Category: Nursing

Illness or Disorder: Tubal pregnancy Essay

Epidemiology

Definition
: Tubal pregnancy is a type of ectopic pregnancy in which the developing fetus becomes rooted in a site other than the endometrium of the uterus. The fallopian tube, which accounts for 96 percent of all ectopic pregnancies, is the most prevalent extrauterine site. (Tulandi, 2020b) Tubal pregnancy

Essay.

Demographics
:  The incidence of tubal pregnancies has varied significantly through time and patient populations. Recent studies have described a rate of tubal pregnancies at 20.7 per 1000 pregnancies. An increase in prevalence seems to correlate with an increase in age: 15 to 19 years (2.8 per 1000), 20 to 24 (4.4), 25 to 29 (7.4), 35 to 39 (9.9), and 40 to 44 (9.8). Tubal pregnancies can affect women of all different races, ethnicities, and ages Tubal pregnancy Essay. However, there is a notable higher prevalence in African American patients compared to White patients where African American patients had a 1.5-fold risk compared with White patients (Tulandi, 2020b).

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Causative agent
: It is commonly accepted that the etiology of tubal pregnancies is the result of conditions that delay or inhibit the passage of the fertilized oocyte into the uterine cavity or due to embryo-inherent factors that result in premature implantation. Several recent studies of tubal pregnancies have discovered various factors that may influence implantation which include the following: chronic  salpingitis, salpingitis isthmica nodosa, varying depths of implantation of the gestational sac in the fallopian tubes, serum or extracellular factors such as lectin, integrin, matrix-degrading cumulus, prostaglandins, growth factors, cytokines, and modulator proteins may cause premature implantation in the tube, and lastly embryonic/chromosomal abnormalities (Tulandi, 2020b).

Risk Factors & Exposures
: There are many risk factors for tubal pregnancy. Prior tubal pregnancy and a history of tubal surgery are the highest risk factors for tubal pregnancy. Other risk factors include pelvic inflammatory diseases such as nonspecific salpingitis, chlamydia, and gonorrhea in which all can lead to scarring of the fallopian tubes, endometriosis, intrauterine devices, infertility, and in vitro fertilization (Green, 2019). Smoking during the period before conception is associated with a higher risk of tubal pregnancy. A history of smoking is associated with a two- to threefold increase in the risk of tubal pregnancy, and a two- to fourfold risk is associated with current use. The reasoning for this is that smoking may impair tubal motility or impair immunity, thus predisposing the patient to pelvic inflammatory disease. Tubal pregnancy Essay Lastly, regular vaginal douching has a three times greater risk of tubal pregnancy as well as increase age. There is an associated increased risk for tubal pregnancies as the patient ages (Tulandi, 2020b).

Time Course

Duration
: Acute

 

Pattern or Prodrome of Symptoms
:  First-trimester vaginal bleeding and/or abdominal pain is the most common clinical presentation of tubal pregnancy. Tubal pregnancy can also be asymptomatic. Clinical manifestations of tubal pregnancy characteristically appear six to eight weeks after the last normal menstrual period but can occur later. Tubal pregnancy Essay Normal pregnancy discomforts such as breast tenderness, frequent urination, and nausea are sometimes present. A tubal pregnancy can be unruptured or ruptured at the time the patient seeks care. Tubal rupture can lead to life-threatening intra-abdominal bleeding. Rupture may present with severe or persistent abdominal pain or symptoms suggestive of hypovolemia/shock due to blood loss (Tulandi, 2020a) Tubal pregnancy Essay.

Clinical Presentation with Classic S&S

Key & Differentiating Features
: Signs and Symptoms suggestive of tubal pregnancy: Vaginal bleeding and/or abdominal pain early in pregnancy, typically weeks six to eight, along with a positive pregnancy test.

Vaginal bleeding and abdominal pain are the two most common features of a tubal pregnancy. Vaginal bleeding is present, but the volume and pattern of vaginal bleeding varies. Bleeding may range from light brown staining to profuse bleeding. Bleeding can occur as a single incident or it can be continuous, however, it is usually intermittent. Vaginal bleeding that occurs with tubal pregnancy is stereotypically led by amenorrhea. Abdominal pain also varies with timing, character, and severity of the pain. Abdominal pain is usually described as continuous or intermittent that is described as dull or sharp. The pain also ranges from mild to severe. The pain usually presents in the pelvis region or lower abdomen that may be diffuse or contained to one side of the lower abdomen. The onset of abdominal pain typically presents anywhere between five and seven weeks of pregnancy. Tubal rupture may be accompanied with sudden onset of severe pain (Tulandi, 2020a).

Must Have Features
: A positive pregnancy test. Visualization of an extrauterine (fallopian tube) gestational sac with a yolk sac or embryo on a transvaginal ultrasound. A positive serum human chorionic gonadotropin (hCG) and no products of conception on uterine aspiration with subsequent rising hCG (rises <35 percent every two days across three different measurements) or plateauing hCG levels. If patient is hemodynamically unstable, visualization during surgery with histologic confirmation of tubal pregnancy (Tulandi, 2020a). Rejecting Features : Negative serologic pregnancy test. Transvaginal ultrasound showing no evidence of extrauterine gestational sac with a yolk sac or embryo. Transvaginal ultrasound showing evidence of intrauterine pregnancy. A positive serum hCG with products of conception from uterine aspiration with subsequent rising hCG levels (hCG levels rising greater than or equal to 35 percent). In normal early intrauterine pregnancies hCG levels will rise by at least 35 percent every two days (Tulandi, 2020a) Tubal pregnancy Essay. Mechanism of Disease Process Pathophysiology : Tubal pregnancy is the implantation of an embryo within the fallopian tube which is outside of the uterus. Through smooth muscle contraction and ciliary beat, the fallopian tubes facilitate the transport of an oocyte and embryo. Tubal dysfunction occurs when there is damage or injury to the fallopian tubes, usually due to inflammation, which then results in retention of an oocyte or embryo. Inflammation is caused by several local factors, such as toxic, infectious, immunologic, and hormonal. As inflammation persists there is then upregulation of pro-inflammatory cytokines following tubal damage. This then promotes embryo implantation, invasion, and angiogenesis within the fallopian tube. Infection from Chlamydia trachomatis causes an inflammatory response which results in the production of interleukin 1 by tubal epithelial cells. This happens to be a crucial factor for embryo implantation within the endometrium. Interleukin 1 also has a part in downstream neutrophil recruitment which further contributes to fallopian tubal injury. Cilia beat function is destroyed by smoking and infection. Hormonal alterations during the menstrual cycle has also proven effects on cilia beat function in which all can cause oocyte and embryo retention. The retained embryo tries to grow and develop within the small space of the fallopian tube which ultimately leads to a nonviable pregnancy and possible tubal rupture (Mummert & Gnugnoli, 2020). Diagnostic Test(s) & Findings Transvaginal ultrasound imaging is fundamental in diagnosing suspected tubal pregnancy. Serial testing with transvaginal imaging and serum hCG level measurements are both required to confirm the diagnosis (Tulandi, 2020a). Transvaginal ultrasound results: Performed at the time of presentation of a suspected tubal pregnancy. Findings to confirm diagnosis of tubal pregnancy would include visualization of an extrauterine, in this case within the fallopian tube, gestational sac with a yolk sac or embryo (Tulandi, 2020a). Serum hCG measurements: Serum hCG is measured serially, typically every 48 to 72 hours, to determine whether the change is consistent with a normal or an abnormal pregnancy. Diagnosis of tubal pregnancy cannot be confirmed by a single hCG measurement. A positive serum hCG and no products of conception on uterine aspiration with subsequent rising hCG (hCG that rises <35 percent every two days across three different measurements) or plateauing or decreasing hCG levels can help confirm ectopic pregnancy along with transvaginal ultrasound findings (Tulandi, 2020a) Tubal pregnancy Essay.   References Green, K. (2019). Assessment of the pregnant woman. In H.A. Carcio & R.M. Secor (Eds.), Advanced health assessment of women: Clinical skills and procedures (4th ed., pp. 119-148). Springer. Mummert, T., & Gnugnoli, D.M. (2020). Ectopic pregnancy. StatPearls . Retrieved November 12, 2020 from https://www.ncbi.nlm.nih.gov/books/NBK539860/Tubal pregnancy Essay Tulandi, T. (2020a). Ectopic pregnancy: Clinical manifestations and diagnosis. UpToDate. Retrieved November 12, 2020 from https://www.uptodate.com/contents/ectopic-pregnancy-clinical-manifestations-and-diagnosis?search=tubal%20pregnancy&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1 Tulandi, T. (2020b). Ectopic pregnancy: Epidemiology, risk factors, and anatomic sites. UpToDate . Retrieved November 12, 2020 from https://www.uptodate.com/contents/ectopic-pregnancy-epidemiology-risk-factors-and-anatomic-sites?search=tubal%20pregnancy&source=search_result&selectedTitle=3~150&usage_type=default&display_rank=3#H3 (Links to an external site Tubal pregnancy Essay.)

