The first step of the evidence-based practice process is to evaluate a nursing practice environment to identify a nursing problem in the clinical area. When a nursing problem is discovered, the nurse researcher develops a clinical guiding question to address that nursing practice problem.

The first step of the evidence-based practice process is to evaluate a nursing practice environment to identify a nursing problem in the clinical area. When a nursing problem is discovered, the nurse researcher develops a clinical guiding question to address that nursing practice problem.

For this assignment, you will create a clinical guiding question know as a PICOT question. The PICOT question must be relevant to a nursing practice problem. To support your PICOT question, identify six supporting peer-revised research articles, as indicated below. The PICOT question and six peer-reviewed research articles you choose will be utilized for subsequent assignments.

Use the “Literature Evaluation Table” to complete this assignment.

  1. Select a nursing practice problem of interest to use as the focus of your research. Start with the patient population and identify a clinical problem or issue that arises from the patient population. In 200–250 words, provide a summary of the clinical issue.
  2. Following the PICOT format, write a PICOT question in your selected nursing practice problem area of interest. The PICOT question should be applicable to your proposed capstone project (the project students must complete during their final course in the RN-BSN program of study).
  3. The PICOT question will provide a framework for your capstone project. 
  4. Conduct a literature search to locate six research articles focused on your selected nursing practice problem of interest. This literature search should include three quantitative and three qualitative peer-reviewed research articles to support your nursing practice problem.

Note: To assist in your search, remove the words qualitative and quantitative and include words that narrow or broaden your main topic. For example: Search for diabetes and pediatric and dialysis. To determine what research design was used in the articles the search produced, review the abstract and the methods section of the article. The author will provide a description of data collection using qualitative or quantitative methods. Systematic Reviews, Literature Reviews, and Metanalysis articles are good resources and provide a strong level of evidence but are not considered primary research articles.  Therefore, they should not be included in this assignment.

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

 
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Professionalism And Social Media

Report Issue

Social media plays a significant role in the lives of nurses in both their professional and personal lives. Additionally, social media is now considered a mainstream part of the process for recruiting and hiring candidates. Inappropriate or unethical conduct on social media can create legal problems for nurses as well as the field of nursing.

Login to all social media sites in which you engage. Review your profile, pictures and posts. Based on the professional standards of nursing, identify items that would be considered unprofessional and potentially detrimental to your career and that negatively impact the reputation of the nursing field.

In 500-750 words, summarize the findings of your review. Include the following:

  1. Describe the posts or conversations in which you have engaged that might be considered inappropriate based on the professional standards of nursing.
  2. Discuss why nurses have a responsibility to uphold a standard of conduct consistent with the standards governing the profession of nursing at work and in their personal lives. Include discussion of how personal conduct can violate HIPAA or be considered unethical or unprofessional. Provide an example of each to support your answer.
  3. Based on the analysis of your social media, discuss what areas of your social media activity reflect Christian values as they relate to respecting human value and dignity for all individuals. Describe areas of your social media activity that could be improved.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

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

 
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Identify a research or evidence-based article that focuses comprehensively on a specific intervention or new diagnostic tool for the treatment of diabetes in adults or children.

Identify a research or evidence-based article that focuses comprehensively on a specific intervention or new diagnostic tool for the treatment of diabetes in adults or children.

In a paper of 750-1,000 words, summarize the main idea of the research findings for a specific patient population. Research must include clinical findings that are current, thorough, and relevant to diabetes and the nursing practice. Include a minimum of three in-text citations (references must be within the last 5-7 years). In addition, include the following in your paper:

A strong thesis statement

Complete sentences

Factual information must be supported be in-text citations and references, as required for scholarly work

Prepare this assignment according to the APA guidelines. An abstract is not required.

This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment.

 
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What are the skills necessary for the provider to identify, address, and assess this clinical ethical issue?

Bioethics Case Study

1.      

1.      Bioethics Case Study: This assignment asks you to examine a current ethical controversy case study. The paper is informal, but should be in APA style, and does not need an abstract or cover page. With a minimum of two pages and a maximum of four pages A reference page is needed. In-text citations should be in APA format. Papers will be graded on a 0 to 25-point scale.

Case Study in Primary care:

One hypothetical case study involves Jim a 54, year old patient who has recently diagnose with hypertension and his Creatinine and BUN laboratory results are elevated, if left untreated, will result in kidney failure. The patient refuses to take the medication because he said it will affect his sex life The NP must work with the patient to respect the fact that he doesn’t want the medication (autonomy), and needs to find a solution that would prevent him from going into kidney failure and other complications, which is in his best interest (beneficence). Although medications are the best choice, forcing the patient to accept the medication will result in probably patient leaving the care (non-maleficence). Finally, the NP needs to consider the impact that the patient’s choices might have on others if he starts to go into preventable kidney failure, he’ll need dialysis, which affects other people who need the same treatment (justice). So before making the final decision the NP must consider all four principles of health care ethics, which will help the NP make the choice that will have the best possible benefits for both the patient and society.

Questions?

