatient treatment can significantly affect a hospital\’s use of beds and its overall organization. However, the move to outpatient care also poses some risks, especially to patients with difficult medical histories. The move from inpatient to outpatient care is driven by cost containment, as well as by new technologies. However, there are risks to care provided in the ambulatory setting. For example, advanced age (especially older than 70 years) is associated with increased hospital stay and perioperative morbidity and mortality. Additionally, the type of surgery is important in the risk assessment.

In the following three case scenarios, determine if the patient has an increased risk for surgical complications based on their current health status and medical history. Write a 1-2 paragraph response for each scenario, and determine the following:

Does the patient\’s medical history pose a potential risk for complications prior/post surgery?

Explain your reasoning.

Based on the patient\’s current health status and their medical history, should they receive surgery or be evaluated and treated outside of the ambulatory care setting? Explain your reasoning.

Case Scenario 1:

Mr. Rogers is a 51-year old male. During his pre-operative examination, he tells the nurse, \”I have an ache in my right foot\”. He offers an explanation, suggesting, \”I must have stepped on something or twisted my ankle. Maybe I got bitten by a bug when I was outside yesterday\”. The nurse notes that the patient\’s ankle is reddened, slightly swollen, and warm to the touch. However, his temperature is within normal limits. Mr. Roger\’s ankle is x-rayed and there is no fracture noted. He has full range-of-motion of his right ankle. Mr. Rogers has a preexisting medical condition of gout. He is scheduled for outpatient surgery on his thyroid.

Case Scenario 2:

Mr. Sanders is a 61-year old male who presents with nausea and has been vomiting for two days. He is also experiencing mental confusion. His blood glucose is 796 mg/dL. He is a newly diagnosed diabetic and has not been getting medical treatment. Intravenous regular insulin is administered to Mr. Sanders in order to bring his blood glucose level down to a normal level. Further tests show that his Hemoglobin A1C is 10.3%. Mr. Sanders has a preexisting medical condition of coronary heart disease and hypertension. He is scheduled for outpatient surgery on his thyroid.

Case Scenario 3:

Mrs. Miller is an 88-year old woman who presents with nausea, vomiting, and severe abdominal pain. Further tests reveal that her white blood cell count is 13,000/mm3. Her physical examination reveals that her abdomen is distended and very tender to the touch. Her doctor suspects that she has acute pancreatitis. Mrs. Miller has a preexisting medical condition of heart failure and gastroesophageal reflux disease (GERD). She is also scheduled for outpatient surgery on her thyroid.

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Discussion: Evaluate the Health History and Medical Information for Mr M.

Discussion: Evaluate the Health History and Medical Information for Mr M.

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It is necessary for an RN-BSN-prepared nurse to demonstrate an enhanced understanding of the pathophysiological processes of disease, the clinical manifestations and treatment protocols, and how they affect clients across the life span.

Evaluate the Health History and Medical Information for Mr. M., presented below.

Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below.

Health History and Medical Information

Health History

Mr. M., a 70-year-old male, has been living at the assisted living facility where you work. He has no know allergies. He is a nonsmoker and does not use alcohol. Limited physical activity related to difficulty ambulating and unsteady gait. Medical history includes hypertension controlled with ACE inhibitors, hypercholesterolemia, status post appendectomy, and tibial fracture status postsurgical repair with no obvious signs of complications. Current medications include Lisinopril 20mg daily, Lipitor 40mg daily, Ambien 10mg PRN, Xanax 0.5 mg PRN, and ibuprofen 400mg PRN.

Case Scenario

Over the past 2 months, Mr. M. seems to be deteriorating quickly. He is having trouble recalling the names of his family members, remembering his room number, and even repeating what he has just read. He is becoming agitated and aggressive quickly. He appears to be afraid and fearful when he gets aggressive. He has been found wandering at night and will frequently become lost, needing help to get back to his room. Mr. M has become dependent with many ADLs, whereas a few months ago he was fully able to dress, bathe, and feed himself. The assisted living facility is concerned with his rapid decline and has decided to order testing.

Objective Data

Temperature: 37.1 degrees C

BP 123/78 HR 93 RR 22 Pox 99%

Denies pain

Height: 69.5 inches; Weight 87 kg

Laboratory Results

WBC: 19.2 (1,000/uL)

Lymphocytes 6700 (cells/uL)

CT Head shows no changes since previous scan

Urinalysis positive for moderate amount of leukocytes and cloudy

Protein: 7.1 g/dL; AST: 32 U/L; ALT 29 U/L

Critical Thinking Essay

In 750-1,000 words, critically evaluate Mr. M.\’s situation. Include the following:

Describe the clinical manifestations present in Mr. M.

Based on the information presented in the case scenario, discuss what primary and secondary medical diagnoses should be considered for Mr. M. Explain why these should be considered and what data is provided for support.

When performing your nursing assessment, discuss what abnormalities would you expect to find and why.

Describe the physical, psychological, and emotional effects Mr. M.\’s current health status may have on him. Discuss the impact it can have on his family.

Discuss what interventions can be put into place to support Mr. M. and his family.

Given Mr. M.\’s current condition, discuss at least four actual or potential problems he faces. Provide rationale for each.

You are required to cite to a minimum of two sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.

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

Requirements: 750 – 1000 words

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Discussion: Consider the impact of potential pharmacotherapeutics for cardiovascular disorders introduced in the media piece.

Discussion: Consider the impact of potential pharmacotherapeutics for cardiovascular disorders introduced in the media piece.

