Tag: Clinical-Nursing

Individual Assignment EBP Implementation Project Plan on your PICOT Question

Module #4: Individual Assignment

EBP Implementation Project Plan on your PICOT Question

INSTRUCTIONS

Complete
the assignment, using this
Word file
as a worksheet.
Type
your answers directly on this sheet. Use APA style for the reference list and include citations to support your work ideas or plans for each question.

QUESTIONS

The objective of this assignment is to guide you in creating a plan to implement an evidence-based practice (EBP) quality improvement (QI) project based on your PICOT questions.

Instructions:

State your PICOT question (this should be the revised version of your question after incorporating feedback from previous assignments).

Answer the following questions (limit your answers to 250-300 words per question):

What initial steps can be implemented to garner support from the administration and other key stakeholders regarding the need for practice change proposed by your PICOT question?

Describe how you would engage leadership, interdisciplinary teams, and other stakeholders.

Identify potential barriers and describe ways to address them.

What steps can be performed prior to implementing the practice change? (20 pts)

Identify preparatory actions such as conducting a needs assessment, reviewing current policies, securing resources, education/training needs, pilot/small scale testing.

How will you incorporate patient preferences and clinical expertise in your project?

How does your proposed QI project (for your PICOT question) address the Quadruple Aim of Healthcare?

How can the practice change be sustained over time? Individual Assignment EBP Implementation Project Plan on your PICOT Question

Discuss methods to ensure long-term success, such as ongoing training, integrating the change into policies and procedures, and monitoring outcomes.

Consider strategies for continuous quality improvement (CQI), stakeholder feedback, and period evaluation.

 
References

SUBMITTING YOUR ASSIGNMENT

SAVE THIS WORD FILE

with your responses as a PDF

SUBMIT
the completed document via Canvas, under the Assignments tab

 

GRADES

Submissions will be graded according to the specific assignment rubric.

In addition, the following point deductions will apply: five points for each day after the submission deadline. No work will be accepted beyond one week after the original due date.

 

Individual Assignment EBP Implementation Project Plan on your PICOT Question 

Module #4: Individual Assignment

The Revised PICOT Question

The revised PICOT question is; “In adult patients diagnosed with hypertension (P), how does implementing a combination of patient education and home blood pressure monitoring (I) compared to standard hypertension management without these interventions (C) improve blood pressure control and reduce complications (O) over 6 months (T)”

Question Two

Initial Steps for Acquiring Administration’s Support, Engagement Strategies, and Potential Barriers

Implementing some initial can trigger key stakeholders to support practice change recommended by the PICOT question. The first step involves identifying the clinical issue of priority. A clear explanation of the problem being addressed with the proposed PICOT question and its potential adverse outcomes should be presented to the key stakeholders, including the administration. In this case, stakeholders should be informed about current ineffective measures for managing blood pressure among individuals diagnosed with hypertension and potential health complications. Research shows that ineffective management of hypertension exposes patients to potential health complications, including cardiovascular diseases (Lak et al., 2024). The second step is developing a clear evidence-based (EB) rationale supporting the recommended practice change. Research shows that a multi-approach combining patient education and home blood pressure monitoring enhances hypertension management, resulting in a desired blood pressure level (Heshmat-Ghahdarijani et al., 2022) Individual Assignment EBP Implementation Project Plan on your PICOT Question . Therefore, incorporating patient education and home blood pressure monitoring into patient hypertension management care would lower blood pressure and reduce the risk of potential health complications. Consequently, stakeholders would support recommended practice change to enhance hypertension management; thereby preventing potential adverse treatment outcomes.

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Engaging stakeholders would enhance the implementation of the proposed change. First, one can engage leadership by identifying relevant top leaders, including heads of departments affected by ineffective hypertension management care. These top leaders will provide significant inputs needed during change implementation. Moreover, interdisciplinary teams, including physicians, registered nurses, specialists, pharmacists, and nurse practitioners can be engaged by fostering collaboration. Organizing workshops, meetings, or focus groups would enable interdisciplinary teams to discuss the impact of the proposed change in hypertension management on their day-to-day operations. The last group of stakeholders who should be engaged during the implementation of practice change are patients and their families. These stakeholders are at the center of the practice change since they will actively participate in patient education and monitoring blood pressure at home.

           
The first barrier to successful implementation of practice change is resistance to change. Staff members are usually resistant to change due to discomfort associated with new practices, including additional training. This issue can be addressed by informing staff members about the benefits of the recommended change in open communication, making them willing to implement new hypertension management measures. Another potential barrier is communication gaps. Effective communication with key stakeholders leads to the successful implementation of practice change within clinical settings (Metz & Bartley, 2020). Communication gaps can be resolved by introducing multiple communication channels, including newsletters, memos, and regular meetings; thereby informing stakeholders about the progress.

Pre-Implementation Steps

           
The first pre-implementation step is conducting a needs assessment. It involves identifying the clinical issue being addressed by implementing practice change. A gap in the current hypertension management care can be identified by gathering baseline data through stakeholder feedback, interviews, data analysis, or surveys. In this case, the number of hypertension-related hospital admissions or health complications can be used as the baseline data that will be used to evaluate the current state of hypertension management. The second step reviewing current practices. Current procedures and protocols related to hypertension management will be reviewed in this second step. Besides, inconsistencies or gaps that might compromise the implementation of the new hypertension management protocol are identified. Step three involves securing all necessary resources. For instance, financial resources needed for the practice change are gathered in this phase. Besides, this step involves ensuring the availability of all human resources that would contribute to a successful practice change and their willingness to participate in the change implementation Individual Assignment EBP Implementation Project Plan on your PICOT Question .

Additionally, the fourth pre-implementation step involves evaluating education and training needs. Staff members’ knowledge gap that might hinder the change implementation is identified and addressed through training sessions. Step five involves communicating with all key stakeholders regularly throughout the preparatory phase via multiple forums. Regular communication keeps them updated about the change project’s objectives, progress, and expected outcomes. A detailed implementation timeline is developed in step six. It should include significant milestones and deadlines for every activity. The last pre-implementation step involves establishing a clear evaluation criterion. The incidence of hypertension-related complications can be used as the outcome measure for assessing the effectiveness of the practice change.

Incorporating clinical expertise and patient preferences in the EBP project

Incorporating clinical expertise and patient preferences into the proposed practice change for enhancing hypertension management care would result in desired patient/clinical treatment outcomes.

Patient preferences would lead to better treatment outcomes by creating personalized care plans, which would encourage patients to actively participate in blood pressure management and adhere to the recommended treatment plan. The first step of incorporating patient preferences into the practice change project involves assessing patient preferences. This vital information would be collected by administering surveys or questionnaires to patients, conducting patient interviews, and adopting a shared decision-making model that allows patients to influence decisions regarding their treatment interventions. The second step involves developing patient-tailored treatment plans. Research shows that designing personalized medication plans based on patients’ preferences enhanced medication adherence in individuals receiving long-term treatments for chronic illnesses (Menditto et al., 2020). Thus, patients would adhere to the treatment regimens if their preferences were incorporated into their patient-centric plans. The last step involves collecting feedback regarding patients’ side effects, progress, and satisfaction with the current treatment plan regularly.