1. What are the skills necessary for the provider to identify, address, and assess this clinical ethical issue?

2. What are the provider’s obligations when a patient discloses does he not intent to follow the treatment?

3. What are the ethical considerations in evaluating a patient’s failure to adhere to a prescribed therapy?

4. Will you terminate care for this patient? What are the implications?

Case Study Rubric

CriterionOutstanding  (25)Very Good  (22)   Average (18)Unacceptable (15)Score
CompletenessComplete in all respects; reflects all requirementsComplete in most respects; reflects most requirementsIncomplete many respects; reflects few requirementsIncomplete in most respects; does not reflect requirements 
UnderstandingDemonstrates excellent understanding of the topic(s) and issue(s) Demonstrates an accomplished understanding of the topic(s) and issue(s)Demonstrates an acceptable understanding of the topic(s) and issue(s)Demonstrates an inadequate understanding of the topic(s) and issue(s) 
AnalysisPresents an insightful and through analysis  of the issue (s) identifiedPresents a thorough analysis of most of the issue(s) identifiedPresents a superficial analysis of some of the issue(s) identifiedPresents an incomplete analysis of the issue(s) identified. 
EvaluationMakes appropriate and powerful connections between the issue(s) identified and the concept(s) studiedMakes appropriate connections between the issue(s) identified and the concept(s) studiedMakes appropriate but somewhat vague connections between the issue(s) identified and the concept(s) studiedMakes little or no connection between the issue(s) identified and the concept(s) studied. 
OpinionSupports opinion with strong arguments and evidence; presents a balanced and critical view; interpretation is both reasonable and objectiveSupports opinion with reasons and evidence; presents a fairly balanced view; interpretation is both reasonable and objectiveSupports opinion with limited reasons and evidence; presents a somewhat one-sided argumentSupports opinion with few reasons and little evidence; argument is one-sided and not objective. 
RecommendationsPresents detailed, realistic, and appropriate recommendations clearly supported by the information presented and concepts studiedPresents specific, realistic and appropriate recommendation supported by the information presented and the concepts studiedPresents realistic or appropriate recommendation supported by the information presented and the concepts studiedPresents realistic or appropriate recommendation with little, if any, support from the information and the concepts studied. 
Grammar and SpellingMinimal spelling and grammar errorsSome spelling and grammar errorsNoticeable spelling and grammar errorsUnacceptable number of spelling and grammar errors 
APA guidelinesUses APA guidelines accurately and consistently to cite sourcesUses APA guidelines with minor violations to cite sourcesReflects incomplete knowledge of APA guidelinesDoes not use APA guidelines 
                Total
 
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Describe the diagnosis and staging of cancer.

Write a paper (1,250-1,500 words) describing the approach to care of cancer. In addition, include the following in your paper:

  1. Describe the diagnosis and staging of cancer.
  2. Describe at least three complications of cancer, the side effects of treatment, and methods to lessen physical and psychological effects.
  3. Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a grading rubric. Instructors will be using the
rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment.

You are required to submit this assignment to LopesWrite

 
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4-Technology play a very core role in the process of being able to implement projects. Further, through technology, projects can be sustained and maintained so that they are able to be achieved. Through the use of technology, implementation is easier and also more effective. Therefore, one has to look for the best form of technology that can help in the implementation or supporting the project to ensure that the implementation goes as smoothly as possible (Powell-Cope, Nelson, Patterson, 2008). The project that I will be handling looks to establish whether the involvement of healthcare facilities in nursing education can be able to help reduce the shortage of nurses that the country is facing currently. Technology in this project can be used in monitoring whether the involvement of healthcare facilities in nursing education will help to reduce the shortage of nurses in the country.

4-Technology play a very core role in the process of being able to implement projects. Further, through technology, projects can be sustained and maintained so that they are able to be achieved. Through the use of technology, implementation is easier and also more effective. Therefore, one has to look for the best form of technology that can help in the implementation or supporting the project to ensure that the implementation goes as smoothly as possible (Powell-Cope, Nelson, Patterson, 2008). The project that I will be handling looks to establish whether the involvement of healthcare facilities in nursing education can be able to help reduce the shortage of nurses that the country is facing currently. Technology in this project can be used in monitoring whether the involvement of healthcare facilities in nursing education will help to reduce the shortage of nurses in the country.

The best technology to use in the monitoring of the progress of this project is through use of data collection from every facility and the action they are making and the number of nurses it helps to bring to the workforce. The actions that facilities can take are very many, therefore one has to monitor which action results in a higher number of nurses to the workforce. The best action can then be selected through the evaluation and analysis of the data that is collected. However, there are barriers to the use of this technology. One of the barriers is the lack of sufficient information from the facilities on what actions they are taking and the number of nurses they are able to successfully help to bring to the workforce (Powell-Cope, Nelson, Patterson, 2008). Therefore, one of the barrier is the lack of sufficient information to help in monitoring.

