Respond to the post bellow (positive comment), using one or more of the following approaches:

Ask a probing question, substantiated with additional background information, and evidence.

Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.

Offer and support an alternative perspective using readings from the classroom or from your own review of the literature in the Walden Library.

Validate an idea with your own experience and additional sources.

Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.

Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.

                                                            Main post

Evidence based Practice is using information and practices obtained from prior research and preferences (Polit & Beck, 2017). When I think of evidenced based practice, I think of current practice utilizing certain practices and procedures because they have been tested and proven in the past. Evidenced based practice can be derived from literature, healthcare workers and patient experiences (Polit & Beck, 2017). There are many practices that we utilize around the hospital today that come from evidenced based practice. We use them so lightly daily and many times not understanding the meaning behind them and that others have tested them making it safe for us to use them. The one thing that came to mind was the use of off label drugs to treat various mental health issues. In Behavioral health it requires various combinations of drugs to gain the warranted effect (Narsa, 2018). When treating bipolar disorder and other mood instabilities there are the well-known medication like lithium, but evidence as presented itself showing that various seizure medicines can elicit the intended result (Narsa, 2018). In Psychiatry they utilize antiepileptic medications such as Depakote, Tegretol and Topamax to stabilize a patient with mood disorders (Demland, 2017). This is many times used in combination with the popular medications such as Lithium. Patients are many times very stunned to find out that they will be placed on such a medication. Many times, these medications will be introduced if the patient has a difficult time adjusting to the medication dosage changes or the intended effect is not seen (Demland, 2017). Many patients have testified to the benefit of these medicines. I think about how evidence-based practice comes in to play here because prior to this medication healthcare providers were only using antiepileptics for seizures only.

            Another medicine being used as an off-label drug is Lorazepam. Many in healthcare know this drug as an anxiolytic and never think about its other uses. In Behavioral health this drug is actually used for the opposite effect in patients who are catatonic. When one first thinks of prescribing a drug that is meant to calm a person down and many times sedate them to a patient that is not talking, moving or interacting is seems somewhat bizarre. How will this work? Will it make the patient even more disengaged and possibly sedated? These are all questions myself and many of my coworkers had. In this case, the physicians relied on evidenced based practice to assist them in making such a decision. They utilized such an unpopular treatment but it gained the intended effect. The catatonic patients respond well to this treatment. They can be seen becoming more engaged with peers and staff and taking part in their care. 

References

Demland, J. (2017). Use pattern and off-label use of atypical antipsychotics in bipolar disorder, 

1998-2002. American Health & Drug Benefits, 2(4), 184–191.

Nasra, K. (2018). An analysis of the high psychotropic off-label use in psychiatric disorders: 

The majority of psychiatric diagnoses have no approved drug. Asian 

Journal of Psychiatry, 2(1), 29–36.

Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for 

nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer.

 

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procedures that they provide to patients. A physician and the facility must keep track of the services and procedures that they are providing to the patients to bill out and receive the appropriate reimbursement. The chargemaster or charge description master (CDM) is the billing process that is used in all health care facilities, and it is updated yearly.

Focus your discussion on the following questions:

• What are the consequences of not utilizing current codes and charges? Discuss how using last year’s CDM will affect the current year’s bottom line.
• Will this create a positive or negative result for the health care facility? Explain your answer.
• How can facilities ensure that the current CDM is used?

Part 2

Summative Discussion Board

Review and reflect on the knowledge you have gained from this course. Based on your review and reflection, write at least 3 paragraphs on the following:

• What were the most compelling topics learned in this course?
• How did participating in discussions help your understanding of the subject matter? Is anything still unclear that could be clarified?
• What approaches could have yielded additional valuable information?
• The main post should include at least 1 reference to research sources, and all sources should be cited using APA format.

 

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Research Benign Positional Vertigo and Meniere’s Disease. Compare and contrast them in discussion post. NOTE: A comparison and contrast assignment is not about listing the info regarding each disease separately but rather looking at each disease side by side and discussing the similarities and differences given the categories below. Consider how each patient would actually present to the office. Consider how their history would affect their diagnosis, etc. Evaluation of mastery is focused on the student’s ability to demonstrate specific understanding of how the diagnoses differ and relate to one another. Address the following topics below in your own words:

Presentation

Pathophysiology

Assessment

Diagnosis

Treatment

Example below:

NOTE: A comparison and contrast assignment is not about listing the info regarding each disease separately but rather looking at each disease side by side and discussing the similarities and differences given the categories below. Consider how each patient would actually present to the office. Basically after you compare/compare, write a brief synopsis

Consider How does the patient history would affect the diagnosis, etc.

We focus on (YOU) the student’s ability to demonstrate specific understanding of how the diagnoses differ and relate to one another. Address the following topics below in your own words:

Presentation (I place the patho first but either way is perfect)

Pathophysiology

Assessment

Diagnosis

Treatment

Pathophysiology of the 2 diagnoses.

Traumatic Brain Injury Patho: Diffuse axonal injury resulting from edema due to the body’s inflammatory response after injury from impact or shearing force. This causes damage to the axonal cytoskeleton which permanently disrupts proper neuronal function (SOURCE)

Post-Concussive Syndrome Patho: neuroinflammatory damage leading to abnormal cerebral perfusion. (SOURCE)

Please not a book report. See my note on what is patho.

