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Nursing

Problem: Nicholine is an 80-year-old female that presented to her Primary Care P

Problem: Nicholine is an 80-year-old female that presented to her Primary Care Provider with intermittent, bilateral calf pain, mild dyspnea on exertion and Angina that has been going on for the past six months. She reports climbing steps makes it worse, walking makes it worse. She reports that she does not take her weekly walks anymore due to the pain associated with walking. She reports rest makes the pain better. A few weeks ago, she was diagnosed with Peripheral Vascular Disease. Use the above information to answer the following questions:
What assessment tool would you recommend as a screening tool for this patient? Why did you pick this tool? Considerations if any for picking the assessment tool? Provide references to support your answer.
Identify tool recommended in the EB article e.g https://medlineplus.gov/lab-tests/heart-disease-risk-assessment/Links to an external site.
Is there another tool/s that can be used to assess this problem? – if so, list alternate evidenced based tools which may be considered
Background of selected tool:
Define or Describe your selected tool
Indications for use/ who needs to be assessed
Rationale for this selection. Why is the tool the best selection for the problem compared to the other (not selected)?
Include Reliability and validity of the use
How is it scored
How are the scores obtained with the tool interpreted and how does the tool provide guidance to the treatment plan and improve patient outcomes. Ex. statin therapy indicated. expected outcomes. Additional therapies to support the prevention of MI, etc

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Nursing

A 70-year-old male patient presented to your clinic with complaint of a “wet cou

A 70-year-old male patient presented to your clinic with complaint of a “wet cough” x 2 weeks. Confirms fever, mild dyspnea on exertion, chills, tachycardia, and chest congestion. Describes cough as reproductive with clear to yellow sputum. Medical history is unremarkable. He reports nicotine dependence for 30 years smoking 1 pack per day. On inspection, patient appeared to be tachypneic with respiratory rate at 30, appeared to have shallow breathing with crackles heard in all lung fields.
Discuss at least five questions you would ask this patient to elicit a history about the patient’s symptoms.
List three physical findings in the respiratory examination that will concern you as the nurse.
What differential diagnosis would you consider as the nurse practitioner seeing this patient?