References

Powell-Cope G, Nelson AL, Patterson ES. 2008. Patient Care Technology and Safety. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); Apr. Chapter 50. Available from: https://www.ncbi.nlm.nih.gov/books/NBK2686/

Williamson K., Fineout- Overholt E., Kent B., Hutchinson A. & MBioeoth B. (2015). Teaching EBP: Integrating Technology Into AcademicCurricula to Faciltate Evidence- Based Decision Making. World View on Evidence-Based Nursing. Fourth Quarter. Retrieved from.https://www.ncbi.nlm.nih.gov/pubmed/20456725

5-The use of technology is very necessary in this time and age. As healthcare continue to grow and improve, so do the use of technology need to change to improve the implementation process and the outcomes of EBP projects. In my project, I am going to be using the Electronic Health Record to collect useful data for my project. Accessing the HER will give me an overview of useful information about patient safety, evaluating care quality, maximizing efficiency, and measuring staffing needs (ANA, 2015) which are some of the issues related to fall. I will also implement the use of Information and Communication Technology to access adequate EBP evidence that pertain to my project. ICT will enable me to obtain lots of relevant information through the internet on my project.

Reference

American Nurses Association [ANA](2015.). Health Information Technology, Patient Safety, and Professional Nursing Care Documentation in Acute Care Settings. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-20-2015/No2-May-2015/Articles-Previous-Topics/Technology-Safety-and-Professional-Care-Documentation.html

6- it sounds like you are doing a qualitative research project and with that you will need the internet to gather material related to your study. The use of technology is essential for EBP as it help us learn new things through different ways. Before online and distant learning was not possible, today students are able to study anywhere anytime. Also we needed to go to the hospital for every little thing so the doctor or nurse can check us out; but today we can do everything in the comfort of our homes. This is amazing and I am looking forwards to see what the future holds for nursing with technology.

 
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Soap Note 2 Chronic Conditions

Soap Note 2 Chronic Conditions

Soap Note Chronic Conditions (15 Points)

Pick any Chronic Disease from Weeks 6-10

Soap notes will be uploaded to Moodle and put through TURN-It-In (anti-Plagiarism program)
 Follow the MRU Soap Note Rubric as a guide

Turn it in Score must be less than 50% or will not be accepted for credit, must be your own work and in your own words. You can resubmit, Final submission will be accepted if less than 50%. Copy paste from websites or textbooks will not be accepted or tolerated. Please see College Handbook with reference to Academic Misconduct Statement

SOAP NOTE SAMPLE FORMAT FOR MRC

Name:  LP

Date: 

Time: 1315

Age: 30

Sex: F

SUBJECTIVE

CC:  

“I am having vaginal itching and pain in my lower abdomen.”

HPI:  

Pt is a 30y/o AA female, who is   a new patient that has recently moved to Miami. She seeks treatment today after   unsuccessful self-treatment of vaginal itching, burning upon urination, and   lower abdominal pain. She is concerned   for the presence of a vaginal or bladder infection, or an STD. Pt denies fever. She reports the itching and burning with   urination has been present for 3 weeks, and the abdominal pain has been   intermittent since months ago. Pt has   tried OTC products for the itching, including Monistat and Vagisil. She denies any other urinary symptoms,   including urgency or frequency. She   describes the abdominal pain as either sharp or dull. The pain level goes as high as 8 out of 10   at times. 200mg of PO Advil PRN reduces   the pain to a 7/10. Pt denies any   aggravating factors for the pain. Pt   reports that she did start her menstrual cycle this morning, but denies any   other discharge other that light bleeding beginning today. Pt denies douching or the use of any vaginal   irritants. She reports that she is in   a stable sexual relationship, and denies any new sexual partners in the last   90 days. She denies any recent or   historic known exposure to STDs. She   reports the use of condoms with every coital experience, as well as this   being her only form of contraceptive. She reports normal monthly menstrual cycles that last 3-4 days. She reports dysmenorrhea, which she also   takes Advil for. She reports her last   PAP smear was in 7/2016, was normal, and reports never having an abnormal PAP   smear result. Pt denies any hx of   pregnancies. Other medical hx includes   GERD. She reports that she has an Rx   for Protonix, but she does not take it every day. Her family hx includes the presence of DM   and HTN. 

Current Medications: 

Protonix 40mg PO Daily for GERD

MTV OTC PO Daily

Advil 200mg OTC PO PRN for pain

PMHx:

Allergies:  

NKA & NKDA

Medication Intolerances: 

Denies

Chronic Illnesses/Major traumas

GERD

Hospitalizations/Surgeries

Denies

Family History

Father- DM & HTN; Mother-   HTN; Older sister- DM & HTN; Maternal and paternal grandparents without   known medical issues; 1 brother and 3 other sisters without known medical   issues; No children.

Social History

Lives alone. Currently in a stable sexual relationship   with one man. Works for DEFACS. Reports occasional alcohol use, but denies   tobacco or illicit drug use.

ROS

General 

Denies weight change, fatigue,   fever, night sweats

Cardiovascular

Denies chest pain and edema.   Reports rare palpitations that are relieved by drinking water

Skin

Denies any wounds, rashes,   bruising, bleeding or skin discolorations, any changes in lesions

Respiratory

Denies cough. Reports dyspnea   that accompanies the rare palpitations and is also relieved by drinking water

Eyes

Denies corrective lenses,   blurring, visual changes of any kind

Gastrointestinal

Abdominal pain (see HPI) and Hx   of GERD. Denies N/V/D, constipation,   appetite changes

Ears

Denies Ear pain, hearing loss,   ringing in ears

Genitourinary/Gynecological

Reports burning with urination,   but denies frequency or urgency. Contraceptive and STD prevention includes condoms with every coital   event. Current stable sexual   relationship with one man. Denies   known historic or recent STD exposure. Last PAP was 7/2016 and normal.   Regular monthly menstrual cycle lasting 3-4 days. 