Presentation

Traumatic Brain Injury

Physical symptoms include headache, dizziness, fatigue, drowsiness, insomnia, nausea, balance control, sensitivity to light, sensitivity to sound

Psychological symptoms include irritability, depression

Cognitive symptoms include memory problems, concentration problems, confusion, processing speed decreased

(SOURCE)

Post-Concussive Syndrome

Physical symptoms include headache, dizziness, fatigue, insomnia, sensitivity to noise

Psychological symptoms include irritability, depression

Cognitive symptoms include impaired memory, difficulty concentrating, decreased processing speed, impulse control

(SOURCE)

The differences between conditions are due to the body’s inflammatory protective response which causes damage to the brain tissue and consequently impairs normal brain function.

WHAT ARE THE SIMILARITIES

Assessment

The similarities between the conditions is that they are injuries to the same body system, the brain; therefore, the physical evaluation is the same.

WHAT ARE THE DIFFERENCES that makes you diagnose TBI and not PCS?

Traumatic Brain Injury

Patient health history

Medication list

Description of injury

Progression of symptoms

Physical examination

Cognitive evaluation

Vital signs

Post-Concussive Syndrome

Patient health history

Medication list

Description of injury

Progression of symptoms

Physical examination

Cognitive evaluation/Behavioral evaluation

Vital signs

Diagnosis

The diagnosis of the conditions has very few similarities since TBI is an acute condition and requires immediate diagnostic imaging to rule out more severe conditions, such as brain bleeding or fractures. The PCS is a stable condition and a strictly clinical diagnosis (SOURCE)

WHAT ARE THE DIFFERENCES?

Traumatic Brain Injury

Glasgow coma scale

Neurological examination

Diagnostic imaging (TYPE, if any)

(SOURCE)

Post-Concussive Syndrome

Glasgow coma scale

Neurological examination

EEG

Neuropsychological testing

(SOURCE)

Treatment

The treatment for both conditions will be different since with a TBI, the goal is to keep the patient quiet and rest when they are in the acute phase of the injury; whereas, for PCS, the goal and plan of care is long-standing.

Traumatic Brain Injury

Rest – both physical and cognitive

Medication management for acute symptoms such as headache, dizziness and pain management

(SOURCE)

What type of medication would be appropriate?

Post-Concussive Syndrome

Medication management for chronic symptoms such as headache, dizziness, depression, and pain management

What type of medication would be appropriate?

Multidisciplinary treatment for physical therapy and psychological therapy

(SOURCE)

References

 

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Answer: In last weeks discussion question, I had mentioned that the culture of the institution can be a barrier, and in addition to this,the lack of leadership support, education and time can compound the problem. It takes support from management as well as from fellow personnel (nurses, ancillary staff) to initiate, promote and maintain EBP in an organization. According to Polit & Beck, (2018),”Although many organizations support the idea of EBP in theory, they do not always provide the necessary supports in terms of staff release time and provisions of resources”. There are ways to address this particular barrier:

Organizing a staff meeting and explaining the value of implementing the EBP method

Explanations (posters on walls in break room, bathrooms,pamphlets) on how this new EBP method will bring quality care to the patient or improve a system within the organization helps staff become more receptive to new information.The staff has to see EBP as valuable and feasible.

Schedule monthly forums or meetings, enlist the aid of different staff members(on a rotation basis) and make them accountable to finish the task (making it count towards the annual evaluation). At my organization, extra duty tasks are included as favorable in the yearly evaluation. The incentive is pay increases, bonuses, time off awards.

Encourage online research. In the hospital that I work at there is a library (in the basement) but it is underutilized by everyone.Keep the staff informed as to when the library is open and provide administrative time off the floor for continued education, (Jennifer, 2017).  

Original Question: Consider an obstacle or barrier to the implementation of evidence-based practice you identified in last week’s discussion. What are two ways to address this problem?

 

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Topic: Case Report: Part 1

You will be creating a case report in stages over four course topics. Use an example from your own personal practice, experience, or own personal/family; however, simulated cases are not acceptable for practice hours and therefore not acceptable for this assignment. Examples might include a patient with Duchesne’s muscular dystrophy. Huntington’s disease, Down’s syndrome, sickle cell anemia, BRCA 1 or BRCA 2 mutations, or other genetic disorder that you and/or the organization in which you practice may specialize in treating.

General Requirements:

Use the following information to ensure successful completion of the assignment:

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

· Doctoral learners are required to use APA style for their writing assignments. 

· This assignment requires that at least two additional scholarly research sources related to this topic, and at least one in-text citation from each source be included.

· Guidelines and reasons behind the FDA regulations for introducing new pharmaceutical agents (policy).

· The role that money and grants play in scientific advances; the economics of health care (capitalism).

· The role and involvement family plays into the health care decision.

Directions:

For this assignment (Part 1 of the Case Report), write a 1,000-1,250 word paper incorporating genetics information learned from assigned readings in Topics 1 and 2. Include the following:

1. Describe the disease, its prevalence, and its incidence.

2. Discuss the laboratory testing that is possible.

Portfolio Practice Hours:

Practice immersion assignments are based on your current course objectives, and are intended to be application-based learning using your real-world practice setting. These assignments earn practice immersion hours, and are indicated in the assignment by a Portfolio Practice Hours statement which reminds you, the student, to enter in a corresponding case log in Typhon. Actual clock hours are entered, but the average hours associated with each practice immersion assignment is 10.

You are required to complete your assignment using real-world application. Real-world application requires the use of evidence-based data, contemporary theories, and concepts presented in the course. The culmination of your assignment must present a viable application in a current practice setting. 

 

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