Additionally, integrating clinical expertise with practice change projects would optimize patient treatment outcomes through the utilization of current clinical guidelines for hypertension management. For instance, utilizing guidelines recommended by the “American Heart Association” (AHA) would ensure that the patient’s hypertension management care plan is designed based on the latest clinical protocols (Abdalla et al., 2023). Consequently, desired blood pressure levels would be achieved, lowering the risk of potential health complications. Moreover, considering clinical expertise would improve treatment through interdisciplinary collaboration. Clinical experts from multiple disciplines, including nurses, dietitians, pharmacists, and exercise physiologists would work together in developing a comprehensive hypertension management plan, lowering blood pressure levels.

The Connection Between Hypertension Management Care Plan and the Quadruple Aim of Healthcare

The Quadruple Aim targets four significant objectives, including patient experience, cost-effectiveness, population health, and healthcare provider well-being. The recommended EB hypertension management care plan addressed these four objectives.

First, the care plan focuses on improving patient experience. A better patient experience is achieved by designing patient-centered care that incorporates patient preferences. Hence, patients feel valued, respected, and understood once the recommended treatment intervention incorporates their preferences, values, and cultural factors. Besides, designing a personalized treatment intervention based on patient input and clinical evidence makes individual patients feel empowered to actively participate in their recovery journey, thereby boosting their overall experience.

Secondly, the hypertension management care plan can improve population health. This goal is achieved by designing a patient-centered care plan that would effectively lower an individual’s blood pressure level, thereby preventing hypertension-related health complications, such as heart disease, kidney failure, and stroke (Alrashed et al., 2024). Lowering the risk of these comorbidities leads to better population health outcomes. Additionally, the hypertension management care plan includes an education program, which would create awareness among community members. Consequently, individuals would check their blood pressure regularly and adopt healthy lifestyles, which would lower hypertension risk; thereby improving population health.

Moreover, the recommended care plan can enhance cost-effectiveness by reducing healthcare costs. The management of hypertension-related health complications, such as stroke, kidney disease, and heart attack is associated with relatively high treatment costs (Zhou et al., 2021).  The proposed care plan focuses on enhancing hypertension management to lower blood pressure, thereby preventing potential complications, including heart attack, stroke, and kidney disease. Consequently, the expensive long-term treatment for these medical conditions is eliminated, enhancing cost-effectiveness.

Lastly, the proposed care plan boosts healthcare provider well-being. The plan focuses on enhancing blood management to prevent comorbidities among hypertension patients. As a result, high workloads caused by hypertension-related medical conditions would be reduced. Thereby lowering providers’ burnout and improving their mental health and overall well-being Individual Assignment EBP Implementation Project Plan on your PICOT Question .

Strategies for making practice change sustainable over time

Various methods can be adopted to enhance the success of the practice change in the long term. The first approach is ongoing staff training and education programs. Conducting training sessions regularly will keep healthcare professionals updated on the latest evidence-based (EB) hypertension management guidelines, techniques, and resources, thereby achieving better patient outcomes through their hypertension management efforts. Moreover, the change can be sustained by incorporating the recommended hypertension management measures into current policies and procedures. Therefore, the proposed hypertension plan would become the new care protocol for managing blood pressure upon being integrated into healthcare organization’s policies and procedures. The last strategy for making the new hypertension management protocol sustainable involves monitoring outcomes. The new intervention would be embraced as the new clinical guideline for managing hypertension upon demonstrating effectiveness in lowering blood pressure.

Additionally, different strategies should be adopted to support continuous quality improvement (QI), period evaluation, and stakeholders’ feedback. First, the PDSA model can be adopted due to its efficacy in facilitating continuous QI in clinical settings (Burke & Marang-Van De Mheen, 2021) Individual Assignment EBP Implementation Project Plan on your PICOT Question . This model will allow changes in hypertension care to be tested in manageable and small steps in a cyclic approach. Moreover, feedback on the efficacy of the new care plan will be obtained by engaging various stakeholders, including healthcare providers, administrators, and patients throughout the change project implementation process. Lastly, conducting periodic evaluations will provide feedback that will be used to determine the efficacy of the new care plan in achieving operational and clinical goals.

References

Abdalla, M., Bolen, S. D., Brettler, J., Egan, B. M., Ferdinand, K. C., Ford, C. D., … & American Heart Association and American Medical Association. (2023). Implementation strategies to improve blood pressure control in the United States: a scientific statement from the American Heart Association and American Medical Association. 
Hypertension
, 
80
(10), e143-e157.
https://www.ahajournals.org/doi/full/10.1161/HYP.0000000000000232

Alrashed, S. F. M., Alruwaili, R. R. M., Alrwaili, N. A. K., Alruwaili, R. J. F., Alhazmi, G. A. A., & Alruwaili, S. A. D. (2024). Hypertension and Heart Health. 
Gland Surgery
, 
9
(2), 367-373.
https://www.glandsurgery.net/index.php/GS/article/view/109

Burke, R. E., & Marang-Van De Mheen, P. J. (2021). Sustaining quality improvement efforts: emerging principles and practice. 
BMJ Quality & Safety
, 
30
(11), 848-852.
https://qualitysafety.bmj.com/content/30/11/848.abstract

Heshmat-Ghahdarijani, K., Najafian, J., Vafaei, Z., Mostafavi, S., Mohammadifard, N., Mansourian, M., … & Sarrafzadegan, N. (2022). Rationale, design and preliminary results of a cohort study on breast and colorectal cancer to develop a risk assessment model to predict future cardiovascular events.“Cardio vascular events In Breast and Colorectal cancers (CIBC) study”. 
Current Problems in Cardiology
, 
47
(10), 100958.
https://doi.org/10.1016/j.cpcardiol.2021.100958

Lak, M., Divsalar, F., Charmduzi, F., Soltani, S. R., & Reza, M. (2024). Evaluation of the Relationship between Neurological and Cardiovascular Diseases in Adults and Children with Infection and HTN Basen on pharmacological points. 
International Neurourology Journal
, 
28
(1), 821-832. DOI: 10.5123/inj.2024.1. inj91

Menditto, E., Orlando, V., De Rosa, G., Minghetti, P., Musazzi, U. M., Cahir, C., … & Almeida, I. F. (2020). Patient centric pharmaceutical drug product design—The impact on medication adherence. 
Pharmaceutics
, 
12
(1), 44.
https://www.mdpi.com/1999-4923/12/1/44

Metz, A., & Bartley, L. (2020). Implementation teams: a stakeholder view of leading and sustaining change. 
Implementation Science 3.0
, 199-225.
https://link.springer.com/chapter/10.1007/978-3-030-03874-8_8

Zhou, B., Perel, P., Mensah, G. A., & Ezzati, M. (2021). Global epidemiology, health burden and effective interventions for elevated blood pressure and hypertension. 
Nature Reviews Cardiology
, 
18
(11), 785-802.
https://www.nature.com/articles/s41569-021-00559-8
  Individual Assignment EBP Implementation Project Plan on your PICOT Question

Vivian is an 88-year-old Caucasian female brought into the office by her caregiver. Complains of dark, cloudy, foul-smelling urine, with new confusion and night-time hallucinations

Case # 3

 
Case Description

Vivian, an 88-year-old Caucasian female presented with dark, cloudy, foul-smelling urine, confusion, night sleep disturbances, and hallucinations of spiders crawling under the bed at night followed by poor oral intake, lethargy, and agitation the next morning. Vivan also reported mild fever, lower abdominal pain, urinary frequency, and dysuria and had two suspected UTI treatments over the past 12 months. She has a history of hypertension, stage 2 of chronic kidney disease, diverticular disease, osteoporosis, previous hip fracture, and vesicovaginal fistula. She lives with a caregiver following the death of her husband three years ago. Physical examination indicated tachycardia with a pulse rate of 109, cloudy urine with leukocytosis, and positive nitrates pointing at a possible UTI associated with delirium.