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Nursing

CASE: The patient, Mrs. Maria Perez, is a 53-year-old Puerto Rican female who ha

CASE:
The patient, Mrs. Maria Perez, is a 53-year-old Puerto Rican female who has presented for consultation regarding a personal issue she finds sensitive in nature.
The client reports a history of alcohol use disorder dating back to her late teens and involvement with Alcoholics Anonymous over the past 25 years, with increased difficulty maintaining sobriety since the opening of a nearby casino. She describes a high associated with gambling and an increased frequency of drinking and cigarette smoking while gambling, as well as concerns about the health effects of the smoking. Despite attempts at abstinence, the client reports feeling the need for alcohol during gambling activities. She has also experienced weight gain from excessive drinking. The client expresses concern about having borrowed a substantial sum from her retirement account to pay off gambling debts without her husband’s knowledge
The patient is a 53-year-old Puerto Rican female who is conscious and oriented to her surroundings. She is dressed appropriately for the weather and the season. Her speech is clear and coherent, with a clear goal. Her eye contact during the clinical interview is somewhat limited, but her mannerisms, gestures, and tics are not notable. She reports feeling “sad” and her affect is consistent with her reported mood. There is no evidence of hallucinations or delusional thinking, and her insight and judgment appear to be intact. However, she has an impaired ability to control her impulses. There are no reported suicidal or homicidal ideations at this time.
Diagnosis: Gambling Disorder, Alcohol Use Disorder.
– Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.
Decision #1
After a thorough history and physical from the patient, the diagnosis is gambling disorder and alcohol use disorder. Select what the PMHNP should do:
• Naltrexone (Vivitrol) injection, 380 mg intramuscularly in the gluteal region
every 4 weeks
• Antabuse (Disulfiram) 250 mg orally daily
• Campral (Acamprosate) 666 mg orally three times/day
My decision: Naltrexone (Vivitrol) injection, 380 mg intramuscularly in the gluteal region
every 4 weeks (BASE ANSWER ON THIS DECISION)
RESULTS OF DECISION POINT ONE
Client returns to clinic in four weeks. Mrs. Perez says she feels “wonderful” as she has not “touched a drop” of alcohol since receiving the injection. Client reports that she has not been going to the casino, as frequently, but when she does go she “drops a bundle” (meaning, spends a lot of money gambling). Client She is also still smoking, which has her concerned. She is also reporting some problems with anxiety, which also has her concerned
• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #2
Select what the PMHNP should do next:
• Add on Valium (diazepam) 5 mg orally TID/PRN/anxiety
• Refer to a counselor to address gambling issues
• Add on Chantix (varenicline) 1 mg orally BID
My decision: Refer to a counselor to address gambling issues (BASE ANSWER ON THIS DECISION)
RESULTS OF DECISION POINT TWO
Mrs. Perez returns in 4 weeks and reports that the anxiety that she had been experiencing is gone. She reports that she has met with the counselor, but she did not really like her. She also started going to a local meeting of Gamblers Anonymous. She states that last week, for the first time, she spoke during the meeting. She reports feeling supported in this group.
• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #3
Select what the PMHNP should do next:
• Explore the issue that Mrs. Perez is having with her counselor, and encourage her to continue attending the Gamblers Anonymous meetings
• Encourage Mrs. Perez to continue seeing her current counselor as well as continuing the Gamblers Anonymous group
• Discontinue Vivitrol. Encourage Mrs. Perez to continue seeing her counselor and to continue participating in the Gamblers Anonymous group
My decision: Explore the issue that Mrs. Perez is having with her counselor, and encourage her to continue attending the Gamblers Anonymous meetings (BASE ANSWER ON THIS DECISION)
Guidance to Student
Although controversy exists in the literature regarding how long to maintain a client on Vivitrol, 8 weeks is probably too soon to consider discontinuation. The psychiatric mental health nurse practitioner should explore the issues that Mrs. Perez is having with her counselor. As will be covered in more depth in future courses, ruptures in the therapeutic alliance can result in clients stopping therapy. Clearly, if the client does not continue with therapy, the likelihood of the gambling problem spontaneously remitting is lower (than had the client continued to receive therapy). Recall that there are no FDA-approved treatments for gambling addiction. The mainstay of treatment for this disorder is counseling. Since Mrs. Perez reports good perceived support from the Gamblers Anonymous meetings, she should be encouraged to continue her participation with this group.
You need to discuss smoking cessation options with Mrs. Perez in order to address the totality of addictions, and to enhance her overall health.
• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
CONCLUSION:
– Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.
PRIMARY LITERATURE:
• Kelly, J. E., & Renner, J. A. (2016). Alcohol-Related disorders. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 163–182). Elsevier.
• Renner, J. A., & Ward, N. (2016). Drug addiction. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 163–182). Elsevier.
• Substance Abuse and Mental Health Services Administration. (1999). Treatment of adolescents with substance use disorders: Treatment improvement protocol series Links to an external site., no. 32. http://www.ncbi.nlm.nih.gov/books/NBK64350/
o Chapter 1, “Substance Use Among Adolescents”
o Chapter 2, “Tailoring Treatment to the Adolescent’s Problem”
o Chapter 7, “Youths with Distinctive Treatment Needs”
• University of Michigan Health System. (2016). Childhood trauma linked to worse impulse control. Journal of Psychosocial Nursing & Mental Health Services Links to an external site., 54(4), 15.
• Grant, J. E., Odlaug, B. L., & Schreiber, L. N. (2014). Pharmacological treatments in pathological gambling. British Journal of Clinical Pharmacology Links to an external site., 77(2), 375–381. https://doi.org/10.1111/j.1365-2125.2012.04457.x
• Hulvershorn, L. A., Schroeder, K. M., Wink, L. K., Erickson, C. A., & McDougle, C. J. (2015). Psychopharmacologic treatment of children prenatally exposed to drugs of abuse. Human Psychopharmacology Links to an external site., 30(3), 164–172. https://doi.org/10.1002/hup.2467
• Loreck, D., Brandt, N. J., & DiPaula, B. (2016). Managing opioid abuse in older adults: Clinical considerations and challenges. Journal of Gerontological Nursing Links to an external site., 42(4), 10–15. https://doi.org/10.3928/00989134-20160314-04
• Salmon, J. M., & Forester, B. (2012). Substance abuse and co-occurring psychiatric disorders in older adults: A clinical case and review of the relevant literature. Journal of Dual Diagnosis Links to an external site., 8(1), 74–84. https://doi.org/10.1080/15504263.2012.648439
• Sanches, M., Scott-Gurnell, K., Patel, A., Caetano, S. C., Zunta-Soares, G. B., Hatch, J. P., Olvera, R., Swann, A. C., & Soares, J. C. (2014). Impulsivity in children and adolescents with mood disorders and unaffected offspring of bipolar parents. Comprehensive Psychiatry Links to an external site., 55(6), 1337–1341. https://doi.org/10.1016/j.comppsych.2014.04.018