NRS-451 HealthCare Organizations Essay

Research a health care organization or network that spans several states with in the United States (United Healthcare, Vanguard, Banner Health, etc.). Assess the readiness of the health care organization or network you chose in regard to meeting the health care needs of citizens in the next decade.

Prepare a 1,000-1,250 word NRS-451 HealthCare Organizations Essay paper that presents your assessment and proposes a strategic plan to ensure readiness. Include the following:

Describe the health care organization or network.

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Describe the organization’s overall readiness based on your findings.

Prepare a strategic plan to address issues pertaining to network growth, nurse staffing, resource management, and patient satisfaction.

Identify any current or potential issues within the organizational culture and discuss how these issues may affect aspects of the strategic plan.

Propose a theory or model that could be used to support implementation of the strategic plan for this organization. Explain why this theory or model is best.

Prepare this NRS-451 HealthCare Organizations Essay assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required

 

NRS-451, Health Care Organizations

Introduction

Organizational leadership and management play a major role in meeting the healthcare needs of American citizens. The demographics within the US are constantly changing, as well as the changing diversity of patients’ needs (Salmond & Echevarria, 2017). Therefore, strategic planning is necessary for the healthcare organizations within the US, to ensure that the future health needs of populations are met. This NRS-451 HealthCare Organizations Essay paper provides an analysis regarding the ability of Hospital Corporation of America (HCA) to meet consumer needs. Additionally, the strategic plan for HCA will be provided.

Description of the Organization

HCA is a for-profit healthcare-management organization within the US, that was established in 1968. The organization was privatized in 1989 and in 1990 it acquired over 130 acute-care and mental hospitals, located within the US (Stinnett & Wrather, 2018). HCA headquarters is at Nashville, Tennessee and currently, it owns and operates approximately 186 hospitals and about 2,000 care sites, which include urgent care centers, clinics, and surgical centers within the 21 American states, and the UK. HCA is among the largest hospital-management organizations within the US in providing healthcare services. It provides healthcare clinics, surgical centers, outpatient care, among other different healthcare facilities. Even though HCA provides traditional care services, it has been a pioneer in the fast-growing hospital-management and for-profit medical-services industry; therefore, HCA has attained a strong international presence. The organization was privatized in 1989 and in 1990 it acquired over 130 acute-care and mental hospitals, located within the US (Stinnett & Wrather, 2018).

The Readiness of HCA to meet Health Care Needs

The American healthcare industry is typified by increasingly high healthcare costs, and also the country’s populations are becoming sicker with chronic diseases, due to the longer life expectancy (Raghupathi & Raghupathi, 2018). To be able to meet healthcare needs, the organization has invested in various healthcare services to support its consumers. For example, the organization has heavily invested in acute care services, nursing homes, as well as in the mental healthcare industry. Additionally, the organization continues to invest heavily in the education of healthcare professionals and leadership programs for its workers and affiliates. HCA employs about 280,000 staff members, who include 98,000 nurses and 47,000 physicians (Paulson, 2020). HCA healthcare professionals are qualified and have the required competencies and skills to provide high-quality and safe care. This makes HCA an organization of choice for Americans when they seek healthcare services.

Strategic Plan

Growth

The growth of any organization is based on its financial strength, the competency of its personnel, reputation, as well as the uniqueness of its product offering. For a long time, HCA has been financially strong and this has put the organization at a competitive organization. The organizational personnel is also a strong component as the organization employs competent healthcare organizations. HCA also offers its workers competitive salaries and has a profit-sharing model, an aspect that has consistently motivated the personnel. The business strategy of being among the leading healthcare services providers within the healthcare industry facilitates the personnel elements since the HCA facilities remain appealing employment preferred locations to healthcare providers
.
The uniqueness of HCA’s product offerings as well as its reputation on quality services have significantly contributed to its continuous growth. The organization has also invested heavily in health education and continues to expand its operations in different locations. Accordingly, HCA should continue to invest heavily in employing the most competent healthcare providers and in technology to provide healthcare to more consumers effectively and efficiently. The organization should also continue expanding its operations in various locations to reach wider populations.

Resource Management

Management of resources at HCA is decentralized and thus each organizational administrator develops and manages its own budget, establishes individual pricing systems, and determines the services to provide. The organization headquarters uses a computerized digital monitoring system to evaluate and measure each hospital’s efficiency regarding the other healthcare organizations in the HCA network. Inefficiencies can then be addressed fast and promptly while allowing specific healthcare organizations to function independently. NRS-451 HealthCare Organizations Essay HCA needs to continue using the decentralized system to manage its resources and operations, and at the same time involve the corporate personnel to manage its resources (Liwanag & Wyss, 2018).

Staffing

HCA employs about 280,000 staff members, who include 98,000 nurses and 47,000 physicians. The organization’s personnel is qualified with the required skills and competency to provide high-quality services
(
Paulson, 2020). However, recently the organization has experienced a shortage of nursing staff. To address the shortage, the organization has invested heavily in healthcare education programs to ensure the supply of healthcare practitioners within the healthcare industry. HCA needs to continue employing qualified personnel, provide educational opportunities to healthcare professionals, and also recruit more nursing staff to address the shortage of nurses in the organization.

Patient Satisfaction

HCA provides high-quality care services and patient-centered care to ensure patient satisfaction. HCA facilities have skilled nurses and specialist doctors who are highly coordinated and provide high-quality care to improve the patient experience. HCA needs to continue investing in strategies aimed to improve patient satisfaction, such as providing personalized care, ensuring cultural competency among healthcare providers, and investing in technologies that enhance the patient experience (Berkowitz, 2016).

Issues in the Organizational Culture

The culture at HCA prioritizes the needs of patients and embraces diversity, teamwork, and collaboration. The organization also priorities the provision of high-quality care. To continue leading the healthcare industry, the organization needs to cultivate a culture of innovation, collaborative practice, and research. The organizational management should continue supporting its employees to ensure a shared vision towards achieving the organizational goals.

Theory to Support the Strategic Plan

Roger’s innovation diffusion theory can be very helpful during the implementation of the strategic plan. According to the theory, the five phases of implementing proposed changes include “knowledge, persuasion, decision, implementation, and finally confirmation.” The theory is thus suitable to implement the strategic plan because the “knowledge” phase has been addressed already (Mohammadi et al., 2018). The next step should be persuading and convincing suitable stakeholders to support strategic plans. After analyzing the benefits and shortcomings of the proposed strategic plan a decision should be arrived at to implement the strategic plan NRS-451 HealthCare Organizations Essay.

NRS-451 HealthCare Organizations Essay Conclusion

HCA was established in 1968 and it operates various facilities within the US and UK. Since, its inception, the organization has invested heavily in acquiring various healthcare organizations. Currently, the organization employs about 280,000 staff members. To maintain the leading position in the healthcare industry, HCA needs to continue expanding its operations, employing competent healthcare practitioners, supporting its personnel, and recruiting more nurses to address the shortage of nursing staff.

 

 

References

Berkowitz, B. (2016). The patient experience and patient satisfaction: measurement of a complex dynamic.
The Online Journal of Issues in Nursing
,
21
(1).

Liwanag, H. J., & Wyss, K. (2018). What conditions enable decentralization to improve the health system? Qualitative analysis of perspectives on decision space after 25 years of devolution in the Philippines.
PLoS One
,
13
(11), e0206809.

Mohammadi, M. M., Poursaberi, R., & Salahshoor, M. R. (2018). Evaluating the adoption of evidence-based
practice
using Rogers’s diffusion of innovation theory: a model testing study.
Health promotion perspectives
,
8
(1), 25–32 NRS-451 HealthCare Organizations Essay.

Paulson D. (2020).
HCA Healthcare celebrates workers with a virtual concert, ‘With Gratitude’
. Nashville Tennessean.

Raghupathi, W., & Raghupathi, V. (2018). An Empirical Study of Chronic Diseases in the United States: A Visual Analytics Approach.
International journal of environmental research and public health
,
15
(3), 431.
https://doi.org/10.3390/ijerph15030431

Salmond, S. W., & Echevarria, M. (2017). Healthcare Transformation and Changing Roles for Nursing.
Orthopedic nursing
,
36
(1), 12–25.

Stinnett J & Wrather M. (2018). Timeline: How HCA grew from a startup into a behemoth.
Nashville Business Journal
, 1(1). NRS-451 HealthCare Organizations
Essay

For this Identification of Healthcare Policy Concern assignment, the student must first select a healthcare policy concern. The concern must be a community-based, public health policy concern. Student may not use healthcare entities or organizational concerns occurring within a private or public healthcare facility. Scholarly evidence supporting the concern must be presented that provides a comprehensive picture of the selected healthcare concern as well as the student-identified solution. The elected official whom the student will interview is also identified in this paper.