Subjective Data.

Data Provided

Symptoms

Dark, cloudy, and foul-smelling urine

Confusion

Hallucinations at night

Mild fever

Lower abdominal pain

Urinary frequency and dysuria

Medical History

Hypertension, stage 2 chronic kidney disease, diverticular disease, and vesicovaginal fistula

Osteoporosis

Two suspected UTIs in the past 12 months

Medications

Olmesartan, Alendronate, and vitamin D3

Social History

Widowed, stays with a 24-hour caregiver, and has no history of alcohol use or smoking

Objective Data

 

Data Provided

Vitals:
Blood pressure 110/70, Pulse: 109, Respiration Rate: 17, Temperature: 99.0
0
F, BMI 22.

General: Restless although oriented to place and person

Cardiovascular: Tachycardic with no murmurs or extra heart sounds

Respiratory: the lungs are clear on auscultation. The abdomen is soft and non-tender

Genitourinary: +++ leukocytes, pH 6.0, and positive nitrites

There is no notable edema of the extremities.

Diagnostic Tests, Procedures, Laboratory Work

 

Diagnostic Tests and Rationale

Complete blood count for WBC count to assess leukocytosis

A basic metabolic panel (BMP) assesses electrolyte imbalance and renal function in stage 2 CKD

Post-void residual (PVR) scan is used to rule out urinary retention, which is common in the elderly population. According to Nuotio et al. (2019), PVR is common in women with hip fractures. Vivian has a history of hip fracture thus a possible risk factor for elevated PVR.

Urine culture and sensitivity confirms urinary tract infection (UTI), and isolates the causative organism and the appropriate antibiotic (Mehboob et al., 2021).

If delirium persists, CT/MRI rules out possible stroke or brain abnormalities

Differential diagnoses

 

Urinary Tract infection UTI-induced delirium. Vivan presented with classical symptoms of UTI such as urinary frequency, dark, cloudy, and foul-smelling urine accompanied by delirium and hallucinations. According to Pipili and Grapsa (2019) cited UTIs as the main cause of delirium in elderly patients.

Vesicovaginal fistula associated UTIs. The recurrent episodes of UTIs in the past 12 months and the foul-smelling urine are indicative of UTI predisposed from the fistula. Mourad and Higazy (2023) noted fistulas as a major predisposing factor to chronic UTIs.

Urosepsis is evidenced from fever, tachycardia, and alteration in mental status. van Lelyveld-Haas et al. (2022) noted that sepsis in elderly can present atypically.

Medications, treatments, or other interventions for each differential

UTI-induced delirium can be treated with oral nitrofurantoin 100mg twice daily or use Fosfomycin if resistant. According to van Lelyveld-Haas et al. (2022), UTI management prevents nephrotoxicity in chronic kidney disease.

Vesicovaginal fistula requires referral to a urologist for surgical repair. Surgical repair of genitourinary fistulas is crucial in preventing recurrent UTIs (Gonzales-Alabastro et al., 2023).

Urosepsis can be confirmed by positive culture results and can be managed by intravenous fluids and ceftriaxone. Treatment focuses on covering gram-negative bacteria.

Key

Social Determinants of Health (SDoH)

Isolation or loneliness predisposes to the risk of delirium (Tait, 2022). The patient is a widow living with a full-time caregiver thus feeling isolated and lonely.

Mobility: The patient had a prior hip fracture which increases fall risk.

Care access: The patient needs regular monitoring for UTIs secondary to the fistula.

Collaborative care referrals and patient education needs

 

Relevant Referrals

Urologist to assess the fistula for repair

Geriatrician to manage delirium management

Physiotherapy to prevent fall incidences

Patient Education such as maintaining

hydration status to prevent UTIs,

Timely identification of delirium symptoms such as confusion

Individual hygiene such as proper perineal care to reduce the risk of UTI prevalence.

Additional Data Required

Hydration status, i.e., fluid intake and signs of dehydration

Cognition: mental status before the illness and any history of dementia

Recent history of antibiotic uses: can predispose to resistance and recurrent UTIs

Bowel habits such as constipation exacerbate UTI symptoms

Risk of delirium from mobility changes and recent falls

 
Additional Data Required

Neurological examination to evaluate possible delirium or dementia.

Post-void urine to rule out urinary retention

Urine culture and sensitivity to identify the specific causative organism and the appropriate antibiotic for management

Vivian is an 88-year-old Caucasian female brought into the office by her caregiver. Complains of dark, cloudy, foul-smelling urine, with new confusion and night-time hallucinations

 

References

Gonzales-Alabastro, C., Goyette, B., & Kielb, S. J. (2023). Urethrovaginal Fistula Repair. In 
Female Genitourinary and Pelvic Floor Reconstruction
 (pp. 693-705). Cham: Springer International Publishing.
https://doi.org/10.1007/978-3-031-19598-3_41

Mehboob, M., Hakim, M., Ullah, O., Lodhi, S. S., Anees, M., Khalil, I., & Shuja, M. N. (2021). Identification and characterization of urinary tract infectious bacteria and its antibiotic sensitivity. 
BioScientific Review
, 
3
(3), 43-62.
https://doi.org/10.32350/BSR.0303.04

Mourad, M. S., & Higazy, A. M. G. A. (2023). Fistula. In 
Handbook of Neurourology: Theory and Practice
 (pp. 1-13). Singapore: Springer Nature Singapore.
https://doi.org/10.1007/978-981-16-7939-1_84-1
  Vivian is an 88-year-old Caucasian female brought into the office by her caregiver. Complains of dark, cloudy, foul-smelling urine, with new confusion and night-time hallucinations

Nuotio, M. S., Luukkaala, T., & Tammela, T. (2019). Elevated post-void residual volume in a geriatric post-hip fracture assessment in women-associated factors and risk of mortality. 
Aging Clinical and Experimental Research
, 
31
, 75-83.
https://doi.org/10.1007/s40520-018-0946-5

Petrosillo, N., Granata, G., Boyle, B., Doyle, M. M., Pinchera, B., & Taglietti, F. (2020). Preventing sepsis development in complicated urinary tract infections. 
Expert Review of Anti-infective Therapy
, 
18
(1), 47-61.
https://doi.org/10.1080/14787210.2020.1700794

Pipili, C., & Grapsa, E. (2019). Urinary Tract Infections in the Elderly. 
Clinical Nephrogeriatrics: An Evidence-Based Guide
, 87-101.
https://doi.org/10.1007/978-3-030-18711-8_6

Tait, D. (2022). The patient with delirium. 
Tait D, Williams C, Barton D, et al. Acute and Critical Care in Adult Nursing
, 
3
, 209-226.
https://www.torrossa.com/en/resources/an/5282165#page=220

van Lelyveld-Haas, L., de Lange, D., & Martin-Loeches, I. (2022). Sepsis in older adults. In 
The very old critically ill patients
 (pp. 463-483). Cham: Springer International Publishing.
https://doi.org/10.1007/978-3-030-94133-8_30
  Vivian is an 88-year-old Caucasian female brought into the office by her caregiver. Complains of dark, cloudy, foul-smelling urine, with new confusion and night-time hallucinations

Pearson’s r in BlueSky Statistics Correlation Analysis Example’

This will cover Week 10 (Chapter 11: Correlation) Application Lesson videos. Students will have one opportunity and 24 hours to complete the 10 questions. The must be completed in one sitting.

