Discuss the history of present illness that you would take on this patient in preparation for the clinic visit.

Comment using your own words but please provide at least one reference for each comment.

Do a half page for discussion #1 and another half page for discussion #2 for a total of one page.

Provide the comment for each discussion separate.

Discussion #1

1.Discuss the history of present illness that you would take on this patient in preparation for the clinic visit. Include questions regarding Onset, Location, Duration, Characteristics, Aggravating Factors, Relieving Factors, Treatment, Severity (OLDCARTS).

HPI:

Ms. Susan Johnston is a 60 year old female that presented to the clinic with complaints of intermittent chest pain that has been occurring for the last 3 months on exertion. She has a history of hyperlipidemia, hypertension and a family history of Diabetes and cardiac disease. At the present time she is non-compliant with her current medication regime of lisinopril 20mg, hydrochlorothiazide 25mg and occasional aspirin. 

Ms. Johnston states that her chest pain is in the “middle of her chest” and says her pain level can be 6/10 on the pain scale at its worst. She states that the discomfort occurs when she is “active” climbing stairs and is relieved by rest. Ms. Johnston describes her pain as “burning at times and sometimes tingling” but also stated “it always goes away”. She did state that she has some shortness of breath with the occurrence.

She denies any symptoms of dizziness or passing out. Also denies any radiation of pain to the neck, jaw or arm. She has not been woken by the pain and has no nausea or vomiting during or after pain onset.

Describe the physical exam and diagnostic tools to be used for Ms. Johnston. Are there any additional you would have liked to be included that were not? 

 The physical exam to be used on Ms. Johnston includes a full head to toe assessment which showed no abnormalities besides obesity and hypertension.  An EKG was also completed which showed normal sinus rhythm. Labs were drawing including a CBC, TSH, basic metabolic panel, and a fasting lipid panel. CBC allows us to get a foundation of the hemodynamic of her system and check for signs ischemia. By drawing a TSH we can check for possible thyroid dysfunctions that may be contributing to her aliments such as her weight gain. With the lipid panel we can assess the risk to Ms. Johnston for coronary artery disease 

After receiving the Lab results back it was noted that her ASCVD score was at a 7.2% which increases her risk for a cardiac event. A chest xray was completed and Ms. Johnston was sent for stress test and a cardiac Cath procedure where a stent was placed. 

I feel that all the diagnostics and labs performed were appropriate. If we were do add anything possibly dopplers to make sure there are no other signs of lack of perfusion to the peripherals as well.  

What plan of care will Ms. Johnston be given at this visit; what is the patient education and follow-up?

During the follow up visit we would like to gauge Ms. Johnston’s compliance with her medications. Set up an appointment for 6-12 weeks to redraw the lipid panel to check for compliance (University of Michigan Medicine, 2014).We will discuss possible diet changes and safe physical activities for her to complete in order to better her health and weight.

Discussion #2

Ms. Johnston, a 60-year old patient presented with complaint of non-radiating midline chest pain, onset about 3 moths ago, intermittent in nature and lasting 2-3 minutes after the onset, described as burning with occasional tingling sensations. The patient is not endorsing any aggravating factors, associated with the complaint of this chest pain.The patient didn’t identify any specific relieving factors, stating that the chest pain is self-resolving with worst exacerbation’s pain score of 6/10.

The patient’s initial vital signs are within defined limits, with exception of blood pressure of 138/78, and 136/82 thereafter. Review of medications was performed in order to connect the findings from the physical exam to the medication efficacy. The patient endorses taking lisinopril and hydrochlorothiazide, although is still hypertensive. Family history was obtained, which helps identify the risk factors, as related to the genetic pre-disposition. Paternal family history of heart attack at age 57, which poses a risk factor when looking comprehensively at findings. Social history was obtained and the patient is a non-smoker, which decreases her associated cardiovascular risk. Also, the dietary habits were assessed with the patient shown to be obese with a BMI of 35.5 and denying following healthy diet habits. This finding created a need for associated education and dietary intervention plan. Overall, the physical assessment was within defined limits. I think that additionally, an EKG should be a standard tool of gathering data when related to any patients with complains of chest pain, arrhythmia and/or shortness of breath. In this particular case with Ms.Johnson, she also presents with multiple risk factors that just amplify the need for EKG testing.