Criteria for Content

Overview of healthcare policy: This section introduces healthcare policy. It should contain the following elements:
Define healthcare policy in general and its implications for the nursing profession
Define the role of advocacy and how it can impact healthcare policy
Explain how the role of advocacy is consistent with the responsibilities of an advance practice nurse
Identification of selected healthcare policy concern: This section provides foundational information regarding the student-selected healthcare policy concern. It should contain the following elements:
Specifically identify the selected healthcare policy concern
Description of the impacted population group
Provide a comprehensive description of the selected healthcare concern by including:
How frequently does it occur? Identification of Healthcare Policy Concern
What impact does the selected healthcare concern have upon the community and population group?
Description of student-identified solution to the selected healthcare concern: This section presents a comprehensive picture of the student-selected solution to the selected healthcare concern. It should contain the following elements:
Identify, with specific detail, the solution to the student-selected healthcare concern
Identify the following areas:

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What would be the positive outcome if the solution was implemented?
What changes would need to occur in the community to foster implementation?
What changes would need to occur in the population group to foster implementation?
What measureable actions will demonstrate a positive outcome if the solution was implemented?
What might be 2 (two) challenges to implementing the proposed solution and how can each of these challenges be avoided or resolved?
Identification of elected official: This section identifies the elected official that the student will present the selected healthcare concern and its solution to. It should contain the following elements:
The name of the elected official Identification of Healthcare Policy Concern
The position of the elected official
Explanation of why this individual was selected
Conclusion: This section provides a comprehensive and concise review of the key elements of the assignment.
Preparing the Assignment

Criteria for Format and Special Instructions

The paper (excluding the title page and reference page) should be at least 6, but no more than 10 pages. Points will be lost for not meeting these length requirements.
Title page, body of paper, and reference page must follow APA guidelines as found in the current edition of the manual. This includes the use of headings for each section of the paper except for the introduction where no heading is used.
A minimum of 6 (six) appropriate research-based scholarly references must be used of which 2 may be empirical evidence from state and county website data… (Check with your instructor regarding .org or .gov sites). Required textbook for this course, dictionary and Chamberlain College of Nursing lesson information may NOT be used as scholarly references for this assignment. For additional assistance regarding scholarly nursing references, please see the course Library Guide. Be aware that information from .com websites may be incorrect and should be avoided. References are current – within a 5-year time frame unless a valid rationale is provided and the instructor has approved them prior to submission of the assignment.
Ideas and information from scholarly, peer reviewed, nursing sources must be cited must be cited within the text of the paper as well as appearing in the reference list with correct APA format.
Rules of grammar, spelling, word usage, and punctuation are followed and consistent with formal, scientific writing.
This assignment must be submitted to TurnItInâ„¢ (TII) as required by the TurnItInâ„¢ policy. To allow sufficient time for revision, early submission of the assignment to TurnItInâ„¢ is highly encouraged. The final submission will be graded by faculty. If a TurnItinâ„¢ report indicates that plagiarism has occurred, the Academic Integrity policy will be followed.
Rubric
W2 HealthCare Policy Concern (NOV18)
W2 HealthCare Policy Concern (NOV18)
Criteria Ratings Pts
This criterion is linked to a Learning OutcomeOverview of Healthcare Policy
20 pts
Presentation of information was exceptional and included all the following elements: • Define healthcare policy in general and its implications for the nursing profession • Define the role of advocacy and how it can impact healthcare policy • Explain how the role of advocacy is consistent with the responsibilities of an advance practice nurse
18 pts
Presentation of information was good, but was superficial in places and included all the following elements: • Define healthcare policy in general and its implications for the nursing profession • Define the role of advocacy and how it can impact healthcare policy • Explain how the role of advocacy is consistent with the responsibilities of an advance practice nurse
16 pts
Presentation of information was minimally demonstrated in the all the following elements: • Define healthcare policy in general and its implications for the nursing profession • Define the role of advocacy and how it can impact healthcare policy • Explain how the role of advocacy is consistent with the responsibilities of an advance practice nurse
8 pts
Presentation of information in one of the following elements fails to meet expectations: • Define healthcare policy in general and its implications for the nursing profession • Define the role of advocacy and how it can impact healthcare policy • Explain how the role of advocacy is consistent with the responsibilities of an advance practice nurse
0 pts
Presentation of information is unsatisfactory in two or more of the following elements: • Define healthcare policy in general and its implications for the nursing profession • Define the role of advocacy and how it can impact healthcare policy • Explain how the role of advocacy is consistent with the responsibilities of an advance practice nurse
20 pts
This criterion is linked to a Learning OutcomeIdentification of Selected Healthcare Policy Concern
60 pts
Presentation of information was exceptional and included all the following elements: • Specifically identify the selected healthcare concern • Description of the impacted population group • Provide a comprehensive description of the selected healthcare concern by including: o How frequently does it occur? o What impact does the selected healthcare concern have upon the community and population group?
53 pts
Presentation of information was good, but was superficial in places and included all the following elements: • Specifically identify the selected healthcare concern • Description of the impacted population group • Provide a comprehensive description of the selected healthcare concern by including: o How frequently does it occur? o What impact does the selected healthcare concern have upon the community and population group?
48 pts
Presentation of information was minimally demonstrated in the all of the following elements: • Specifically identify the selected healthcare concern • Description of the impacted population group • Provide a comprehensive description of the selected healthcare concern by including: o How frequently does it occur? o What impact does the selected healthcare concern have upon the community and population group?
23 pts
Presentation of information in one of the following elements fails to meet expectations: • Specifically identify the selected healthcare concern • Description of the impacted population group • Provide a comprehensive description of the selected healthcare concern by including: o How frequently does it occur? o What impact does the selected healthcare concern have upon the community and population group?
0 pts
Presentation of information is unsatisfactory in two or more of the following elements: • Specifically identify the selected healthcare concern • Description of the impacted population group • Provide a comprehensive description of the selected healthcare concern by including: o How frequently does it occur? o What impact does the selected healthcare concern have upon the community and population group?
60 pts
This criterion is linked to a Learning OutcomeDescription of Student-identified Solution to the Selected Healthcare Policy Concern
70 pts
Presentation of information was exceptional and included all the following elements: • Identify, with specific detail, the solution to the student-selected healthcare concern • Identify the following areas: o What would be the positive outcome if the solution was implemented? o What changes would need to occur in the community to foster implementation? o What changes would need to occur in the population group to foster implementation? o What measureable actions will demonstrate a positive outcome if the solution was implemented? o What might be 2 (two) challenges to implementing the proposed solution and how can each of these challenges be avoided or resolved?
62 pts
Presentation of information was good, but was superficial in places and included all the following elements: • Identify, with specific detail, the solution to the student-selected healthcare concern • Identify the following areas: o What would be the positive outcome if the solution was implemented? o What changes would need to occur in the community to foster implementation? o What changes would need to occur in the population group to foster implementation? o What measureable actions will demonstrate a positive outcome if the solution was implemented? o What might be 2 (two) challenges to implementing the proposed solution and how can each of these challenges be avoided or resolved?
56 pts
Presentation of information was minimally demonstrated in the all the following elements: • Identify, with specific detail, the solution to the student-selected healthcare concern • Identify the following areas: o What would be the positive outcome if the solution was implemented? o What changes would need to occur in the community to foster implementation? o What changes would need to occur in the population group to foster implementation? o What measureable actions will demonstrate a positive outcome if the solution was implemented? o What might be 2 (two) challenges to implementing the proposed solution and how can each of these challenges be avoided or resolved?
27 pts
Presentation of information in one of the following elements fails to meet expectations: • Identify, with specific detail, the solution to the student-selected healthcare concern • Identify the following areas: o What would be the positive outcome if the solution was implemented? o What changes would need to occur in the community to foster implementation? o What changes would need to occur in the population group to foster implementation? o What measureable actions will demonstrate a positive outcome if the solution was implemented? o What might be 2 (two) challenges to implementing the proposed solution and how can each of these challenges be avoided or resolved?
0 pts
Presentation of information is unsatisfactory in two or more of the following elements: • Identify, with specific detail, the solution to the student-selected healthcare concern • Identify the following areas: o What would be the positive outcome if the solution was implemented? o What changes would need to occur in the community to foster implementation? o What changes would need to occur in the population group to foster implementation? o What measureable actions will demonstrate a positive outcome if the solution was implemented? o What might be 2 (two) challenges to implementing the proposed solution and how can each of these challenges be avoided or resolved
70 pts Identification of Healthcare Policy Concern
This criterion is linked to a Learning OutcomeIdentification of Elected Official
30 pts
Presentation of information was exceptional and included all the following elements: • The name of the elected official • The position of the elected official • Explanation of why this individual was selected
26 pts
Presentation of information was good, but was superficial in places and included all the following elements: • The name of the elected official • The position of the elected official • Explanation of why this individual was selected
24 pts
Presentation of information was minimally demonstrated in the all the following elements: • The name of the elected official • The position of the elected official • Explanation of why this individual was selected
11 pts
Presentation of information in one of the following elements fails to meet expectations: • The name of the elected official • The position of the elected official • Explanation of why this individual was selected
0 pts
Presentation of information is unsatisfactory in two or more of the following elements: • The name of the elected official • The position of the elected official • Explanation of why this individual was selected
30 pts
This criterion is linked to a Learning OutcomeConclusion
25 pts
Presentation of information was exceptional and included all the following element: Provides a summary of key elements from the assignment
22 pts
Presentation of information was good, but was superficial in places and included all the following element: Provides a summary of key elements from the assignment
20 pts
Presentation of information was minimally demonstrated in the all the following element: Provides a summary of key elements from the assignment
10 pts
Presentation of information in one of the following elements fails to meet expectations: Provides a summary of key elements from the assignment
0 pts
Presentation of information is unsatisfactory: Provides a summary of key elements from the assignment
25 pts
This criterion is linked to a Learning OutcomePaper Specifications
15 pts
This section included all of the following: Paper meets length requirements of 6 to 10 pages. Minimum of 6 (six) appropriate research scholarly nursing references A dictionary, required textbook for this course and Chamberlain College of Nursing lesson information, may NOT be used as scholarly references for this assignment. References are current – within a 5-year time frame unless a valid rationale is provided and the instructor has approved them prior to assignment submission.
13 pts
This section included three of the following: Paper meets length requirements of 6 to 10 pages. Minimum of 6 (six) appropriate research scholarly nursing references A dictionary, required textbook for this course and Chamberlain College of Nursing lesson information, may NOT be used as scholarly references for this assignment. References are current – within a 5-year time frame unless a valid rationale is provided and the instructor has approved them prior to assignment submission.
12 pts
This section included only two of the following: Paper meets length requirements of 6 to 10 pages. Minimum of 6 (six) appropriate research scholarly nursing references A dictionary, required textbook for this course and Chamberlain College of Nursing lesson information, may NOT be used as scholarly references for this assignment. References are current – within a 5-year time frame unless a valid rationale is provided and the instructor has approved them prior to assignment submission.
6 pts
This section included only one of the following: Paper meets length requirements of 6 to 10 pages. Minimum of 6 (six) appropriate research scholarly nursing references A dictionary, required textbook for this course and Chamberlain College of Nursing lesson information, may NOT be used as scholarly references for this assignment. References are current – within a 5-year time frame unless a valid rationale is provided and the instructor has approved them prior to assignment submission.
0 pts
This section included none of the following: Paper meets length requirements of 6 to 10 pages. Minimum of 6 (six) appropriate research scholarly nursing references A dictionary, required textbook for this course and Chamberlain College of Nursing lesson information, may NOT be used as scholarly references for this assignment. References are current – within a 5-year time frame unless a valid rationale is provided and the instructor has approved them prior to assignment submission.
15 pts
This criterion is linked to a Learning OutcomeAPA Format
10 pts
APA guidelines, as per the 6th edition of the manual, are demonstrated for the • title page, • running head, • body of paper (including citations and headings), and reference page One deduction for each type of APA format error 0 to 1 APA error was present
9 pts