Students must use Excel and BlueSky Statistics to complete this multiple-choice assessment.

Download this pre-populated Excel workbook file to complete your calculations.

 

You are interested in the relationship between obesity and renal disease so you design a project with 20 participants to assess the impact of weight loss on key renal parameters, particularly proteinuria. Specifically, you seek to find out if significant reductions in body mass index (BMI) through weight loss interventions could lead to improved renal outcomes, providing valuable insights into potential non-pharmacological strategies for managing renal disease and potentially preventing its progression to end-stage renal disease. Use the data attached to calculate the correlation between BMI and proteinuria using Pearson’s r in BlueSky Statistics for these 20 participants. Alpha is set at .05.

(NOTE: this data is contrived and randomly generated. It may or may not be realistic.)
 

BMI and proteinuria for 20 participants is provided in the spreadsheet.

 

In the correlation between BMI and Proteinuria (Prot) the Pearson’s r is:

Group of answer choices

0.71

0.7478

0.70

0.6969

 

What is the direction of the association?

Group of answer choices

Negative

No way to tell from the data

Positive

Neutral

 

PLACE YOUR ORDER HERE

 

What is the strength of the association?

Group of answer choices

 

Strong

 

No way to tell from the data

 

Moderate

 

Weak

 

 

When BMI increases…

Group of answer choices

 

Proteinuria increases

 

No way to tell from the data

 

Proteinuria decreases

 

Proteinuria remains neutral

 

 

What is the p value?

Group of answer choices

 

There is no p value in correlation statistics

 

0.0002

 

0.0006

 

0.05

 

 

The result is statistically significant. (True or False)

Group of answer choices

 

True

 

False

 

 

 

The results show a:

Group of answer choices

 

Small effect

 

No way to tell the effect from the data

 

Medium effect

 

Large effect

 

 

The effect size influences the sample size needed to achieve statistical significance. (True or False)

Group of answer choices

 

True

 

False

 

 

What is the percent of variance?

Group of answer choices

 

0.5592

 

0.5

 

No way to tell from the data

 

0.4856

 

 

Based on the percent of variance, we know that:

Group of answer choices

 

55.92% of the percentage of change in proteinuria is accounted for by the BMI

 

48.56% of the percentage of change in proteinuria is accounted for by the BMI

 

50% of the percentage of change in proteinuria is accounted for by the BMI

 

Cannot calculate percent of variance from the data

 

BMI

Prot

age

fasting glucose

random glucose

35

152

57

134

209

26

140

49

98

169

33

142

62

150

184

28

140

53

117

176

33

152

46

126

193

30

150

59

112

201

36

160

68

105

195

35

162

50

122

173

28

160

56

129

182

35

170

45

116

164

38

177

52

123

185

37

180

71

137

177

33

182

38

108

212

38

200

60

127

168

41

212

43

119

174

32

180

75

143

198

39

192

35

97

179

35

200

54

125

204

34

151

56

133

208

36

153

58

135

210

 

Pearson’s r in BlueSky Statistics Correlation Analysis Example

 

 

Exploring the Relationship Between BMI and Proteinuria: A Correlation Analysis

 

You are interested in the relationship between obesity and renal disease so you design a project with 20 participants to assess the impact of weight loss on key renal parameters, particularly proteinuria. Specifically, you seek to find out if significant reductions in body mass index (BMI) through weight loss interventions could lead to improved renal outcomes, providing valuable insights into potential non-pharmacological strategies for managing renal disease and potentially preventing its progression to end-stage renal disease. Use the data attached to calculate the correlation between BMI and proteinuria using Pearson’s r in BlueSky Statistics for these 20 participants. Alpha is set at .05.

(NOTE: this data is contrived and randomly generated. It may or may not be realistic.)
 

BMI and proteinuria for 20 participants is provided in the spreadsheet.

In the correlation between BMI and Proteinuria (Prot) the Pearson’s r is:

Group of answer choices

0.71

0.7478

0.70

0.6969

What is the direction of the association?

Group of answer choices

Negative

No way to tell from the data

Positive

Neutral

What is the strength of the association?

Group of answer choices

Strong
(since 0.6969 is close to 0.7)

No way to tell from the data

Moderate

Weak

 

 

When BMI increases…

Group of answer choices

Proteinuria increases

No way to tell from the data

Proteinuria decreases

Proteinuria remains neutral

What is the p value?

Group of answer choices

There is no p value in correlation statistics

0.0002

0.0006

0.05

The result is statistically significant. (True or False)

Group of answer choices

True
(p-value < 0.05) False The results show a: Group of answer choices Small effect No way to tell the effect from the data Medium effect Large effect The effect size influences the sample size needed to achieve statistical significance. (True or False) Group of answer choices True False     What is the percent of variance? Group of answer choices 0.5592 0.5 No way to tell from the data 0.4856 Based on the percent of variance, we know that: Group of answer choices 55.92% of the percentage of change in proteinuria is accounted for by the BMI 48.56% of the percentage of change in proteinuria is accounted for by the BMI 50% of the percentage of change in proteinuria is accounted for by the BMI Cannot calculate percent of variance from the data BMI Prot age fasting glucose random glucose 35 152 57 134 209 26 140 49 98 169 33 142 62 150 184 28 140 53 117 176 33 152 46 126 193 30 150 59 112 201 36 160 68 105 195 35 162 50 122 173 28 160 56 129 182 35 170 45 116 164 38 177 52 123 185 37 180 71 137 177 33 182 38 108 212 38 200 60 127 168 41 212 43 119 174 32 180 75 143 198 39 192 35 97 179 35 200 54 125 204 34 151 56 133 208 36 153 58 135 210 Pearson’s r value. 0.69685 Pearson’s r in BlueSky Statistics Correlation Analysis Example

Healthcare Information Technology Trends discussion post with response

Healthcare Information Technology Trends

Introduction

The use of technology in healthcare has revolutionized patient care provision worldwide. Technological innovations, from electronic health records that streamline documentation to telemedicine systems that reach remote areas, have altered healthcare operations. For the patient, such innovations mean improved diagnostic accuracy, personalized treatment regimens, and greater participation in their health process. For the practitioner, they mean improved clinical decision support, streamlined workflow, and enhanced communication. Technology facilitates data-driven policy-making, resource optimization, and cost containment at a system level. However, other concerns, such as the costs of implementation, digital literacy, and data usage, should be considered in light of these new trends. This paper aims to identify technological trends in healthcare, discuss the advantages and disadvantages that may result from their usage, and what other technologies may change the sphere of healthcare services.