Nose/Mouth/Throat

Denies sinus problems,   dysphagia, nose bleeds or discharge

Musculoskeletal

Denies back pain, joint   swelling, stiffness or pain

Breast

Denies SBE

Neurological

Denies syncope, seizures,   paralysis, weakness

Heme/Lymph/Endo

Denies bruising, night sweats,   swollen glands

Psychiatric

Denies depression, anxiety,   sleeping difficulties

OBJECTIVE

Weight   140lb 

Temp -97.7

BP 123/82

Height 5’4”

Pulse 74

Respiration   18

General Appearance

Healthy appearing adult female   in no acute distress. Alert and oriented; answers questions appropriately. 

Skin

Skin is normal color for   ethnicity, warm, dry, clean and intact. No rashes or lesions noted.

HEENT

Head is norm cephalic, hair   evenly distributed. Neck: Supple. Full ROM. Teeth are in good repair.

Cardiovascular

S1, S2 with regular rate and   rhythm. No extra heart sounds. 

Respiratory

Symmetric chest walls.   Respirations regular and easy; lungs clear to auscultation bilaterally.

Gastrointestinal

Abdomen flat; BS active in all   4 quadrants. Abdomen soft, suprapubic tender. No hepatosplenomegaly.  

Genitourinary

Suprapubic tenderness   noted. Skin color normal for   ethnicity. Irritation noted at labia   majora, minora, and perineum. No ulcerated lesions noted. Lymph nodes not   palpable. Vagina pink and moist   without lesions. Discharge minimal,   thick, dark red, no odor. Cervix pink   without lesions. No CMT. Uterus normal size, shape, and consistency.  

Musculoskeletal

Full ROM seen in all 4   extremities as patient moved about the exam room.

Neurological 

Speech clear. Good tone.   Posture erect. Balance stable; gait normal.

Psychiatric

Alert and oriented. Dressed in   clean clothes. Maintains eye contact. Answers questions appropriately.

Lab Tests

Urinalysis – blood noted (pt.   on menstrual period), but results negative for infection

Urine culture testing   unavailable

Wet prep – inconclusive 

STD testing pending for   gonorrhea, chlamydia, syphilis, HIV, HSV 1 & 2, Hep B & C 

Special Tests- No ordered at this time.

Diagnosis 

Differential Diagnoses

  • 1-Bacterial Vaginosis (N76.0)
  • 2- Malignant neoplasm of female genital organ,         unspecified. (C57.9)
  • 3-Gonococcal infection, unspecified. (A54.9)

Diagnosis

o Urinary   tract infection, site not specified. (N39.0) Candidiasis of vulva and vagina.   (B37.3) secondary to presenting symptoms (Colgan & Williams, 2011) &   (Hainer & Gibson, 2011). 

Plan/Therapeutics

  • Plan:  
    • Medication – 

§ Terconazole   cream 1 vaginal application QHS for 7 days for Vulvovaginal Candidiasis; 

§ Sulfamethoxazole/TMP   DS 1 tablet PO twice daily for 3 days for UTI (Woo & Wynne, 2012)

  • Education – 

§ Medications   prescribed. 

§ UTI and   Candidiasis symptoms, causes, risks, treatment, prevention. Reasons to seek   emergent care, including N/V, fever, or back pain. 

§ STD risks   and preventions. 

§ Ulcer   prevention, including taking Protonix as prescribed, not exceeding the   recommended dose limit of NSAIDs, and not taking NSAIDs on an empty   stomach. 

  • Follow-up – 

§ Pt will be   contacted with results of STD studies. 

§ Return to   clinic when finished the period for perform pap-smear or if symptoms do not   resolve with prescribed TX.

References

Colgan, R. & Williams, M. (2011). Diagnosis and Treatment of Acute Uncomplicated Cystitis. American Family Physician, 84(7), 771-776

Hainer, B. & Gibson, M. (2011). Vaginitis: Diagnosis and Treatment. American Family Physician, 83(7), 807-815. 

Woo, T. M., & Wynne, A. L. (2012). Pharmacotherapeutics for Nurse Practitioner Prescribers (3rd ed.). Philadelphia, PA: F.A. Davis Company.

Sample Soap Note Template (2)

PATIENT INFORMATION

Name: Mr. W.S.

Age: 65-year-old

Sex: Male

Source: Patient

Allergies: None

Current Medications: Atorvastatin tab 20 mg, 1-tab PO at bedtime

PMH: Hypercholesterolemia

Immunizations: Influenza last 2018-year, tetanus, and hepatitis A and B 4 years ago.

Surgical History: Appendectomy 47 years ago.