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APA guidelines, as per the 6th edition of the manual, are demonstrated for the • title page, • running head, • body of paper (including citations and headings), and reference page One deduction for each type of APA format error 2 – 3 APA errors were present
8 pts
APA guidelines, as per the 6th edition of the manual, are demonstrated for the • title page, • running head, • body of paper (including citations and headings), and reference page One deduction for each type of APA format error 4 – 5 APA were are present
4 pts
APA guidelines, as per the 6th edition of the manual, are demonstrated for the • title page, • running head, • body of paper (including citations and headings), and reference page One deduction for each type of APA format error 6 – 7 APA were are present
0 pts
APA guidelines, as per the 6th edition of the manual, are demonstrated for the • title page, • running head, body of paper (including citations and headings), and reference page One deduction for each type of APA format error 8 or greater APA errors were present
10 pts
This criterion is linked to a Learning OutcomeCitations in Text
10 pts
There were 0-1 errors in the crediting of ideas, and information that contributed to knowledge
9 pts
There were 2-3 errors in the crediting of ideas, and information that contributed to knowledge
8 pts
There were 4-5 errors in the crediting of ideas, and information that contributed to knowledge
4 pts
There were 6-7 errors in the crediting of ideas, and information that contributed to knowledge
0 pts Identification of Healthcare Policy Concern
There were 8 or greater errors in the crediting of ideas, and information that contributed to knowledge
10 pts
This criterion is linked to a Learning OutcomeWriting Mechanics
10 pts
1–2 errors or exceptions to the rules of grammar, spelling, word usage, punctuation and other aspects of formal written work as found in the 6th edition of the APA manual
9 pts
3 – 4 errors or exceptions to the rules of grammar, spelling, word usage, punctuation and other aspects of formal written work as found in the 6th edition of the APA manual
8 pts
5 – 6 errors or exceptions to the rules of grammar, spelling, word usage, punctuation and other aspects of formal written work as found in the 6th edition of the APA manual
4 pts
7 – 8 errors or exceptions to the rules of grammar, spelling, word usage, punctuation and other aspects of formal written work as found in the 6th edition of the APA manual
0 pts
9 or greater errors or exceptions to the rules of grammar, spelling, word usage, punctuation and other aspects of formal written work as found in the 6th edition of the APA manual
10 pts
This criterion is linked to a Learning OutcomeLate Deductions
0 pts
0 pts lost – submission met deadline
0 pts
Student does not meet the deadline for submission 10% per day up to 30% total (3-days)
0 pts
Total Points: 250 Identification of Healthcare Policy Concern

NRNP 6540 Week 5 Case Assignment – 
Case Title:

A 67-year-old With Tachycardia and Coughing

Ms. Jones is a 67-year-old female who is brought to your office today by her daughter Susan. Ms. Jones lives with her daughter and is able to perform all activities of daily living (ADLs) independently. Her daughter reports that her mother’s heart rate has been quite elevated, and she has been coughing a lot over the last 2 days. Ms. Jones has a 30-pack per year history of smoking cigarettes but quit smoking 3 years ago. Other known history includes chronic obstructive pulmonary disease (COPD), hypertension, vitamin D deficiency, and hyperlipidemia Case Title: A 67-year-old With Tachycardia and Coughing. She also reports some complaints of intermittent pain/cramping in her bilateral lower extremities when walking, and has to stop walking at times for the pain to subside. She also reports some pain to the left side of her back, and some pain with aspiration.

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Ms. Jones reports she has been coughing a lot lately, and notices some thick, brown-tinged sputum. She states she has COPD and has been using her albuterol inhaler more than usual. She says it helps her “get the cold up.” Her legs feel tired but denies any worsening shortness of breath. She admits that she has some weakness and fatigue but is still able to carry out her daily routine. Case Title: A 67-year-old With Tachycardia and Coughing

Vital Signs: 99.2, 126/78, 96, RR 22

Labs: Complete Metabolic Panel and CBC done and were within normal limits

CMP Component

Value

CBC Component

Value

Glucose, Serum

86 mg/dL

White blood cell count

5.0 x 10E3/uL

BUN

17 mg/dL

RBC

4.71 x10E6/uL

Creatinine, Serum

0.63 mg/dL

Hemoglobin

10.9 g/dL

EGFR

120 mL/min

Hematocrit

36.4%

Sodium, Serum

141 mmol/L

Mean Corpuscular Volume

79 fL

Potassium, Serum

4.0 mmol/L

Mean Corpus HgB

28.9 pg

Chloride, Serum

100 mmol/L

Mean Corpus HgB Conc

32.5 g/dL

Carbon Dioxide

26 mmol/L

RBC Distribution Width

12.3%

Calcium

8.7 mg/dL

Platelet Count

178 x 10E3/uL

Protein, Total, Serum

6.0 g/dL

 

 

Albumin

4.8 g/dL

 

 

Globulin

2.4 g/dL

 

 

Bilirubin

1.0 mg/dL

 

 

AST

17 IU/L

 

 

ALT

15 IU/L

 

 

 

Allergies: Penicillin

Current Medications:

Atorvastatin 40mg p.o. daily

Multivitamin 1 tablet daily

Losartan 50mg p.o. daily

ProAir HFA 90mcg 2 puffs q4–6 hrs. prn

Caltrate 600mg+ D3 1 tablet daily

Diagnosis: Pneumonia

Directions:
Answer the following 10 questions directly on this template.