The Technology Healthcare Trends

EHRs and RPM are two new trends utilized in managing health information. EHRs contain records of patient details, diagnoses, test results, medications, and recommended treatments. These systems facilitate the easy exchange of information between providers, informing data-driven decisions with embedded analytics packages that identify patterns and treatment effectiveness (Upadhyay & Hu, 2022). RPM technologies collect real-time patient information outside the traditional clinical setting through wearable devices, smart sensors, and mobile applications. These systems monitor vital signs, medication compliance, and disease- specific indicators, transmitting data to healthcare providers for analysis. Advanced algorithms can detect concerning trends, triggering alerts for early intervention. Together, these technologies facilitate unparalleled data continuity, redesigning episodic care in continuous health management while creating vast datasets that drive predictive analytics, precision medicine, and population health initiatives.

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The Risks Associated with the Trends

The proliferation of EHRs and Remote Patient Monitoring systems creates severe privacy and security threats in healthcare. As Shojaei et al. (2024) argue, these technologies generate unprecedented volumes of sensitive health data, which makes them attractive targets for cyberattacks. Data breaches can expose patients’ confidential data, exposing them to identity theft, insurance fraud, and psychological damage. Healthcare organizations also face significant financial penalties for HIPAA violations, with the average cost of settlements reaching $25,000 per violation category per year. (The HIPAA Journal). Beyond regulatory concerns, unauthorized access undermines patient-provider trust, potentially discouraging the sharing of sensitive information necessary for adequate care. The extended usage of these trends also brings security problems because third-party vendors and clouds have numerous access points. They expose further the improved identification of other significant identity categories that are not only concerned with protection, although this raises issues of consent and ownership in the current healthcare systems Healthcare Information Technology Trends discussion post with response.

Benefits and Risks Associated With Data Safety, Legislation, and Patient Care

Health technologies like EHRs and RPM offer substantial benefits for data security through standardized encryption procedures and access controls that reduce documentation errors and facilitate care coordination (Paul et al., 2023). Recent policies, including the 21st Century Cures Act, have accelerated interoperability standards while strengthening patients’ rights to access their health data, supporting transparency and engagement. However, the significant threats associated with the privacy and safety of patient data appear to be evident with these trends. Regulatory requirements take time to integrate new technologies that create legal ambiguities that challenge healthcare organizations’ compliance. Also, multiple peculiarities of data protection legislation in different countries raise jurisdiction concerns in the scope of cross- border healthcare services and research collaboration. However, patient care is threatened because the decision-support tools embedded in these systems could compromise efficiency and effectiveness should they be trained on non-diverse datasets. Furthermore, its use may hinder the development of a therapeutic alliance inherent in the therapeutic process, which has implications for patient harm,, particularly those with low technological proficiency.

Promising Trends that will Impact Healthcare Technology in Nursing Practice

Artificial intelligence and machine learning that reconstruct the clinical methods and effects are significant technologies in the field of nursing practice. Even before human nurses identify it, deterioration patterns can be observed through the help of predictive analytics, leading to proactive work rather than working reactively in important critical care structures (Bajwa et al., 2021). Besides, depending on the data obtained from such sources, EHR data and wearable sensor-based algorithms can offer individualized care plans to ease the decision- making burden on nurses. The above technologies also support voice-natural language processing for automatic documentation. According to Theihn et al. (2021), such technologies can free 30-35% of the nursing work time on paperwork. Facing a problem of shortages and high turnover rates globally, AI assists in the organization of the nurse-to-patient ratio and staff assignments based on patient acuity. Furthermore, other uses of machine learning in clinical learning include simulated training designed to reduce the learning curve amongst nursing students and the likelihood of initial and interim assessments throughout their career to enhance that the EBP is the core foundation for the nursing practice.

Impact of the Trend on Patient Outcomes and Efficiency

Overall, AI and machine learning technologies have the potential to bring about positive changes in different healthcare systems. Regarding patient outcomes, studies have demonstrated that early detection using the early warning systems facilitated by AI decreases cardiac arrest and ICU mortality by 6-12 hours before the identification by traditional methods (Alamgir et al., 2021). This is achieved by automating clinical documentation and pushing nursing documentation through AI transcripts. Regarding data management, machine learning algorithms give prognostic results on using NLP to predict the social determinants of health in narrative text such as clinical notes. In addition, the effective use of the inpatient unit beds in the emergency department and the shortening of the time a patient spends at the facility is made possible by the advanced predictive algorithms in the system. Some of these concrete achievements are easy to comprehend as they clarify how AI is applied in reality and on what theoretical basis this application is based.

Conclusion

In conclusion, the modern trends in healthcare, such as EHRs and RPM, are not only advanced technologies but effective systems that have altered the process of data collection and utilization in the medical field. Despite the privacy and security challenges that come with these technologies in health, the gains of converting care and accessing patients are enormous. AI, especially ML, can potentially be beneficial in early intervention, simultaneous increase in efficiency through automation, and dealing with mass data. Altogether, the potential of future technology in improving healthcare advancement and subsequent care remains fragile on this middle ground between health Informatics, data protective cover, and interjection.

References

Alamgir, A., Mousa, O., & Shah, Z. (2021). Artificial Intelligence in predicting cardiac arrest: A scoping review. JMIR Medical Informatics, 9(12). https://doi.org/10.2196/30798

Bajwa, J., Munir, U., Nori, A., & Williams, B. (2021). Artificial Intelligence in healthcare: Transforming the practice of medicine. Future Healthcare Journal, 8(2). https://doi.org/10.7861/fhj.2021-0095

The HIPAA Journal. (n.d.). HIPAA violation fines – updated for 2024. https://www.hipaajournal.com/hipaa-violation-fines/Links to an external site.

Paul, M., Maglaras, L., Ferrag, M. A., & Almomani, I. (2023). Digitization of Healthcare Sector: A Study on privacy and security concerns. ICT Express, 9(4), 571–588. https://doi.org/10.1016/j.icte.2023.02.007

Shojaei, P., Vlahu-Gjorgievska, E., & Chow, Y.-W. (2024). Security and privacy of technologies in Health Information Systems: A systematic literature review. Computers, 13(2), 41. https://doi.org/10.3390/computers13020041

Upadhyay, S., & Hu, H. (2022). A qualitative analysis of the impact of electronic health records (EHR) on Healthcare Quality and safety: Clinicians’ lived experiences. Health Services Insights, 15. https://doi.org/10.1177/11786329211070722

Healthcare Information Technology Trends discussion post with response

Healthcare Information Technology Trends (Discussion Response)

Your discussion on HIT trends offers a detailed and comprehensive overview of the changing landscape of digital health innovations. In agreement with your point, the integration of EHRs and RPM technologies has undeniably enhanced patient care through the improvement of decision-making, data-driven decisions, data continuity, and care coordination. As identified by Upadhyay & Hu (2022), integration of EHRs has helped in streamlining clinical workflows which also supports data-driven insights that overall result in improved or better treatment outcomes. RPM further helps to bridge the gap in care delivery by supporting real-time patient monitoring beyond hospital or traditional healthcare settings.