Family History: Father- died 81 does not report information

 Mother-alive, 88 years old, Diabetes Mellitus, HTN

Daughter-alive, 34 years old, healthy

Social Hx: No smoking history or illicit drug use, occasional alcoholic beverage consumption on social celebrations. Retired, widow, he lives alone.

SUBJECTIVE:

Chief complain: “headaches” that started two weeks ago

Symptom analysis/HPI:

The patient is 65 years old male who complaining of episodes of headaches and on 3 different occasions blood pressure was measured, which was high (159/100, 158/98 and 160/100 respectively). Patient noticed the problem started two weeks ago and sometimes it is accompanied by dizziness. He states that he has been under stress in his workplace for the last month.

Patient denies chest pain, palpitation, shortness of breath, nausea or vomiting.

ROS:

CONSTITUTIONAL: Denies fever or chills. Denies weakness or weight loss. NEUROLOGIC: Headache and dizziness as describe above. Denies changes in LOC. Denies history of tremors or seizures. 

HEENT: HEAD: Denies any head injury, or change in LOC. Eyes: Denies any changes in vision, diplopia or blurred vision. Ear: Denies pain in the ears. Denies loss of hearing or drainage. Nose: Denies nasal drainage, congestion. THROAT: Denies throat or neck pain, hoarseness, difficulty swallowing.

Respiratory: Patient denies shortness of breath, cough or hemoptysis.

Cardiovascular: No chest pain, tachycardia. No orthopnea or paroxysmal nocturnal

dyspnea.

Gastrointestinal: Denies abdominal pain or discomfort. Denies flatulence, nausea, vomiting or

diarrhea.

Genitourinary: Denies hematuria, dysuria or change in urinary frequency. Denies difficulty starting/stopping stream of urine or incontinence.

MUSCULOSKELETAL: Denies falls or pain. Denies hearing a clicking or snapping sound.

Skin: No change of coloration such as cyanosis or jaundice, no rashes or pruritus.

Objective Data

CONSTITUTIONAL: Vital signs: Temperature: 98.5 °F, Pulse: 87, BP: 159/92 mmhg, RR 20, PO2-98% on room air, Ht- 6’4”, Wt 200 lb, BMI 25. Report pain 0/10.

General appearance: The patient is alert and oriented x 3. No acute distress noted. NEUROLOGIC: Alert, CNII-XII grossly intact, oriented to person, place, and time. Sensation intact to bilateral upper and lower extremities. Bilateral UE/LE strength 5/5.

HEENT: Head: Normocephalic, atraumatic, symmetric, non-tender. Maxillary sinuses no tenderness. Eyes: No conjunctival injection, no icterus, visual acuity and extraocular eye movements intact. No nystagmus noted. Ears: Bilateral canals patent without erythema, edema, or exudate. Bilateral tympanic membranes intact, pearly gray with sharp cone of light. Maxillary sinuses no tenderness. Nasal mucosa moist without bleeding. Oral mucosa moist without lesions,.Lids non-remarkable and appropriate for race.

Neck: supple without cervical lymphadenopathy, no jugular vein distention, no thyroid swelling or masses.

Cardiovascular: S1S2, regular rate and rhythm, no murmur or gallop noted. Capillary refill < 2 sec.

Respiratory: No dyspnea or use of accessory muscles observed. No egophony, whispered pectoriloquy or tactile fremitus on palpation. Breath sounds presents and clear bilaterally on auscultation.

Gastrointestinal: No mass or hernia observed. Upon auscultation, bowel sounds present in all four quadrants, no bruits over renal and aorta arteries. Abdomen soft non-tender, no guarding, no rebound no distention or organomegaly noted on palpation

Musculoskeletal: No pain to palpation. Active and passive ROM within normal limits, no stiffness.

Integumentary: intact, no lesions or rashes, no cyanosis or jaundice.

Assessment 

Essential (Primary) Hypertension (ICD10 I10): Given the symptoms and high blood pressure (156/92 mmhg), classified as stage 2. Once the organic cause of hypertension has been ruled out, such as renal, adrenal or thyroid, this diagnosis is confirmed.

Differential diagnosis:

Ø Renal artery stenosis (ICD10 I70.1)

Ø Chronic kidney disease (ICD10 I12.9)

Ø Hyperthyroidism (ICD10 E05.90)

Plan

Diagnosis is based on the clinical evaluation through history, physical examination, and routine laboratory tests to assess risk factors, reveal identifiable causes and detect target-organ damage, including evidence of cardiovascular disease.

These basic laboratory tests are:

· CMP

· Complete blood count

· Lipid profile

· Thyroid-stimulating hormone

· Urinalysis

· Electrocardiogram

Ø Pharmacological treatment: 

The treatment of choice in this case would be:

Thiazide-like diuretic and/or a CCB

· Hydrochlorothiazide tab 25 mg, Initial dose: 25 mg orally once daily. 

Ø Non-Pharmacologic treatment

· Weight loss

· Healthy diet (DASH dietary pattern): Diet rich in fruits, vegetables, whole grains, and low-fat dairy products with reduced content of saturated and trans l fat

· Reduced intake of dietary sodium: <1,500 mg/d is optimal goal but at least 1,000 mg/d reduction in most adults

· Enhanced intake of dietary potassium

· Regular physical activity (Aerobic): 90–150 min/wk.