Question 1: What findings would you expect to be reported or seen on her chest x-ray results, given the diagnosis of pneumonia? Case Title: A 67-year-old With Tachycardia and Coughing

Question 2: Define further what type of pneumonia Ms. Jones has, HAP (hospital-acquired pneumonia) or CAP (community-acquired pneumonia)? What’s the difference/criteria?

Question 3:

3A) What assessment tool should be used to determine the severity of pneumonia and treatment options?

3B) Based on Ms. Jones’ subjective and objective findings, apply that tool and elaborate on each clinical factor for this patient.

Question 4: Ms. Jones was diagnosed with left lower lobe pneumonia. What would your treatment be for her based on her diagnosis, case scenario, and evidence-based guidelines?

Question 5: Ms. Jones has a known history of COPD. What is the gold standard for measuring airflow limitation?

Question 6: Ms. Jones mentions intermittent pain in her bilateral legs when walking and having to rest to stop the leg pain/cramps. Which choice below would be the best choice for a potential diagnosis for
this
? Explain your reasoning. Case Title: A 67-year-old With Tachycardia and Coughing

DVT (Deep Vein Thrombosis)

Intermittent Claudication

Cellulitis

Electrolyte Imbalance

Question 7: Ms. Jones mentions intermittent pain in her bilateral legs when walking and having to rest to stop the leg pain. What test could be ordered to further evaluate this?

Question 8: Name three (3) differentials for Ms. Jones’ initial presentation.

Question 9: What patient education would you give Ms. Jones and her daughter? What would be your follow-up instructions?

Question 10: Would amoxicillin/clavulanate plus a macrolide have been an option to treat Ms. Jones’ Pneumonia? Explain why or why not.

 

 

67-year-old with Tachycardia & Cough

Question 1: Expected Findings on Chest X-Ray Results,

The presence of white infiltrates in the lungs may be seen on an x-ray, which can be utilized to confirm the infection.

Question 2: Type of Pneumonia Ms. Jones has

Mr. Jones is suffering from community-acquired pneumonia. CAP is contracted outside of a clinical environment (Poovieng et al., 2022). As far as we know, Ms. Jones did not contract the illness from the hospital or care facility. As such, her type of pneumonia cannot be hospital-acquired pneumonia.

Question 3A: Assessment Tool Used to Determine the Severity of Pneumonia and Treatment Options

A CURB-65 calculator is an assessment tool that can be used to determine the severity of a person’s community-acquired pneumonia. This tool gives points for confusion and blood urea nitrogen, which is an older patient who is severely sick might be caused by a number of different things.

Question 3B: Application of the Assessment tool Based on Subjective and Objective Findings

CURB-65 stands for confusion, uremia, respiratory rate, BP, age 65 and over (Ilg et al., 2018). It is evident that Ms. Jones understands her symptoms and is not confused; her BUN level is 17 mg/dl; she has an RRR of 22; her systolic pressure is 126; she’s 67 years old. The CURB-65 score for Ms. Jones is 1, which suggests that she should receive outpatient treatment.

Question 4: Treatment Based On Diagnosis, Case Scenario, and Evidence-Based Guidelines

Levofloxacin 750 mg PO daily for five days would be my recommendation for Ms. Jones, given her history of penicillin allergy and the intensity of her condition. For intermittent claudication, I would also prescribe 100 mg of cilostazol PO twice a day. Case Title: A 67-year-old With Tachycardia and Coughing

Question 5: Gold Standard for Measuring Airflow Limitation

Spirometry is necessary for Ms. Jones due to her history of COPD. Spirometry is the standard method for confirming the presence of COPD and determining the best course of therapy (Global Initiative for Chronic Obstructive Lung Disease, 2020).

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Question 6: Best Choice for a Potential Diagnosis

Intermittent claudication is a possible diagnosis in this case. The most prevalent cause of intermittent claudication is a peripheral atherosclerotic artery, which causes leg pain while exerted and alleviates it when resting. Symptom progress has not been provided in the case study. If the symptoms progress quickly, they are probably not caused by atherosclerosis but rather by a nonatherosclerotic claudication etiology like atherothrombosis and arteritis (Patel, S & Surowiec, 2021).

Question 7: Test to Evaluate Intermittent Pain in Bilateral Legs

The ideal test would be the Ankle-brachial index (ABI). The blood pressure in the arm and ankle are compared during this sort of testing. An arterial blockage or obstruction may be present if there is any discrepancy between the two measurements (Herraiz-Adillo et al., 2020).

Question 8: Three Differentials for Ms. Jones’ Initial Presentation

COPD exacerbation, Cardiogenic Pulmonary Edema, and Influenza

Question 9: Patient Education and Follow-Up Instructions

The patient and her daughter should be taught that unvaccinated individuals, particularly those with concomitant conditions like hypertension and COPD, are at an increased risk of developing life-threatening pneumonia (Seo et al., 2020). The patient should be instructed to drink lots of fluids, cough many times a day, and do deep breathing exercises.

There should be a follow-up appointment within the next two to three weeks. If the cough becomes more severe, the patient should contact a healthcare practitioner. Similarly, if the patient’s legs continue to hurt, she should see the doctor.

Question
10
: Would amoxicillin/clavulanate plus a macrolide have been an option to treat Ms. Jones’ Pneumonia?

The patient may be prescribed amoxicillin/clavulanate together with a macrolide regardless of her comorbid conditions. Because of its ability to increase mucociliary clearance and minimize the inflammatory reaction, this combination has been recommended to enhance health outcomes (Ito et al., 2019). Case Title: A 67-year-old With Tachycardia and Coughing

 

 

References

Global Initiative for Chronic Obstructive Lung Disease. (2020). GOLD spirometry guide. 

GOLD Spirometry Guide

Herraiz-Adillo, Á., Cavero-Redondo, I., Álvarez-Bueno, C., Pozuelo-Carrascosa, D. P., & Solera-Martínez, M. (2020). The accuracy of toe brachial index and ankle brachial index in the diagnosis of lower limb peripheral arterial disease: A systematic review and meta-analysis. 
Atherosclerosis
, 
315
, 81-92. 
https://doi.org/10.1016/j.atherosclerosis.2020.09.026

Ilg, A., Moskowitz, A., Konanki, V., Patel, P., Chase, M., Grossestreuer, A., & Donnino, M. (2018). 1054: Performance of curb-65 in predicting critical care interventions in patients with pneumonia. Critical Care Medicine, 46(1), 511-511. 
https://doi.org/10.1097/01.ccm.0000529060.29903.34

Ito, A., Ishida, T., Tachibana, H., Tokumasu, H., Yamazaki, A., & Washio, Y. (2019). Azithromycin combination therapy for community-acquired pneumonia: propensity score analysis. Scientific Report, 9(18406). 
https://doi.org/10.1038/s41598-019-54922-4

Patel, S. K., & Surowiec, S. M. (2021). Intermittent claudication. In 
StatPearls [Internet]
. StatPearls Publishing. Case Title: A 67-year-old With Tachycardia and Coughing

Poovieng, J., Sakboonyarat, B., & Nasomsong, W. (2022). Bacterial etiology and mortality rate in community-acquired pneumonia, healthcare-associated pneumonia and hospital-acquired pneumonia in Thai
university
hospital. 
Scientific Reports
, 
12
(1). 
https://doi.org/10.1038/s41598-022-12904-z

Seo, W. J., Kang, J., Kang, H. K., Park, S. H., Koo, H., Park, H. K., Lee, S., Song, J. E., Kwak, Y. G., & Kang, J. (2022). Impact of prior vaccination on clinical outcomes of patients with COVID-19. 
Emerging Microbes & Infections
, 
11
(1), 1316-1324. 
https://doi.org/10.1080/22221751.2022.2069516
  Case Title: A 67-year-old With Tachycardia and Coughing

Summative 4: Literature Search-How does spirituality play a vital role in labor and delivery?

 

Summative 4: Literature Search

 

How does spirituality play a vital role in 
labor and delivery
?

 

 

Find
5 studies to support the research question you developed in Week 1. You must include quantitative and qualitative evidence for this assignment.

 

Write
a 700- to 1,050-word literature review that includes the following:

An overview of each study in which you discuss:

Research method, design, concepts or variables, sample, data collection, and data analysis

The major conclusions from each study

A discussion of how the conclusions of each study relates to your proposal topic

A synthesis of the information from the studies

A discussion of how you would use the literature you gathered to support your research question

A summary of any additional information that is needed from the literature

Summative 4: Literature Search-How does spirituality play a vital role in labor and delivery?

 

Format
your assignment according to APA guidelines, including title and reference pages.

 

 

Top of Form

 

Summative 4: Literature Search

 

How does spirituality play a vital role in 
labor and delivery
?