Additionally, your post rightly highlights the risks that are associated with these technological advancements i.e. cybersecurity threats. Shojaei et al. (2024) in his article emphasized that the ever-growing digital footprint of health data makes it an obvious or attractive target for cybercriminals, hence posing a threat to organization efforts for compliance with set policies as well as patient confidentiality. Successfully addressing these concerns demands the adoption and installation of access control mechanisms, robust encryption technologies, and continuous training on security matters for healthcare workers.

The mention and inclusion of Artificial intelligence and machine learning as part of trending technologies and their enhancement of nursing practice is compelling. Bajwa et al. (2021) denoted in his research article that, AI-driven predictive analytics can help identify deterioration patterns which in turn allows healthcare professionals to timely implement effective interventions that overall improve patient outcomes. Additionally, automating documentation via natural language processing can help lower administrative burdens and mitigate clinical burnout.

While advancements in technology face challenges regarding their adoption, their potential and ability to change or revolutionize healthcare patient safety and efficiency is undeniable. It is in turn key for future efforts and input in technology use to focus on establishing the right balance between innovations and robust data security measures, while ensuring equal access by patients and populations to the technologies.

References

Bajwa, J., Munir, U., Nori, A., & Williams, B. (2021). Artificial intelligence in healthcare: Transforming the practice of medicine.
Future Healthcare Journal
,
8
(2), 188–194. NCBI.
https://doi.org/10.7861/fhj.2021-0095

Shojaei, P., Gjorgievska, E. V., & Chow, Y.-W. (2024). Security and Privacy of Technologies in Health Information Systems: A Systematic Literature Review.
Computers
,
13
(2).
https://doi.org/10.3390/computers13020041

Upadhyay, S., & Hu, H. (2022). A qualitative analysis of the impact of electronic health records (EHR) on healthcare quality and safety: Clinicians’ lived experiences.
Health Services Insights
,
15
(1), 1–7.
https://doi.org/10.1177/11786329211070722
  Healthcare Information Technology Trends discussion post with response

Patient Safety Fishbone Diagram Analysis

Sheila, a very experienced ICU nurse, has been working with an unstable patient, who is 3 days post-op. The patient’s IV drugs are being adjusted and titrated for runs of V-Tach. The patient has been very restless and somewhat confused, moving around in bed frequently and causing the monitor to alarm. Because Sheila is providing care to this patient on a 1:1 basis, she turns off the alarm while she is in the room. She closely monitors the patient’s vital signs and drips, continuously staying at the patient’s bedside.

Suddenly, the patient across the hall sits up in bed, extubates himself, while thrashing wildly, trying to remove his restraints, and get out of bed. Sheila is in the nearest room and sees what is going on. She rushes to the other room to restrain the patient, calling for help as she goes. Another nurse comes to help her, and within a few minutes, anesthesia has responded, the ET tube has been reinserted, and the patient has been sedatedPatient Safety Fishbone Diagram Analysis.

When Sheila returns to her patient’s bedside, she notes that he is in V-fib and is unresponsive.

 

Questions to facilitate the Fishbone diagram process:

1. What aspects of human factors could have contributed to this situation?

2. What system and/or process factors might have played a role?

3. What system changes related to mistake-proofing could help here?

4. What are the key components to include in a policy on turning off alarms?

 

Patient Safety Fishbone Diagram Analysis

Fishbone Analysis

Aspects of Human Factors that Could Have Contributed to the Situation

The first human factor that could have contributed to the situation is that the patient was on the third-day post-op. This means that the patient was still recovering from surgery and may have felt more pain and discomfort than usual. This could have made the patient more restless and confused than usual. Another human factor that could have contributed to the situation is that the IV drugs were being adjusted and titrated for runs of V-tach. This means that the patient’s medication was constantly changing to control their heart rate (Barbeito et al., 2022). This could have led to the patient feeling more confused and agitated. The third human factor that could have contributed to the situation is that the patient’s monitor was alarming frequently. This would have caused the patient to become more aware of their surroundings and may have caused them to become more restless. Also, Sheila was the only nurse providing care to the patient. This means she was the only person who could monitor the patient closely. This could have led to her missing some warning signs that the patient was becoming agitated Patient Safety Fishbone Diagram Analysis.

The alarm system was not properly functioning and did not alert staff to the patient’s movements. The patient was not properly restrained and could remove the ET tube. The anesthesia team did not respond promptly. Other factors were that the nurse-patient ratio was 1:1, which left little room for error. The patient was post-op and on medication that may have caused confusion and restlessness. The monitor was also turned off while the nurse was in the room, which prevented timely intervention. The patient was not closely monitored after the initial event, which allowed him to become unresponsive. The nurse was not familiar with the anesthesia protocol, which delayed intervention.

Systems and Process Factors that Might Have Played a Role

Several systems and process factors may have played a role in this event. The first is the patient’s instability. The patient was on the third-day post-op and was still very unstable. This made it difficult for the nurses to keep the patient’s vital signs and drips stable. The second factor is the patient’s restlessness and confusion. This made it difficult for the nurses to monitor the patient and keep him from moving around the bed, causing the monitor to alarm. The third factor is anesthesia. The anesthesia could not respond quickly enough to the patient’s need for sedation. This made it difficult for the nurses to keep the patient sedated and from removing the ET tube. The fourth factor is the lack of staff. There was only one nurse available to help Sheila with the patient. This made it difficult to keep the patient restrained and from extubating himself. The fifth factor is the lack of a clear plan of care Patient Safety Fishbone Diagram Analysis. There was no clear plan of care in place for the patient. This made it difficult for the nurses to know what to do and how to respond to the patient’s needs.

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One system factor that may have played a role is the fact that the patient was on the third day post-op. This means that the patient may have still been in a lot of pain and discomfort, which can lead to restlessness and confusion. Additionally, the patient’s IV drugs may have been contributing to the patient’s condition. Another system factor is that the patient was on a 1:1 basis with Sheila. This means that Sheila was the only nurse responsible for the care of this patient. This can lead to much pressure and stress, leading to mistakes. Process factors that may have played a role include that Sheila turned off the alarm while in the room. This may have prevented her from hearing the alarm when the patient across the room began to stir.

Additionally, Sheila may have been too focused on the patient’s vital signs and drips to notice the patient across the room. Another process factor is that the patient across the room could extubate himself and remove the restraint. This may have been because the restraint was not properly secured. Finally, the anesthesia may have responded too slowly to the situation, which allowed the patient to become unresponsive.

Potential Problem-Solving Measures

Some of the system changes that could help include implementing a standardized protocol for postoperative care of patients with unstable vital signs. This protocol should include close monitoring of vital signs and titration of IV medications to maintain stability. Secondly, there is need to incorporate alarms into the postoperative care protocol so that nurses are alerted when a patient’s vital signs become unstable. Training nurses on proper restraint techniques prevents patients from self-extubating or removing other medical devices and standardizing the sedation protocol for patients who become agitated or unresponsive so that nurses can quickly and effectively sedate them—also implementing a system for tracking and reporting postoperative complications so that any trends can be identified and addressed (Soni et al., 2017) Patient Safety Fishbone Diagram Analysis.