· Tobacco cessation

· Measures to release stress and effective coping mechanisms.

Education

· Provide with nutrition/dietary information.

· Daily blood pressure monitoring at home twice a day for 7 days, keep a record, bring the record on the next visit with her PCP

· Instruction about medication intake compliance. 

· Education of possible complications such as stroke, heart attack, and other problems.

· Patient was educated on course of hypertension, as well as warning signs and symptoms, which could indicate the need to attend the E.R/U.C. Answered all pt. questions/concerns. Pt verbalizes understanding to all

Follow-ups/Referrals

· Evaluation with PCP in 1 weeks for managing blood pressure and to evaluate current hypotensive therapy. Urgent Care visit prn.

· No referrals needed at this time.

References

Domino, F., Baldor, R., Golding, J., Stephens, M. (2017). The 5-Minute Clinical Consult 2017 (25th ed.). Print (The 5-Minute Consult Series).

Codina Leik, M. T. (2014). Family Nurse Practitioner Certification Intensive Review (2nd ed.). ISBN 978-0-8261-3424-0

Chronic Conditions:

Diseases   and Disorders of the Renal/GU System

· Acute Kidney Injury (AKI)

· Bladder Cancer

· Glomerulonephritis

· Hematuria

· Hydronephrosis

· Interstitial Cystitis

· Priapism

· Prostate Cancer

· Prostatic Hyperplasia, Benign (BPH)

· Prostatitis

· Pyelonephritis

· Testicular Torsion

· Urinary Tract Infection (UTI)

Diseases   and Disorders of the Endocrine System

· Addison Disease

· Cushing Syndrome

· Diabetes

· Graves Disease

· Hyper-, Hypoparathyroidism

· Hyper-, Hypothyroidism

· Myasthenia Gravis

· Syndrome of Inappropriate Antidiuretic Hormone Secretion

Diseases   and Disorders of the Gastrointestinal System

· Ascites

· Appendicitis

· Celiac Disease

· Cholelithiasis

· Cirrhosis

· Clostridium Difficile (C. Diff)

· Colitis

· Crohn’s Disease

· Constipation

· Diarrhea

· Diverticulitis

· Esophageal Varices

Diseases   and Disorders of the Gastrointestinal System

· Gastritis

· Gastroesophageal Reflux Disease

· Hemorrhoids 

· Hepatic Encephalopathy

· Hepatitis

· Irritable Bowel Syndrome (IBS)

· Pancreatic Cancer

· Pancreatitis

· PepticUlcerDisease (Zollinger-Ellison Syndrome)

· Salmonella Infection

 
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The Importance Of Statistics And Level Of Measurement

In 2-3 paragraph: Discuss the importance of statistics and level of measurement as it relates to the research process

-What does inferential statistics tell you as a reader/consumer of research?

-What does descriptive statistics tell you as a reader/consumer of research?

-Identify the varied numerical values you use in your clinical practice (at least two numerical values). 

-Describe which level of measurements each of those type of values represent (for example, what is the level of measurement when taking a patient’s temperature?-You may not use temperature as your numerical value response). Identify two different level of measurements you use in your nursing practice on a consistent basis. 

-What is your understanding about the importance of the level of measurement as it relates to data analysis?

-Identify your primary research question from the previous week. What descriptive and inferential statistics might you use to respond to your proposed questions? (You may need to slightly alter your question to respond appropriately to this question). 

NOTE:  Your response should consist of complete sentences and should be at least one complete paragraph, but it should be no more than three paragraphs in length

 
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What is the Christian view of the nature of human persons, and which theory of moral status is it compatible with? How is this related to the intrinsic human value and dignity?

Case Study on Moral Status 

Based on “Case Study: Fetal Abnormality” and other required topic study materials, write a 750-1,000-word reflection that answers the following questions:

  1. What is the Christian view of the nature of human persons, and which theory of moral status is it compatible with? How is this related to the intrinsic human value and dignity?
  2. Which theory or theories are being used by Jessica, Marco, Maria, and Dr. Wilson to determine the moral status of the fetus? What from the case study specifically leads you to believe that they hold the theory you selected?
  3. How does the theory determine or influence each of their recommendations for action?
  4. What theory do you agree with? Why? How would that theory determine or influence the recommendation for action?

Remember to support your responses with the topic study materials.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting 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.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