 

 

Find
5 studies to support the research question you developed in Week 1. You must include quantitative and qualitative evidence for this assignment.

 

Write
a 700- to 1,050-word literature review that includes the following:

An overview of each study in which you discuss:

Research method, design, concepts or variables, sample, data collection, and data analysis

The major conclusions from each study

A discussion of how the conclusions of each study relates to your proposal topic

A synthesis of the information from the studies

A discussion of how you would use the literature you gathered to support your research question

A summary of any additional information that is needed from the literature

 

Format
your assignment according to APA guidelines, including title and reference pages. Summative 4: Literature Search-How does spirituality play a vital role in labor and delivery?

Case of the Sweaty Salesman

This week’s topic is: The Case of the Sweaty SalesmanMichael is a thirty-year-old salesman who spends approximately 4 days each week traveling to visit with customers in his region. During his routine physical he casually mentions to his physician that he seems to be sweating more profusely than normal and most rooms that once were comfortable are now too ”hot”. He thought that it was simply due to the change in seasons and companies being slow to turn down the thermostats from the winter temperatures, however, this problem seems to persist even when he is at home. A room that his wife and children find to be comfortable causes him to sweat profusely. Michael also reports that he seems to be losing weight even though his appetite has increased. He also complains that he has a shortened attention span and that he always wants to be moving around. Despite the fact that he feels fatigued, Michael claims to have difficulty sleeping and seems to have more frequent bowel movements, occasionally accompanied by diarrhea. The physician checks Michael’s medical history and finds that indeed he has lost 15 pounds since his last physical. Wanting to rule out the possibility of infection with the human immunodeficiency virus (HIV), the physician asks Michael questions about his sexual history and practices and finds that he is not at risk for HIV infection. Also in checking his chart, the physician finds that Michael has a negative history for chronic illnesses, does not smoke, and has a low risk for cardiovascular disease. He does, however, have a positive family history for autoimmune diseases. His father suffers from idiopathic thrombocytopenia, his mother has been diagnosed with rheumatoid arthritis and his oldest sister was recently diagnosed with systemic lupus erythematosus. Results of Michael’s physical examination were within normal ranges with the exception of the following: he demonstrated tachycardia, loud heart sounds, and apparent cardiac arrhythmia accompanied by slight hypertension. The arrhythmia was confirmed by the electrocardiogram to be supra-ventricular in origin. Michael’s eyeballs appeared large and protruding and his hair was fine and soft. He was also beginning to demonstrate some degree of alopecia. Michael was also observed to have palmar erythema. Palpation of the neck revealed the presence of goiter. Results of blood tests indicated elevated concentrations of thyroid hormones (thyroxin and triiodothyronine),hypercalcemia, and decreased circulating concentrations of lipids. Based on the physical characteristics and the results of the blood tests, Michael’s physician suspected that Michael was suffering from some form of hyperthyroidism and sent him to an endocrinologist to confirm the initial diagnosis Case of the Sweaty Salesman. Following the initial consultation and examination, the endocrinologist ordered tests to determine whether Michael was indeed hyperthyroid. The test results indicated an elevation in the concentration of thyroid hormones in the blood and the presence of thyroid-stimulating antibodies. These antibodies specifically stimulate the thyroid gland by binding with the thyroid-stimulating hormone receptor located on the plasma membrane of the follicular cells of the thyroid gland. Based on these results, the endocrinologist concluded that Michael had Grave’s disease, a form of hyperthyroidism believed to be autoimmune in nature. Michael was presented with a number of possible treatment options. These included treatment with chemicals (propylthiouracil and methimazole) that decrease the production of thyroid hormones by the thyroid gland, radio-isotopic destruction of the thyroid gland by the use of 131I, and surgical removal of the thyroid gland. After considering all the options, especially the possible effects of radiation on gamete development, Michael chose surgery.  Following successful surgery, Michael was prescribed synthetic thyroid hormone to ensure that his body was receiving adequate thyroid hormone and told to return within 2 months for a follow-up evaluation of circulating thyroid hormone concentrations. He was also cautioned to carefully monitor his calcium intake. Using the the terms covered this week
answer
the following questions about this case: Why would an imbalance in thyroid hormones have such a widespread effect on the body? Why was goiter observed in Michael’s case? Given that Michael and his wife may want to have more children, why was radio-isotopic, for the destruction of the thyroid gland, ruled out? Case of the Sweaty Salesman

NURS 6501 Module 2 Knowledge Check

Module 2 Knowledge Check

NURS 6501 Module 2 Knowledge Check – Question 1

Scenario 1: Myocardial Infarction

CC:I woke up this morning at 6 a.m. with numbness in my left arm and pain in my chest. It feels tight right here (mid-sternal).My dad had a heart attack when he was 56-years-old and I am scared because I am 56-years-old.  NURS 6501 Module 2 Knowledge Check.

HPI: Patient is a 56-year-old Caucasian male who presents to Express Hospital  Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states this started this morning and has been getting worse, pointing to the mid-sternal area, it feels like an elephant is sitting on my chest and having a hard time breathing. He rates the pain as 9/10. NURS 6501 Module 2 Knowledge Check Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, or lightheadedness. Nitroglycerin 0.4 mg tablet sublingual x 1 which decreased pain to 7/10.

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Lipid panel reveals Total Cholesterol 424 mg/dl, high density lipoprotein (HDL) 26 mg/dl, Low Density Lipoprotein (LDL) 166 mg/dl, Triglycerides 702 mg/dl, Very Low-Density Lipoprotein (VLDL) 64 mg/dl

His diagnosis is an acute inferior wall myocardial infarction.

Question: Which cholesterol is considered the good cholesterol and what does it do?

According to the CDC, HDL is regarded as the good cholesterol as it takes up cholesterol in the blood and transports it back to the liver and is removed from the body. HDL also plays a role in anti-inflammatory anti-atherosclerotic and endothelial protective effects. It promotes RCT which is an anti-atherogenic outcome of HDL which promotes the breakdown of atherosclerotic lesions (Kosmas et al., 2018). HDL also prevents endothelial dysfunction and cell death by tumor necrosis factor-alpha and ox-LDL. Therefore high levels of HDL reduce the risk of stroke or heart disease.

NURS 6501 Module 2 Knowledge Check – Question 2

Scenario 1: Myocardial Infarction

CC:I woke up this morning at 6 a.m. with numbness in my left arm and pain in my chest. It feels tight right here (mid-sternal).My dad had a heart attack when he was 56-years-old and I am scared because I am 56-years-old.

HPI: Patient is a 56-year-old Caucasian male who presents to Express Hospital  Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states this started this morning and has been getting worse, pointing to the mid-sternal area, it feels like an elephant is sitting on my chest and having a hard time breathing. He rates the pain as 9/10. Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, or lightheadedness. Nitroglycerin 0.4 mg tablet sublingual x 1 which decreased pain to 7/10.

Lipid panel reveals Total Cholesterol 424 mg/dl, high density lipoprotein (HDL) 26 mg/dl, Low Density Lipoprotein (LDL) 166 mg/dl, Triglycerides 702 mg/dl, Very Low-Density Lipoprotein (VLDL) 64 mg/dl

His diagnosis is an acute inferior wall myocardial infarction.

Question: How does inflammation contribute to the development of atherosclerosis?

Atherosclerosis primarily occurs via a repeated process of arterial wall lesions secondary to lipid retention in the intima layer by a matrix that includes proteoglycans leading to modification which as a result aggravates chronic inflammation at the vulnerable sites in the artery and plays a crucial role in the atherogenic progression phases (Pahwa & Ishwarlal Jialal, 2021) NURS 6501 Module 2 Knowledge Check. The immune and non-immune cells cause plague formation via the interplay of inflammatory mediators. Without removal of the underlying risk factor, the inflammatory process persists leading to chronic non-resolving inflammation.

Question 3

A 35-year-old female with a positive history of systemic lupus erythematosus (SLE) presents to the Emergency Room (ER) with complaints of sharp retrosternal chest pain that worsens with deep breathing or lying down. She reports a 5-day history of low-grade fever, listlessness and says she feels like she had the flu. Physical exam reveals tachycardia and a pleural friction rub. She was diagnosed with acute pericarditis.

Question: Because of the result of a pleural friction rub, what does the APRN recognize?

Pleural friction rub is often brought about by the pleural disease which is as a result of the movement of roughened and inflamed pleural surfaces against each other during movement of the chest wall. The pleural friction rub described as a grating sound and is heard on both inspiration and expiration (Adderley & Sharma, 2021). On palpation, the examiner might pick up a sandpaper-rubbing type of sensation. It is often accompanied by sudden, sharp intense pain that worsens with inspiration.