Other system changes to mistake proofing that could help here include; reviewing and updating policies and procedures related to postoperative care, specifically about IV drug administration and monitoring of unstable patients (Rodziewicz et al., 2022) Patient Safety Fishbone Diagram Analysis. Additional interventions include implementing a system of bedside alarms that nurses cannot turn off while they are in the room with a patient, increasing staffing levels on postoperative units to allow for more one-on-one care of unstable patients, educating all staff members on the signs and symptoms of postoperative complications and the importance of timely intervention.

Key Components to Include in Policy of Turning Off Alarms

Alarms should only be turned off when the nurse is providing direct care to the patient and can closely monitor the patient’s vital signs. The nurse should turn off the alarm and monitor the patient’s vital signs and drips. If the patient across the room extubates himself and tries to remove the restraint, the nurse should rush into the room and call for help. Once the anesthesia has responded and the ET tube is reinserted, the patient should be sedated (Ramlaul et al., 2021). The nurse should then return to the patient’s bedside and check for v-fib and unresponsiveness. The alarm must be turned off by the nurse providing care to the patient on a 1:1 basis. The nurse must document all actions taken in the patient’s medical record (Woo & Bacon, 2020). Once the patient is sedated, the nurse should return to the bedside and check for signs of V-fib. If the patient is unresponsive, the nurse should turn off the alarm and provide CPR if necessary Patient Safety Fishbone Diagram Analysis.

 

References

Barbeito, A., Dolinski, S. Y., & Lemm, J. (2022). Postoperative care after cardiac surgery.
https://www.uptodate.com/contents/postoperative-care-after-cardiac-surgery

Ramlaul, A., Chironda, G., & Brysiewicz, P. (2021). Alarms in the ICU: A study investigating how ICU nurses respond to clinical alarms for patient safety in a selected hospital in KwaZulu-Natal Province, South Africa.
Southern African Journal Of Critical Care
,
37
(2), 57.
https://doi.org/10.7196/sajcc.2021.v37i2.469

Rodziewicz, T. L., Houseman, B., & Hipskind, J. E. (2022). Medical error reduction and prevention. In 
StatPearls [Internet]
. StatPearls Publishing.
https://www.ncbi.nlm.nih.gov/books/NBK499956/

Soni, P., Aggarwal, N., Kumar, V., Homel, P., & Kupfer, Y. (2017). Authenticity and Reliability of the Cardiac Monitor Alarms in the ICU: A Patient Safety Concern Due to Alarm Fatigue.
Chest
,
152
(4), A566.
https://doi.org/10.1016/j.chest.2017.08.596

Woo, M., & Bacon, O. (2020). Alarm Fatigue. In Making Healthcare Safer III: A Critical Analysis of Existing and Emerging Patient Safety Practices [Internet]. Agency for Healthcare Research and Quality (US).
https://www.ncbi.nlm.nih.gov/books/NBK555522/ 
 Patient Safety Fishbone Diagram Analysis

NRNP 6552 Week 8 Case studies – A 32-year-old African American woman presents to the clinic for her 24-week check-up.

 

Case # 4 

 
A 32-year-old African American woman at 24 weeks gestation presents with persistent daily sadness, fatigue, decreased energy, and difficulty completing daily tasks and maintaining work attendance. Although she expresses happiness about her pregnancy, she reports an inability to explain her ongoing sadness. Symptoms began one week prior to presentation. Her family history is significant for paternal chronic depression and diet-controlled diabetes, while her mother has no known medical conditions. The patient currently takes a daily prenatal vitamin and denies allergies.

 

Outline Subjective data.

 

The patient reports daily depressed mood, persistent fatigue, anhedonia, inability to perform usual daily chores, and difficulty attending work. She tried going to bed earlier without improvement. She denies understanding why she feels sad. Additional subjective data required includes a formal validated depression screening score using the Edinburgh Postnatal Depression Scale (EPDS) or Patient Health Questionnaire-9 (PHQ-9), full psychiatric and prior depressive episode history, suicidal ideation assessment, relationship quality and social support evaluation, history of adverse childhood experiences, sleep pattern changes, appetite changes, and current financial or occupational stressors.

Outline

Objective findings.

 

Vital signs include height 5’4”, weight 147 lbs, BMI 25.2, blood pressure 132/78 mmHg, and heart rate 88 bpm. The patient appears well-nourished but demonstrates a flat affect and mildly disheveled appearance, suggesting decreased self-care. HEENT examination is normal. The neck is supple without thyromegaly. Lung auscultation is clear bilaterally. Cardiovascular exam reveals a regular rate and rhythm with a soft grade II/VI systolic murmur, likely physiologic in pregnancy. Peripheral pulses are normal without edema. Breast and genitourinary exams are consistent with normal pregnancy at 24 weeks, and fetal heart tones are present.

Additional objective data should include a documented PHQ-9 or EPDS score. Laboratory evaluation should include thyroid-stimulating hormone (TSH), complete blood count (CBC), and a one-hour glucose challenge test, as this aligns with routine gestational diabetes screening at 24–28 weeks. A validated suicide risk assessment tool should also be completed.

Identify diagnostic tests, procedures, laboratory work indicated.

 

The American College of Obstetricians and Gynecologists recommends systematic screening and diagnosis of mental health conditions during pregnancy, including depression, anxiety, and bipolar disorder, with formal validated instruments at a minimum of twice during gestation (American College of Obstetricians and Gynecologists [ACOG], 2023a). The PHQ-9 or EPDS must be administered immediately, as these are validated, brief, and widely available instruments appropriate for perinatal populations (Kendall-Tackett, 2024). A TSH level is indicated because hypothyroidism shares overlapping symptoms of fatigue and depressed mood with antenatal depression; levothyroxine is the recommended treatment when TSH exceeds 2.5 mIU/L in pregnancy (Nguyen, 2022). A complete blood count is indicated to evaluate for iron-deficiency anemia, a common pregnancy complication contributing to fatigue and low energy. A one-hour glucose challenge test is necessary given the patient’s strong bilateral family history of diabetes. A structured suicide risk assessment using the Patient Safety Screener is mandated whenever depressive symptoms are identified, as untreated perinatal depression carries risk of maternal mortality (MS & Kay Roussos-Ross, 2023).

 

Distinguish at least three differential diagnoses.

 

Antenatal Depression: This is the most likely diagnosis given persistent sadness, anhedonia, fatigue, and impaired functioning. Family history increases susceptibility. ACOG identifies perinatal depression as a leading contributor to maternal morbidity and emphasizes early screening and treatment (ACOG, 2023a).

Adjustment Disorder with Depressed Mood: The recent onset of symptoms suggests a possible stress-related response to pregnancy-related life changes. However, symptom severity and functional impairment raise concern for progression to major depression if persistent (MS & Kay Roussos-Ross, 2023).

Hypothyroidism in Pregnancy: Overlapping symptoms such as fatigue and low mood necessitate exclusion of thyroid dysfunction. Pregnancy increases thyroid hormone demand, and untreated disease carries significant maternal-fetal risks (Nguyen, 2022) NRNP 6552 Week 8 Case studies – A 32-year-old African American woman presents to the clinic for her 24-week check-up..

Identify appropriate medications, treatments or other interventions associated with each differential diagnosis.