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Nursing

This week, you will role-play communication and on-camera presentation skills w

This week, you will role-play communication and on-camera presentation skills
when you advocate for a patient during a virtual interdisciplinary team meeting.
*Note this week’s discussion requires you to record yourself using a webcam.
Discussion prompt:
You are invited to an interdisciplinary team meeting because a patient in your care is on the
agenda for discussion. Because of COVID-19 restrictions, and team
members’ schedules, the meeting is virtual. You are required to be on camera when
presenting.
Record yourself, using a webcam, articulating your concerns about your patient.
• Team members may not know you. You must introduce yourself, your practice role,
and your professional relationship to the patient. This patient situation could be an
experience you have had during your time as a nurse or clinical, or it could be a
made-up (realistic) scenario.
• Use an evidence-based communication strategy when voicing your concerns to the
interdisciplinary team.
• The video recording should be less than 90 seconds.
You must be visible on camera. When recording, consider your appearance, audio, and
background.
Upload your video to the discussion board along with the following written summary.
• Share the rationale for the evidence-based communication tool you used
• Discuss your experience of the role-play exercise including communication strengths
and areas for improvement.
• Provide rational for your response with at least one scholarly source using an APA
in-text citation and full reference.

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Nursing

egin by identifying a patient from your clinicals who has a chronic health issue

egin by identifying a patient from your clinicals who has a chronic health issue such as diabetes, COPD, or hypertension. Propose a healthcare coordination model that will benefit the specific patient and will also fit the clinic setting.
Your paper is to include the following information:
Descriiption of the patient and his/her health issues, diagnoses, and current plan of care.
Descriiption of the clinic setting, the healthcare providers (number and type), and the support staff.
Descriiption of the patients/diagnoses typically seen in this clinic.
Descriiption of the care coordination model being proposed. Please note, you may not use the OPT/CCCR model for this paper
Explain how this model will be effective for patients with similar diagnoses as discussed above.
Explain how this model will fit into the current clinic setting. What will need to change in the clinic setting to improve the fit?
The body of your paper should be a 3-4 pages long. This does NOT include the title page and reference page. Papers that are more than 4 pages long will not be accepted. Incorporate information from the course text plus a minimum of two (2) scholarly references published within the last five (5) years. Textbooks are not to be considered scholarly references.
Use current APA format to style your paper and to cite your sources. Your source(s) should be integrated into the paragraphs. Use internal citations pointing to evidence in the literature and supporting your ideas.
Headings are required and are to be titled as identified above and include these six (6) areas.