 

NURS 6501 Module 2 Knowledge Check – Question 4

Scenario 4: Deep Venous Thrombosis (DVT) A 81-year-old obese female patient who 48 hours post-op left total hip replacement. The patient has had severe nausea and vomiting and has been unable to go to physical therapy. Her mucus membranes are dry. NURS 6501 Module 2 Knowledge Check The patient says the skin on her left leg is too tight. Exam reveals a swollen, tense, and red colored calf. The patient has a duplex ultrasound which reveals the presence of a deep venous thrombosis (DVT).

Question: Given the history of the patient explain what contributed to the development of a deep venous thrombosis (DVT)

The risk factors of DVT are classified under Virchow’s triad which consists of; hypercoagulability, stasis, and endothelial injury. If a patient has either of the mentioned risks there is an activation of the clotting cascade together with aggregation of blood cells particularly the platelets to form a thrombus (Waheed et al., 2021). As a result, there is partial or complete occlusion of the vein resulting in venous stasis lymphedema, and likely ischemia to the surrounding tissue. Some of the risk factors the patient has include; recent surgery intervention dehydration from nausea and vomiting and being obese.

Question 5

Scenario 5:  COPD A 66-year-old female with a 50 pack/year history of cigarette smoking had a CT scan and was diagnosed with emphysema.  He asks if this means he has chronic obstructive pulmonary disease (COPD).

Question: There is a clear relationship between emphysema and COPD, explain the pathophysiology of emphysema and the relationship to COPD

Emphysema is a disease that primarily involves the air spaces to the terminal bronchiole. It is caused by chronic and significant exposure to noxious gases from cigarettes biomass fuels, sulfur dioxide, and others. The inhalation of noxious substances results in the accumulation of inflammatory cells including cytokines and proteases which is directly responsible for tissue remodeling and destruction which eventually complicates to COPD (Parul Pahal et al., 2022). NURS 6501 Module 2 Knowledge Check Chronic obstructive lung disease is characterized by limitation of airflow due to exposure to harmful substances. It is associated with structural changes in the lung secondary to chronic inflammation which leads to narrowing of the airway and reduced lung recoil.

 

References

‌Adderley, N., & Sharma, S. (2021, July 31). 
Pleural Friction Rub
. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK537118/

Kosmas, C. E., Martinez, I., Sourlas, A., Bouza, K. V., Campos, F. N., Torres, V., Montan, P. D., & Guzman, E. (2018). High-density lipoprotein (HDL) functionality and its relevance to atherosclerotic cardiovascular disease. 
Drugs in Context
, 
7
, 1–9. https://doi.org/10.7573/dic.212525

‌ Pahwa, R., & Ishwarlal Jialal. (2021, September 28). 
Atherosclerosis
. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK507799/

‌ Parul Pahal, Akshay Avula, & Sharma, S. (2022, May 8). 
Emphysema
. Nih.gov; StatPearls Publishing.
https://www.ncbi.nlm.nih.gov/books/NBK482217/

Waheed, S. M., Pujitha Kudaravalli, & Hotwagner, D. T. (2021, August 11). 
Deep Vein Thrombosis
. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK507708/ NURS 6501 Module 2 Knowledge Check

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

A 70-year-old male patient presented to your clinic with complaint of a wet cough for 2 weeks. Confirms fever, mild dyspnea on exertion, chills, tachycardia, and chest congestion. Describes cough as reproductive with clear to yellow sputum. Medical history of Nicotine dependence, 30 years, 1PPD. 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 practitioner

What differential diagnosis would you consider as the nurse practitioner seeing this patient?

 

Case overview

A 70 years old male patient presents with a productive cough with clear to yellow sputum. The cough is associated with fever, chills, dyspnea on exertion, chest pain, and tachycardia. The patient has 30 pack years of nicotine dependence. On examination, he has tachypnea and shallow breathing with crackles in the lung fields.

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The five questions I would ask to elicit about the patient’s symptoms

What is the duration of the cough?

How often do you cough?

What time of the day is your cough worst?

Have the symptoms affected your daily activities?

Have you noticed body weight changes?

The duration, frequency, and timing of the cough help determine the intensity of the disease. For example, the duration, frequency, and timing of the cough in obstructive pulmonary disease and rhinitis are different. COPD presents with a chronic cough over more than two years, the cough may persist throughout the day, and it is worse at night (Obling, et al, 2022). Rhinitis presents with a cough of acute onset, short-lived and triggered by cold air or dust. Effect of the cough of daily activities and body weight changes also determines the diagnosis. A 70-year-old male patient presented to your clinic with complaint of a wet cough

Physical findings (3) in the respiratory examination that will concern me as a nurse practitioner

As a nurse practitioner, I would get worried if the patient presents with severe respiratory, distress, cyanosis, and diminished air entry sounds.

Differential diagnosis

Chronic obstructive pulmonary disease

Bacterial pneumonia

Pulmonary tuberculosis

Chronic obstructive pulmonary disease COPD is a superimposed disease comprising of chronic bronchitis and emphysema. It is common in male patients over the age of 40years with a positive history of smoking. The symptoms of COPD are productive cough, dyspnea, fever, chest pain, chest tightness, sputum production clear and yellow, fatigue, frequent respiratory infections, swollen ankle and feet, and congestion (Obling,
et al,
2022). The physical findings include respiratory distress, wheezing, thin barrel chest, hyper-resonant chest, and cyanosis.

Bacteria pneumonia is an infection of the lungs caused by streptococcus pneumonia. It is common in the elderly patients, pediatrics, and immunosuppression. Clinical presentation of bacterial pneumonia are fever, tachypnea, use of accessory muscles for respiration, tachycardia, rhonchi, coarse crackles, and decreased intensity of breath sounds. The patient has similar symptoms except dyspnea on exertion. A 70-year-old male patient presented to your clinic with complaint of a wet cough

Pulmonary embolism is a lodged blood clot in the pulmonary artery blocking blood flow in the lungs. Clinical presentations for pulmonary embolism are fever, productive cough, dyspnea on exertion, seizures, tachypnea, tachycardia, and murmurs. Risk
factors
for pulmonary embolism are obesity, smoking, coronary heart disease, surgery, and immobilization.

 
References

Obling, N., Rangelov, B., Backer, V., Hurst, J. R., & Bodtger, U. (2022). Upper airway symptoms and small airways disease in Chronic Obstructive Pulmonary Disease, COPD. 
Respiratory medicine
, 
191
, 106710. A 70-year-old male patient presented to your clinic with complaint of a wet cough

Nursing practicum objectives example

Assignment 1: Practicum ObjectivesThis course includes a 160-hour practicum as part of the clinical hours that are required for the DNP credential. The Practicum Experience enables you to explore key issues related to your specialty practice and to refine your leadership skills as you work with others at your practicum site. To guide you through your Nursing practicum objectives example practicum hours, you will develop practicum objectives.  Photo Credit: Artur / Adobe Stock To PrepareReview the Practicum Journal Document.Begin to think about learning objectives that would guide your practicum hours, as well as the activities you will undertake to achieve those objectives. Refer to the DNP Essentials and your specialty competencies to inform your development of the learning objectives.Note: You are required to keep a log of the time you spend related to your practicum experience. You can access your time log from the Welcome page in your Meditrek account. Please be sure to continuously input your hours throughout the term. Time logs are reviewed by your Instructors in Weeks 3, 7, and 11.  The Assignment: (1–2 pages)List your practicum objectives that you have identified. The number of practicum objectives will vary based on your practicum experience.Describe key activities associated with your practicum objectives. Be specific. You will have an opportunity to resubmit your practicum objectives, after Faculty feedback, in Week 2. Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Walden Writing Center Sample Paper provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting.

 

Assignment 1: Practicum Objectives

Practicum objectives are often confused with practicum goals. Although the latter relates to the former, practicum goals are broad statements of an expected practicum outcome of a course. They provide a future vision and summarize the subject area and intent of other related practicum objectives.  In comparison, learners draw practicum objectives from the practicum goals. Nursing practicum objectives example As guiding statements for every practicum encounter, they connect the learners’ intent with   the reality within the practicum experience as well as to planned assessments (Yusuff, 2018).

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In this paper, the author identifies the practicum objectives for her practicum experience and describes the key activities that will be associated with each objective. The author identified content areas that the nurse faculty expects DNP learners to learn by the end of the course, and used it as the best strategy to identify the practicum objectives. At DNP level, practicum objectives describe what a DNP learner must be able to do upon completion of the practicum experience (Chatterjee & Corral, 2017). A good practicum objective clearly highlights the skills, knowledge, and attitude that a learner will gain from an activity and must answer how well or how much, who, what, when, and will do, using the SMART mnemonic.

Practicum Objectives

Upon completion of the difficult airway workshop, participants should be able to formulate an accurate algorithm for the management of an obese adult patient with inadequate face mask ventilation, according to the American Society of Anesthesiologists difficult airway algorithm Nursing practicum objectives example.”