This patient should be given a thorough education about the need for lifestyle modifications. The patient needs to follow a heart healthy diet that will help her heart function and also potentially reduce the excess weight. The patient also will need to be instructed that she may benefit from a individually tailored physical activity program and refer her to the resources available. The patient had been started on new medications, so a thorough teaching on medication regiment and medication side effects is warranted. Medication compatibility needs to be assured. The patient will benefit from a referral to cardiology for follow up, so a new evaluation later on can be conducted and see if further need for intervention is warranted. The patient needs to be given education on signs and symptoms of worsening condition, therefore prompting the patient to seek further medical care. It is important to understand that the patient will feel comfortable in received information and navigate it accordingly. Increasing healthcare literacy is paramount. Physicians must promote patient education and engagement through improvement in patients’ health literacy. Health literacy is defined as the capacity to seek, understand, and act on health information. The presumption has been that low health literacy means that physician communication is poorly understood, leading to incomplete self-health management and responsibility and incomplete health care utilization. It is the responsibility of physicians to proactively enable patients to have more accessible interactions and situations that promote health and well-being (Paterick, Patel, Tajik, & Chandrasekaran, 2017).

 
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Do you believe eye contact and personal contact should be avoided?

If you talk about a possible poor health outcome, do you believe that outcome will occur? Do you believe eye contact and personal contact should be avoided?

You would have a difficult time practicing as a nurse if you believed these to be true. But they are very real beliefs in some cultures.

Differences in cultural beliefs, subcultures, religion, ethnic customs, dietary customs, language, and a host of other factors contribute to the complex environment that surrounds global healthcare issues. Failure to understand and account for these differences can create a gulf between practitioners and the public they serve.

In this Assignment, you will examine a global health issue and consider the approach to this issue by the United States and by one other country.

To Prepare:

  • Review the World Health Organization’s (WHO) global health agenda and select one global health issue to focus on for this Assignment.
  • Select at least one additional country to compare to the U.S. for this Assignment.
  • Reflect on how the global health issue you selected is approached in the U.S. and in the additional country you selected.
  • Review and download the Global Health Comparison Matrix provided in the Resources.

The Assignment: (1- to 2-page Global Health Comparison Matrix; 1-page Plan for Social Change)

Part 1: Global Health Comparison Matrix

Focusing on the country you selected and the U.S., complete the Global Health Comparison Matrix. Be sure to address the following:

  • Consider the U.S. national/federal health policies that have been adapted for the global health issue you selected from the WHO global health agenda. Compare these policies to the additional country you selected for study.
  • Explain the strengths and weaknesses of each policy.
  • Explain how the social determinants of health may impact the global health issue you selected. Be specific and provide examples.
  • Using the WHO’s Organization’s global health agenda as well as the results of your own research, analyze how each country’s government addresses cost, quality, and access to the global health issue selected.
  • Explain how the health policy you selected might impact the health of the global population. Be specific and provide examples.
  • Explain how the health policy you selected might impact the role of the nurse in each country.
  • Explain how global health issues impact local healthcare organizations and policies in both countries. Be specific and provide examples.

Part 2: A Plan for Social Change

Reflect on the global health policy comparison and analysis you conducted in Part 1 of the Assignment and the impact that global health issues may have on the world, the U.S., your community, as well as your practice as a nurse leader.

In a 1-page response, create a plan for social change that incorporates a global perspective or lens into your local practice and role as a nurse leader.

  • Explain how you would advocate for the incorporation of a global perspective or lens into your local practice and role as a nurse leader.
  • Explain how the incorporation of a global perspective or lens might impact your local practice and role as a nurse leader.
  • Explain how the incorporation of a global perspective or lens into your local practice as a nurse leader represents and contributes to social change. Be specific and provide examples.
 
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Select a current or proposed health care policy that is designed to improve a specific population’s access to quality, cost-effective health care.