RUBRIC

Attempt Start Date: 24-Jun-2019 at 12:00:00 AM

Due Date: 30-Jun-2019 at 11:59:59 PM

Maximum Points: 200.0

Case Study on Moral Status – Rubric

No of Criteria: 9 Achievement Levels: 5CriteriaAchievement LevelsDescriptionPercentageUnsatisfactory0.00 %Less than Satisfactory65.00 %Satisfactory75.00 %Good85.00 %Excellent100.00 %Content70.0     Christian View of the Nature of Human Persons and Compatible Theory of Moral Status30.0Explanation of the Christian view of the nature of human persons and the theory of moral status that it is compatible is insufficient. Explanation is not supported by topic study materials.Explanation of the Christian view of the nature of human persons and the theory of moral status that it is compatible is unclear. Explanation is not clearly supported by topic study materials.Explanation of the Christian view of the nature of human persons and the theory of moral status that it is compatible is clear. Explanation is supported by topic study materials.Explanation of the Christian view of the nature of human persons and the theory of moral status that it is compatible is clear and thorough. Explanation is supported by topic study materials.Explanation of the Christian view of the nature of human persons and the theory of moral status that it is compatible is clear, thorough, and explained with a deep understanding of the connection between them. Explanation is supported by topic study materials.Determination of Moral Status15.0The theory or theories that are used by each person to determine the moral status of the fetus is not adequately explained. Rationale for choices made is not supported by topic study materials or case study examples.The theory or theories that are used by each person to determine the moral status of the fetus is not clearly explained. Rationale for choices made is unclearly supported by topic study materials or case study examples.The theory or theories that are used by each person to determine the moral status of the fetus is explained and draws relevant conclusions. Rationale for choices made is supported by topic study materials and case study examples.The theory or theories that are used by each person to determine the moral status of the fetus is explained clearly and draws relevant conclusions. Rationale for choices made is clearly supported by topic study materials and case study examples.The theory or theories that are used by each person to determine the moral status of the fetus is explained clearly and draws insightful relevant conclusions. Rationale for choices made is clearly supported by topic study materials and case study examples.Recommendation for Action15.0Explanation of how the theory determines or influences each of their recommendations for action is insufficient. Explanation is not supported by topic study materials.Explanation of how the theory determines or influences each of their recommendations for action is unclear. Explanation unclearly supported by topic study materials.Explanation of how the theory determines or influences each of their recommendations for action is clear. Explanation is supported by topic study materials.Explanation of how the theory determines or influences each of their recommendations for action is clear and demonstrates an understanding of the theory. Explanation is supported by topic study materials.Explanation of how the theory determines or influences each of their recommendations for action is clear, insightful, and demonstrates a deep understanding of the theory and its impact on recommendation for action. Explanation is supported by topic study materials.Personal Response to Case Study10.0Evaluation of which theory is personally preferable along with how that theory would influence personal recommendations for action is inadequate.Evaluation of which theory is preferable along with how that theory would influence personal recommendations for action is lacking a personal connection.Evaluation of which theory is preferable within personal practice along with how that theory would influence personal recommendations for action is clear.Evaluation of which theory is preferable within personal practice along with how that theory would influence personal recommendations for action is clear and relevant.Evaluation of which theory is preferable within personal practice along with how that theory would influence personal recommendations for action is clear, relevant, and insightful.Organization, Effectiveness, and Format 30.0     Thesis Development and Purpose7.0Paper lacks any discernible overall purpose or organizing claim.Paper lacks any discernible overall purpose or organizing claim. Thesis is insufficiently developed or vague. Purpose is not clear. Thesis is apparent and appropriate to purpose.Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose.Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.Argument Logic and Construction8.0Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources.Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility.Argument is orderly, but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis. Argument shows logical progression. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative.Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.Mechanics of Writing (includes spelling, punctuation, grammar, language use)5.0Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used.Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register) or word choice are present. Sentence structure is correct but not varied.Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct and varied sentence structure and audience-appropriate language are employed.Prose is largely free of mechanical errors, although a few may be present. The writer uses a variety of effective sentence structures and figures of speech.Writer is clearly in command of standard, written, academic English.Paper Format (use of appropriate style for the major and assignment)5.0Template is not used appropriately, or documentation format is rarely followed correctly.Appropriate template is used, but some elements are missing or mistaken. A lack of control with formatting is apparent.Appropriate template is used. Formatting is correct, although some minor errors may be present. Appropriate template is fully used. There are virtually no errors in formatting style.All format elements are correct. Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)5.0Sources are not documented.Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors.Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.Sources are documented, as appropriate to assignment and style, and format is mostly correct. Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.Total Percentage  100

 
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Policy/Regulation Fact Sheet

Required Readings

McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.

· Chapter 8, “Legislative Aspects of Nursing Informatics: HITECH and HIPAA” (pp. 145–166)

American Association of Nurse Practitioners. (2018). MACRA/MIPS: The transition from fee-for-service to quality-based reimbursement. Retrieved from https://www.aanp.org/legislation-regulation/federal-legislation/macra-s-quality-payment-program

Centers for Medicare and Medicaid Services. (n.d.). MACRA. Retrieved January 18, 2019, from https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/value-based-programs/macra-mips-and-apms/macra-mips-and-apms.html

HealthIT.gov. (2018a). Health IT legislation. Retrieved from https://www.healthit.gov/topic/laws-regulation-and-policy/health-it-legislation

HealthIT.gov. (2018b). Meaningful use and MACRA. Retrieved from https://www.healthit.gov/topic/meaningful-use-and-macra/meaningful-use-and-macra

U.S. Department of Health and Human Services. (n.d.). Laws & regulations. Retrieved September 27, 2018, from https://www.hhs.gov/regulations/index.html

Assignment: Policy/Regulation Fact Sheet

As a professional nurse, you are expected to apply your expertise to patient care. On occasion, you will also be expected to share that expertise.