Objective 1:
To obtain knowledge and practical home health experience by researching about policies within the context of Homecare Nursing upon completion of the practicum experience

Objective 2:
To obtain knowledge on the services that are available within the community to support greater independence, improve outcomes, and reduce readmissions of patients undergoing homebased care.

Objective 3:
Upon completion of the practicum experience, I shall develop skills in working with interdisciplinary teams in the Home Healthcare Setting and conducting high quality assessments and consultations with patients and families to help them achieve their goals.

Objective 4:
To network  with  other  family nurse practitioners in  the home health setting to advance knowledge and improve outcomes in the management of patients with multimorbid conditions receiving homebased care upon completion  of the practicum experience

Key Activities Associated with Practicum Objectives

Objective 1:
To obtain knowledge and practical home health experience by researching about policies within the context of Homecare Nursing upon completion of the practicum experience

Take advantage of opportunities to be part of  development  meetings, training sessions and learning opportunities  that focus on homecare nursing

Gain insights into the history of Homecare nursing  and how  Medicaid/Medicare  has implemented  new
strategies
for  improved care and efficiency Nursing practicum objectives example

Objective 2:
To obtain knowledge on the services that are available within the community to support greater independence, improve outcomes, and reduce readmissions of patients undergoing homebased care.

search and link up with community based services that support homecare nursing/homebased care

refer/link patients and families with  community based resources that support  homebased care

Objective 3:
Upon completion of the practicum experience, I shall develop skills in working with interdisciplinary teams in the Home Healthcare Setting and conducting high quality assessments and consultations with patients and families to help them achieve their goals.

Integrate newly discovered knowledge or information in every patient or family encounter

Develop communication skills through active listening, Nursing practicum objectives example and exercising situational awareness when working  with  patients, families and other healthcare providers

Conduct consultations with families and  patients to help them attain success and

Objective 4:
To network  with  other  family nurse practitioners in  the home health setting to advance knowledge and improve outcomes in the management of patients with multimorbid conditions receiving homebased care

Every month, attend one conference to network with other FNPs specializing in home healthcare.

 

References

Chatterjee, D., & Corral, J. (2017). How to Write Well-Defined Learning Objectives. 
The journal of education in perioperative medicine : JEPM
, 
19
(4), E610 Nursing practicum objectives example.

Yusuff K. B. (2018). Does personalized goal setting and study planning improve academic performance and perception of learning experience in a developing setting?. 
Journal of Taibah University Medical Sciences
, 
13
(3), 232–237. https://doi.org/10.1016/j.jtumed.2018.02.001 Nursing practicum objectives example

Nursing Education Practicum Documentation (NEPD) Goals Form Example

Assessment Description

The “Nursing Education Practicum Documentation (NEPD) Forms” provide weekly, competency-based documentation of clinical practicum activities and are utilized by learners to communicate practicum experiences to course faculty. Be sure to read the instructions on the form for information on how to complete the assignment before you begin.

 

In your first NEPD form, complete the “Overall Practicum Goals (Week 1)” section of the “Nursing Education Practicum Documentation (NEPD) Goals Form” by writing the overall goals (S.M.A.R.T goals or objectives) for your practicum. You will re-address these goals in the second part of the form during Topic 16 to evaluate if they have been met.

 

When completing the “Nursing Education Practicum Documentation (NEPD) Goals Form,” use the S.M.A.R.T. goal format to write goals you have for your overall practicum experience. Consider what you want to accomplish during this practicum experience. Keep your goals broad enough to cover everything that you would like to accomplish during your practicum experience. You may choose to focus on a specific aspect of nursing education or may choose to sample a variety of nursing education experiences within your selected practicum experience.

 

APA format is not required, but solid academic writing is expected Nursing Education Practicum Documentation (NEPD) Goals Form Example.

 

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 not required to submit this assignment to LopesWrite.

 

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Nursing Education Practicum

Goal 1

 S:
To form a rapport with my students and other nurse instructors

M:  
Success will be measured by assessing the quality of interaction I have with my students and other nurse instructors, and my ability to address each student by their name.

A:
I can achieve this goal in the process of learning and practice.

R:
Communication skills are important for a nurse. Effective communication allows the passing of information between colleagues and patients, which is central in providing health services (Kim, 2018). Furthermore, it allows the creation of working relationships that allow collaboration during learning and patient care.  Furthermore, it allows the creation of working relationships allowing the collaboration of personnel during patient care.

T:
I hope to achieve this by the end of week 2 of the course.

Goal 2

S:
To help the students obtain effective listening skills.

M:
Success will be measured by evaluating the ability of students to obtain a detailed patient history during the patient assessment.

A:
I can achieve this goal during the practical sessions.

R:
Listening skills are central to patient care. They enable one to attain a comprehensive history from the patient while picking out the most important aspects that influence the course of presenting illness and treatment Nursing Education Practicum Documentation (NEPD) Goals Form Example.

T:
I hope to achieve this by week 2.

Goal 3

S:
To teach the students skills of ethical judgment

M:
This will be assessed by constantly evaluating the clinical decisions students make during patient care to ensure that they are morally sound.

A:
I believe I can achieve this in the course of the practicum.

R:
Nursing ethics are the principles guiding the decision-making processes involved during patient care (Subedi, 2018). They ensure that nurses make moral decisions for the benefit of the patients.

T:
I hope to achieve this by the end of week 4.

Goal 4

S:
To help students develop effective time management skills.

M:
The success will be measured by assessing the time taken by students to effectively care for a patient and noting improvements on the same.

A:
I can achieve this in the course of the practicum.

R:
Time management allows one to effectively manage their specific roles through organizing and prioritizing the patient’s needs and care, personal obligations, and educational responsibilities (Lucas, 2019). Furthermore, it limits burnout and increases productivity among healthcare workers.

T:
I hope to achieve this by the end of week 6.

Goal 5

S:
To teach students the legal aspects of patient care such as gaining consent and respecting patient autonomy.

M:
Success will be measured by assessing for active patient involvement and the implementation of their opinions as students conduct their practical’s.

A:
  I can attain this in the course of the practicum.

R:
Patients have a right to decide on the course of their treatment without influence by the healthcare workers. Nurses have a duty to respect the patient wishes. It is the patients’ legal right to decide whether to accept or refuse treatment. Additionally, nurses are obligated to explain any procedures in detail, including the advantages and disadvantages (Subedi, 2018). It is also paramount to obtain informed consent from a patient before performing any medical procedures.

T:
I hope to achieve this by the end of week 6 of the practicum.

 

 

 

References

Kim, G. U., Jung, E., Cho, M., Han, S. Y., Jang, M., Lee, M., & Shim, M. S. (2019). Revisiting the meaning of a good nurse. The Open Nursing Journal, 13(1).

Lucas, B. (2019). Developing the personal qualities required for effective nurse leadership. Nursing Standard, 34(12), 45-50.

Subedi, K. K. P., Timalsina, K., & Bhele, R. L. (2018). Nurse’s awareness on ethico-legal aspects of nursing profession. Journal of Nepal Health Research Council, 16(1), 49-52.

 

Nursing Education Practicum Documentation (NEPD)

Goals Form

NUR-665E Nursing Education Practicum – Weeks 1 and 16

Directions:
Complete the documentation form. The form will expand for as long as you type. You will be submitting this document in both Week 1 and Week 16. The top section is due Week 1 and the bottom section is due Week 16.

 

Overall Practicum Goals (Week 1)

Overall Practicum Goals:
Use the S.M.A.R.T. goal format to create goals you have for your overall practicum experience. Be sure your goals are specific, measurable, achievable, relevant, and time bound (S.M.A.R.T. goals). Type your five practicum goals in the space below. Consider what you want to accomplish during this practicum course. You may choose to focus in on a specific aspect of nursing education or a variety of nursing education experiences within your selected practicum setting and population. Review these goals with your preceptor/mentor prior to submission or as soon as possible.

1.

 

 

2.

 

 

3.

 

 

4.

 

 

5.

 

 

 

Evaluation of Overall Practicum Goals
(
Week 16
)

Review the goals you wrote in Week 1 and write a reflection for each one of them. Include whether or not you met your goals and provide some detail about the process.

 

1.

 

 

2.

 

 

3.

 

 

4.

 

 

5.

 

 

 

 

Example S.M.A.R.T. Goals:

Delete this example page prior to submitting this assignment.

S:
I will develop a learning needs questionnaire and administer it to my students to assess their learning needs regarding my lesson plan topic.

M:
My success with this goal will be measured by my preceptor/mentor’s review/critique of my questionnaire, discussion of the results obtained, and self-reflection on the process and results

A:
I can attain this goal during my practicum.

R:
Learning needs are relevant to developing the lesson plan for students at my practicum site.

T:
I will achieve this goal by X date.