Select a current or proposed health care policy that is designed to improve a specific population’s access to quality, cost-effective health care. In a 4 page, include the following:

  1. Explain the policy and how it is designed to improve cost-effectiveness and health care equity for the population. Is the policy financially sound? Why or why not? How does the policy account for any relevant ethical, legal, and political factors and the nursing perceptive one must consider when implementing it?
  2. To what state, federal, global health policies or goals is this particular policy related? How well do you think the policy is designed to achieve those goals?
  3. Finally, discuss the advocacy strategies you would employ on behalf of your population to ensure they have access to the benefits of the policy. Explain, from a Christian perspective, the professional and moral obligation of advanced registered nurse to advocate for and promote health and prevent disease among diverse populations.

You are required to cite five to 10 sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

 
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Not all EBP projects result in statistically significant results. Define clinical significance, and explain the difference between clinical and statistical significance. How can you use clinical significance to support positive outcomes in your project?

 Not all EBP projects result in statistically significant results. Define clinical significance, and explain the difference between clinical and statistical significance. How can you use clinical significance to support positive outcomes in your project? 

 
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Discuss if a benefit to risk ratio was calculated and how? Did it provide am honest estimation?

Select a healthcare related research study .
 

Identify the sample population.
 

Analyze and critique the study to identify if sampling method reflects ethical principles including consent, conditions of the participants, study approved by IRB.
 

Minimum 12 pages excluding title and reference page. 

Introduction

Paragraph one is the introduction to the paper. It should begin with something that will grab the reader’s attention and provide a citation to support your opening sentence (Norwood, 2002). Next, support that opening sentence with discussion or explanation with one or multiple sentences which will make up the body of the introductory paragraph. The last sentence of the introduction should highlight areas to be covered in the paper. APA success requires knowledge of the format and skill in concise, clear written communication.

Research Study Overview

This section is where you provide a summary of the research study being critiqued? What were the goals of the research? What health care related issue was addressed? Is it a good/feasible study to apply in clinical practice? Was a practical study, from a financial aspect? Use as many paragraphs as needed to cover the content appropriately.

Ethical Issues in Research

Use this paragraph to provide feedback/history on ethical issues on research. 

Protection of Human Rights

What are the five human rights that must be protected during research/investigation? What do they stand for? How do they relate to this research study? Were any/all of the human rights protected in the duration of the research study in question? Use as many paragraphs as needed to cover the content appropriately.

Sampling Method

 What was the sampling method used, how did the researchers choose the subjects for participation? What other sampling methods could have worked better, provided better results? Does the sampling method used reflect ethical principles, was it a fair process? Is the population in question a vulnerable population, and if so were there special considerations taken? Use as many paragraphs as needed to cover the content appropriately.

Informed Consent

What is an informed consent? In regards to this research study, was it obtained, if appropriate? If a consent was part of the study, was it obtained properly? Did the participants assent? If participants unable to consent, were they not competent, did a caregiver consent? Were participants provided full/complete detailed information or was it a short version? What components did it include? Use as many paragraphs as needed to cover the content appropriately.

Ethical Scientific Integrity

What are the credentials of the researchers? Did the researchers fabricate data, publish errors/ publish correction? Is there evidence of plagiarism? Use as many paragraphs as needed to cover the content appropriately. 

IRB

This section is where you will discuss all the information available (or lack thereof) regarding the IRB. Was the research study approved by an institutional review board? If not, why not? Was a research proposal submitted for approval by an IRB? Use as many paragraphs as needed to cover the content appropriately 

HIPPA

What is HIPPA and how does it apply to a research study? Was the research conducted using database information, and if so, was the health information protected? How was it protected? Was any data de-identified? Were participants provided pseudonyms or assigned numbers? Use as many paragraphs as needed to cover the content appropriately.

Benefit to Risk Ratio

Discuss if a benefit to risk ratio was calculated and how? Did it provide am honest estimation? What is your opinion about the outcome of the study and the potential benefits? Can it have a positive impact on the individual, how about in the community? Use as many paragraphs as needed to cover the content appropriately. 

Conclusion

Most papers should end with a conclusion or summary, which consists a short description of the key points of the paper. It should be concise and contain little or no detail. No matter how much space is left on the page, the References are always on the next page.

 
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