With evolving technology and continuous changes to regulations designed to keep up these changes, there is usually a need to share information and expertise to inform colleagues, leadership, patients, and other stakeholders.

In this Assignment, you will study a recent nursing informatics-related healthcare policy, and you will share the relevant details via a fact sheet designed to inform and educate.

To Prepare:

· Review the Resources on healthcare policy and regulatory/legislative topics related to health and nursing informatics.

· Consider the role of the nurse informaticist in relation to a healthcare organization’s compliance with various policies and regulations, such as the Medicare Access and CHIP Reauthorization Act (MACRA).

· Research and select one health or nursing informatics policy (within the past 5 years) or regulation for further study.

The Assignment: (1 page)

Create a 1-page fact sheet that your healthcare organization could hypothetically use to explain the health or nursing informatics policy/regulation you selected. Your fact sheet should address the following:

· Briefly and generally explain the policy or regulation you selected.

· Address the impact of the policy or regulation you selected on system implementation.

· Address the impact of the policy or regulation you selected on clinical care, patient/provider interactions, and workflow.

· Highlight organizational policies and procedures that are/will be in place at your healthcare organization to address the policy or regulation you selected. Be specific.

Rubric Detail

ExcellentGoodFairPoor
Create a 1-page fact sheet that your healthcare organization could hypothetically use to explain the health or nursing informatics policy/regulation you selected. Your fact sheet should address the following: ·   Briefly and generally explain the policy or regulation you selected. ·   Address the impact of the policy or regulation you selected on system implementation. ·   Address the impact of the policy or regulation you selected on clinical care, patient/provider interactions, and workflow. ·   Highlight organizational policies and procedures that are/will be in place at your healthcare organization to address the policy or regulation you selected. Be specific.77 (77%) – 85 (85%)A fully developed and detailed Fact Sheet is provided for the Assignment.  The responses accurately and thoroughly explain in detail the policy and regulation selected.  The responses accurately and thoroughly explain in detail the impact of the policy or regulation selected on system implementation.  The responses accurately and thoroughly explain in detail the impact of the policy or regulation selected on clinical care, patient/provider interactions, and workflow.  Specific and accurate responses thoroughly highlight in detail the organizational policies and procedures that are/will be in place at a healthcare organization to address the policy or regulation selected.  Includes: 3 or more peer-reviewed sources and 2 or more course resources.68 (68%) – 76 (76%)A developed Fact Sheet is provided for the Assignment.  The responses explain the policy or regulation selected.  The responses explain the impact of the policy or regulation selected on system implementation.  The responses explain the impact of the policy or regulation selected on clinical care, patient/provider interactions, and workflow.  Accurate responses highlight the organizational policies and procedures that are/will be in place at a healthcare organization to address the policy or regulation selected.  Includes: 2 peer-reviewed sources and 2 course resources.60 (60%) – 67 (67%)A vague or inaccurate Fact Sheet is provided for the Assignment.  The responses explaining the policy or regulation selected are vague or inaccurate.  The responses explaining the impact of the policy or regulation selected on system implementation are vague or inaccurate.  The responses explaining the impact of the policy or regulation selected on clinical care, patient/provider interactions, and workflow are vague or inaccurate.  The responses highlighting the organizational policies and procedures that are/will be in place at a healthcare organization to address the policy or regulation selected are vague or inaccurate.  Includes: 1 peer-reviewed source and 1 course resource.0 (0%) – 59 (59%)A vague and inaccurate Fact Sheet is provided for the Assignment, or is missing.  The responses explaining the policy or regulation selected are vague and inaccurate, or are missing.  The responses explaining the impact of the policy or regulation selected on system implementation are vague and inaccurate, or are missing.  The responses explaining the impact of the policy or regulation selected on clinical care, patient/provider interactions, and workflow are vague and inaccurate, or are missing.  The responses highlighting the organizational policies and procedures that are/will be in place at a healthcare organization to address the policy or regulation selected are vague and inaccurate, or are missing.  Includes: 1 or fewer resources.
Written Expression and Formatting – Paragraph Development and Organization:  Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance.5 (5%) – 5 (5%)Paragraphs and sentences follow writing standards for flow, continuity, and clarity.4 (4%) – 4 (4%)Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.3.5 (3.5%) – 3.5 (3.5%)Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%- 79% of the time.0 (0%) – 3 (3%)Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time.
Written Expression and Formatting – English writing standards:  Correct grammar, mechanics, and proper punctuation5 (5%) – 5 (5%)Uses correct grammar, spelling, and punctuation with no errors.4 (4%) – 4 (4%)Contains a few (1-2) grammar, spelling, and punctuation errors.3.5 (3.5%) – 3.5 (3.5%)Contains several (3-4) grammar, spelling, and punctuation errors.0 (0%) – 3 (3%)Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.5 (5%) – 5 (5%)Uses correct APA format with no errors.4 (4%) – 4 (4%)Contains a few (1-2) APA format errors.3.5 (3.5%) – 3.5 (3.5%)Contains several (3-4) APA format errors.0 (0%) – 3 (3%)Contains many (≥ 5) APA format errors.
Total Points: 100
 
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