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Patient HM has a history of atrial fibrillation and a transient ischemic attack (TIA). Thepatient has been diagnosed with type 2 diabetes, hypertension, hyperlipidemia and ischemic heart disease. Drugs currently prescribed include the following:

Warfarin 5 mg daily MWF and 2.5 mg daily T, TH, Sat, Sun
Aspirin 81 mg daily
Metformin 1000 mg po bid
Glyburide 10 mg bid
Atenolol 100 mg po daily
Motrin 200 mg 1–3 tablets every 6 hours as needed for pain

To Prepare
Review the Resources for this module and consider the impact of potential pharmacotherapeutics for cardiovascular disorders introduced in the media piece.

Review the case study assigned by your Instructor for this Assignment.

Select one the following factors: genetics, gender, ethnicity, age, or behavior factors.
Reflect on how the factor you selected might influence the patient’s pharmacokinetic and pharmacodynamic processes.

Consider how changes in the pharmacokinetic and pharmacodynamic processes might impact the patient’s recommended drug therapy.

Think about how you might improve the patient’s drug therapy plan based on the pharmacokinetic and pharmacodynamic changes.
Reflect on whether you would modify the current drug treatment or provide an alternative treatment option for the patient.

Write a 2- to 3-page paper that addresses the following:

Explain how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned.

Describe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples.

Explain how you might improve the patient’s drug therapy plan and explain why you would make these recommended improvements.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The College of Nursing Writing Template with Instructions provided at the Walden Writing Center offers an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting.

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Choose a topic related to US History up to 1877 (Chapters 1-15) that you would truly like to explore and that you are willing to spend some time on.

Choose a topic related to US History up to 1877 (Chapters 1-15) that you would truly like to explore and that you are willing to spend some time on.

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The core assignment of this course is a documented research paper (1500-2000 words in length, approx. 6-8 pages double-spaced, 12-point font).

The paper should support a thesis statement with information gained from research or investigation.

The paper will not be just a report presenting information but will be a paper that carefully examines and presents your own historical interpretation of the topic you have chosen and your interpretation of the information you have gathered.

The paper may include consideration of problems and solutions, definition of key terms, or may refute arguments against your thesis statement.

It will be important to choose a topic of interest to you.

Approach this assignment with an open and skeptical mind, then form an opinion based on what you have discovered.

You must suspend beliefs while you are investigating and let the discoveries shape your opinion. (This is a thesis-finding approach.)

Once you have found your thesis, write the paper to support it.

You will use some of the following critical thinking skills in this process:

Choosing an appropriate topic, limiting the topic.

Gathering information, summarizing sources.

Analyzing and evaluating sources.

Defining key terms.

Synthesizing information, comparing and contrasting sources.

Testing a thesis, making a historical argument, using refutation.

Amassing support for a position.

Documenting sources.

Because this may be a longer paper than you have written before and a complex process is involved, it is recommended that you complete this paper using the following steps:

1. Choose a topic related to U.S. History up to 1877 (Chapters 1-15) that you would truly like to explore and that you are willing to spend some time on. Your chosen topic should be focused. Don\’t try to take on some huge topic. For example, \”Slavery in America\” or \”The American Revolution\” are enormous with many issues involved. Where does it stop? Instead look at a specific aspect of slavery or the Revolution, at a specific moment. Pose a question that you really want to answer. You may want to begin with more than one topic in mind.

2. Do some preliminary reading on the topic(s). You may begin with the textbook, then further explore the information available. Refine your topic. Summarize your topic, your interest in the topic, the questions you want to answer, and a hypothesis you want to test. This is not a summary of some issue, idea, or event. This cannot be a biography though you could select an issue, event, or idea from some historical figure.

3. Gather information from a variety of sources. Use a minimum of four sources for your paper, and at least one must be a primary source. You cannot use a text book, wikipedia, encyclopedia, or documentary as a source.

Examples of primary sources are ones that are used in our discussion forums 2-8. None of the sources used for this course can be used for your paper.

They are sources that are contemporary to the times under investigation.

An example of a secondary source is a monograph, that is, the book or article focuses on an issue, idea, or event. The Journal of American History is an example of an academic journal.

4. Outline the results of your research and the plan for your paper (you are not required to submit the outline).

5. Write the final draft and be sure to include a Works Cited List, and use the correct MLA documentation style.

Grade Rubric

INTRODUCTION & THESIS: Includes a clear thesis statement, an assertion or position. Topic is original and manageable in a short research paper. /15

FOCUS AND DEVELOPMENT: Body of the essay focuses on this thesis and develops it fully, recognizing the complexity of issues and refuting arguments in opposition to the thesis. /20

SUPPORT AND SYNTHESIS: Uses sufficient and relevant evidence to support the thesis (and primary points), including facts, inferences, and judgments. Quotes, summarizes, and paraphrases accurately and effectively–appropriately introducing and explaining each quote. /25

RESOURCES: Shows a clear understanding of the sources; has evaluated each source and used it appropriately. Uses a wide variety of sources reflecting significant research. /10

CONVENTIONS: Uses MLA format correctly; includes internal citations and a Works Cited list; is free of errors. /15

CORRECTNESS AND STYLE: Introduces the topic in an interesting way; shows critical thinking and depth of understanding; uses appropriate tone; shows sophistication in language usage and sentence structure. /15

TOTAL: /100

Requirements: 1500-2000 words; 6-8 pages not include Title and Reference page

Answer preview to choose a topic related to U.S. History up to 1877 (Chapters 1-15) that you would truly like to explore and that you are willing to spend some time on.

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