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Nursing

Case Study Rubric: Review the Case Study (Scenario 1 and 2 ). Thoughtfully respo

Case Study Rubric:
Review the Case Study (Scenario 1 and 2 ). Thoughtfully respond to each of the questions below for each scenario. Your
responses should show critical thinking and clinical judgement of an advanced provider:
1. Develop a Mental Status Exam (MSE) based on the descriiption of the patient in the clinical vignette.
Be sure to include appropriate language/descriiptors as reviewed in class. (4 points)
2. Identify at least one differential diagnosis or “rule out” based on the patient’s presenting
symptoms/concerns. Describe your clinical reasoning for this differential diagnosis. (2 points)
3. Identify a primary diagnosis for the patient in the clinical vignette. Support your decision by matching
parts of the identified symptomology to the diagnostic criteria for your chosen diagnosis. (4 points)
The assignment should include the following as well:
Quality:
Responses to questions are comprehensive and accurate showing evidence of critical thinking,
supported by evidence from the course material. Failure to answer all questions will result in zero credit
for the assignment.
Mechanics:
Writing is clear, and error free in terms of grammar, spelling, and mechanics. Graduate level writing is
expected.
___________________________________________________
For the case study on Anxiety disorders when doing the case study there are 2 scenarios- same patient.
For scenario 1- MSE answer Best you can – based of DX of GAD if unable given limited information put what would “normally” be documented for MSE. DX use DSMV criteria and differential using DSMV criteria as to why you chose that differential.
Scenario 2- same thing – answering best you can documenting what you might see in PTSD if information is not able to be gathered from the clips.
________________________________________________

Categories
Nursing

Discussion Questions This week we learned how research designs are different a

Discussion Questions

This week we learned how research designs are different and help us to objectively study nursing problems; the key is to decide which type of research and design will serve the purpose or intent to find a solution. After completing Week 4 readings and lesson, answer the following:
Reflect on your learning about Quantitative and Qualitative research; share two ways that helped you understand how they are different.
Choose one category of study design that you found interesting and describe; include what you learned about the design and how you believe it can help study nursing problems.
Refer back to your clinical nursing priority problem and evidence you located for your week 3 assignment: The nursing-evidenced practice (NEBP) committee has requested for you to make a recommendation to the team: Describe the type of research and the design that you believe would be the best way to study your problem. Discuss your rationale.

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Nursing

The assignment will be used to develop a written implementation plan. Step 1) Re

The assignment will be used to develop a written implementation plan.
Step 1) Review your strategic plan to implement the change proposal, the objectives, the outcomes, and listed resources.
Ste p2) Develop a process to evaluate the intervention if it were implemented.
Step 3) Write a 150-250 word summary of the evaluation plan that will be used to evaluate your intervention.
Address the following in your summary:
What data was collected?
What tool will be used to collect the data?
Who will be responsible for collecting data?
How will this data be communicated to the team?

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Nursing

Week 6: Area of Interest Power Point Presentation Start Assignment Due Feb 19 by

Week 6: Area of Interest Power Point Presentation
Start Assignment
Due Feb 19 by 11:59pm Points 175 Submitting a file upload
Purpose
The process for affecting positive change to improve practice outcomes can start with either the identification of an area of interest or the identification of a potential or existing practice problem. Selecting an area of interest helps to define a direction for further inquiry. The purpose of this assessment is for students to identify and discuss an area of interest specific to advanced practice nursing. Students will identify a common practice problem related to the selected area of interest and provide a recommendation to affect positive change. Students will build on this project in later courses.
Note: The purpose of the MSN project is to translate evidence currently found in the literature into practice within the chosen specialty track. Due to the research complexity, time involvement, and implications regarding human subjects, drug studies are not acceptable areas of interest for an MSN project.
Activity Learning Outcomes
Through this assignment, the student will demonstrate the ability to:
Examine roles and competencies of advanced practice nurses essential to performing as leaders and advocates of holistic, safe, and quality care. (CO1)
Analyze essential skills needed to lead within the context of complex systems. (CO3)
Explore the process of scholarship engagement to improve health and healthcare outcomes in various settings. (CO4)
Due Date:
Assignment should be submitted to the Week 6 Area of Interest Powerpoint Presentation dropbox by Sunday 11:59 p.m. MST at the end of Week 6. The week 6 assignment will not go through Turnitin.
This assignment will follow the late assignment policy specified in the course syllabus.
Students are expected to submit assignments by the time they are due. Assignments submitted after the due date and time will receive a deduction of 10% of the total points possible for that assignment for each day the assignment is late. Assignments will be accepted, with penalty as described, up to a maximum of three days late, after which point a zero will be recorded for the assignment.
In the event of a situation that prevents timely submission of an assignment, students may petition their instructor for a waiver of the late submission grade reduction. The instructor will review the student’s rationale for the request and make a determination based on the merits of the student’s appeal. Consideration of the student’s total course performance to date will be a contributing factor in the determination. Students should continue to attend class, actively participate, and complete other assignments while the appeal is pending.
Total Points Possible: 175
Requirements:
Criteria for Content
For this presentation, select an area of nurse practitioner (NP) practice that is of interest to you and in which you would like to see a practice change occur. Conduct a review of literature to see what is currently known about the topic and to find research support for the practice change you are recommending.  You may use a topic from the list at the link below or may investigate a topic of your choice as long as it pertains to NP practice. If you are unsure of your topic, please reach out to your instructor. Be sure to provide speaker’s notes for all slides except the title and reference slides. 
List of Possible Topics Links to an external site.
Please Use This Template Links to an external site.
Create an 8-12 slide PowerPoint Presentation that includes the following:
Introduction: slide should identify concepts to be addressed and sections of the presentation. Include speaker’s notes that explain, in more detail, what will be covered.
Evidence-based projects: slide should explain the general importance of master’s-prepared nurses engaging in evidence-based projects related to nursing practice and profession. Provide speaker’s notes with additional detail and support from at least one outside scholarly source (not the textbook or course lesson).
Conceptual Model: slide should provide an illustration of a conceptual model that could be used to develop an evidence-based project. Possible models include The John’s Hopkins or Advancing Research and Clinical Practice through Close Collaboration (ARCC) Models or you may select another model you find in the literature. In the speaker’s notes, explain how the model would be applied to the development of an evidence-based project. Provide support from at least one outside scholarly source (not the textbook or course lesson).
Area of Interest: identify an area of interest related to NP practice in which a practice change may be needed. Slide should identify the area of interest and what is currently known on the topic. Speaker’s notes more fully explain what is currently known and should provide rationale for why the area of interest is important to NP practice. Provide support from at least one outside scholarly source (not the textbook or course lesson).
Issue/concern and recommendation for change: slide should identify a specific concern related to your general area of interest and your recommendation for a practice change. Speaker’s notes should more fully explain the recommended change and rationale for the change. Recommendation should be supported by at least one outside scholarly source (not the textbook or course lesson).
Factors Influencing Change: slide should identify at least 2 internal and external factors that could impact your ability to implement your recommended change. Speaker’s notes should more fully explain how the factors you’ve identified would support or impede the implementation of your recommendations. Factors may be based on personal experience or on information you found in your research. If the identified factors come from the literature, provide reference citations to support your ideas.
NONPF Competencies: slide identifies at least two NONPF Competencies that are relevant to an evidence-based project related to your area of interest. Speaker’s notes should explain how the competencies relate to your area of interest. Provide support from at least one outside scholarly source (not the textbook or course lesson).
Conclusion: slide provides summary points of presentation. Speaker’s notes provide final comments on the topic.
 Preparing the presentation
Submission Requirements
Application: Use Microsoft Power Point™ to create the PowerPoint presentation. 
Length: The PowerPoint presentation must be 8-12 total slides (excluding title and reference slides).  
Speaker notes are used and include in-text citations when applicable.
A minimum of four (4) scholarly literature references must be used.
Submission: Submit your file: Last name_First initial_Wk6Assessment_Area of Interest.
 Best Practices in Preparing the Project
The following are best practices in preparing this project:
Review directions thoroughly.
Follow submission requirements.
Make sure all elements on the grading rubric are included.
Rules of grammar, spelling, word usage, and punctuation are followed and consistent with formal, scientific writing.
Review the Creating a Professional Presentation located resource. 
Ideas and information that come from scholarly literature must be cited and referenced correctly.

Categories
Nursing

Submit a written documentation of the abnormal findings of the respiratory syste

Submit a written documentation of the abnormal findings of the respiratory system in this patient scenario:
74-year-old Male presented to the nurse clinic with the complaints of “cough” x 2 weeks. On examination, the nurse did not notice any swelling or deformity on the chest wall but while auscultating the lungs, she noticed a high-pitched whistling sound made while the patient was breathing out.