 

For antenatal depression, cognitive behavioral therapy (CBT) and interpersonal therapy (IPT) are evidence-based, first-line interventions for mild-to-moderate symptoms during pregnancy, avoiding fetal pharmacological exposure. When symptoms are moderate-to-severe or unresponsive to psychotherapy, sertraline is the preferred pharmacological agent given the broadest perinatal safety data among SSRIs (MS & Kay Roussos-Ross, 2023). Suicide as a leading preventable contributor to maternal mortality exceeding hemorrhage underscores the ethical imperative of timely pharmacological intervention when clinically indicated (MS & Kay Roussos-Ross, 2023).

For adjustment disorder, supportive psychotherapy, social work referral, and stress reduction strategies are appropriate initial interventions.

For confirmed hypothyroidism, levothyroxine is the sole recommended thyroid hormone replacement therapy during pregnancy, with monthly TSH monitoring until the target of below 2.5 mIU/L is achieved (Nguyen, 2022). Prenatal vitamins and iron supplementation should be maintained throughout regardless of confirmed diagnosis.

 

 

 

Explain key

Social Determinants of Heath (SDoH) for your chosen case.

 

This patient faces several intersecting social determinants that elevate her risk. As an African American woman, she is subject to structural racism in healthcare systems, contributing to underdiagnosis and undertreatment of perinatal mental health conditions (Blebu et al., 2024). Employment demands and the challenge of attending work while experiencing depression and fatigue signal financial vulnerability and occupational stress, creating an ethical obligation to discuss workplace accommodations. Poor social support and partner relationship quality are among the most consistently identified determinants of antenatal depression and must be explicitly assessed (Insan et al., 2022). The physical burden of untreated depression on fetal outcomes, including low birth weight and preterm birth, reinforces the urgency of intervention. Psychologically, the patient’s flat affect and disorganized appearance suggest moderate functional decline requiring immediate attention.

 

Describe collaborative care referrals and patient education needs for your chosen case.

 

Referral to a perinatal psychiatrist or licensed clinical social worker specializing in maternal mental health is strongly indicated. Integrated collaborative care models combining obstetric and psychiatric expertise demonstrate significantly improved screening utilization and treatment rates for perinatal depression (Blebu et al., 2024). The patient must be educated on the clinical distinction between normal pregnancy fatigue and clinical depression, the safety of both psychotherapy and carefully selected pharmacological agents during pregnancy, and the importance of consistent prenatal attendance and validated screening at every visit. She should be counseled on available community mental health resources, crisis hotlines, and employer accommodation rights to address financial and occupational stressors. Ethically, she must be informed of her right to participate in treatment decisions using shared decision-making. A documented safety plan addressing suicidal ideation warning signs must be established and placed in her medical record at this visit (ACOG, 2023a).

 

 

 

References

American College of Obstetricians and Gynecologists. (2023a). Screening and diagnosis of mental health conditions during pregnancy and postpartum: ACOG Clinical Practice Guideline No. 4.
Obstetrics & Gynecology, 141
(6), 1232–1261.
https://doi.org/10.1097/aog.0000000000005200

Blebu, B., Jackson, A., Reina, A., Dossett, E. C., & Saleeby, E. (2024). Social determinants among pregnant clients with perinatal depression, anxiety, or serious mental illness. 
Health Affairs
, 
43
(4), 532-539. 
https://doi.org/10.1377/hlthaff.2023.01456

Insan, N., Weke, A., Forrest, S., & Rankin, J. (2022). Social determinants of antenatal depression and anxiety among women in South Asia: A systematic review & meta-analysis. 
PLOS ONE
, 
17
(2), e0263760. 
https://doi.org/10.1371/journal.pone.0263760

Kendall-Tackett, K. A. (2024). Screening for perinatal depression: Barriers, guidelines, and measurement scales. 
Journal of Clinical Medicine
, 
13
(21), 6511. 
https://doi.org/10.3390/jcm13216511

MS, M., & Kay Roussos–Ross, M. D. (2023). Treatment and management of mental health conditions during pregnancy and postpartum.
American College of Obstetricians and Gynecologists, 141
(6), 1262–1288.
https://doi.org/10.1097/aog.0000000000005202

Nguyen, C. T. (2022). Postpartum thyroiditis: Diagnosis and management. 
Thyroid Diseases in Pregnancy
, 211-222. 
https://doi.org/10.1007/978-3-030-98777-0_14

 

NRNP 6552 Week 8 Case studies – A 32-year-old African American woman presents to the clinic for her 24-week check-up.

Back to Week at a Glance

Common Health Conditions with Implications for Women

Case studies provide the opportunity to simulate realistic scenarios involving patients presenting with various health problems or symptoms. Such case studies enable nurse learners to apply concepts, lessons, and critical thinking to interviewing, screening, and diagnostic approaches, as well as to the development of treatment plans.

For this Case Study Assignment, you will chose from four case studies to identify common health implications for women. You will then explore the chosen case study to determine the diagnosis, diagnostic tests, and treatment options for the patient.

Resources

Be sure to review the Learning Resources before completing this activity.

Click the weekly resources link to access the resources.

WEEKLY RESOURCES

To prepare:

Review the 4 case studies in this week’s Learning Resources. Select one of the cases to prepare your written assignment.

Review the Learning Resources for this week.

Assignment Instructions:

Use the Case Study Template from the Learning Resources to complete the assignment. Your submission must include a brief case write-up, followed by the fully completed template, which must be integrated into the document rather than submitted separately.

Include a title page, a case summary in your own words, the completed template, and a reference page formatted in APA style.

Ensure your submission meets all criteria outlined in the template and rubric for completeness and accuracy.

By Day 7 of Week 8

Submit
 your case study assignment by 
Day 7 of Week 8
.

submission information

Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the 
Turnitin Drafts
 from the 
Start Here
 area.

To submit your completed assignment, save your Assignment as 
Wk8Assgn_LastName_Firstinitial

Then, click on 
Start Assignment
 near the top of the page.

Next, click on 
Upload File
 and select 
Submit Assignment
 for review.

Rubric

NRNP_6552_Week8_Case_Study_Assignment_Rubric

NRNP_6552_Week8_Case_Study_Assignment_Rubric

Criteria

Ratings

Pts

This criterion is linked to a Learning OutcomeAnalyzes subjective and objective data and outlines applicable diagnostic tests related to case studies.

30 to >26.7 ptsExcellent
The response provides clear, complete, and comprehensive descriptions of subjective and objective case data, appropriately outlining all diagnostic tests, clinical procedures and pharmacological interventions.

26.7 to >23.7 ptsGood
The response provides clear, complete partial descriptions of the components of the subjective and objective case data, appropriately outlining most of the diagnostic tests, clinical procedures and pharmacological interventions.

23.7 to >20.7 ptsFair
The response provides some components of the subjective and objective case data, but they are incomplete, vague or inaccurate, outlining some of the diagnostic tests, clinical procedures and pharmacological interventions.

20.7 to >0 ptsPoor
The response provides unclear or incomplete components of subjective and objective case data. The diagnostic tests, clinical procedures and pharmacological interventions are missing, incorrect, or inappropriately applied.

30 pts

This criterion is linked to a Learning OutcomeIdentifies differential diagnoses related to case studies.

30 to >26.76 ptsExcellent
The response contains at least 3 differential diagnoses relevant and applicable to the case.

26.76 to >23.7 ptsGood
The response contains at least 2 differential diagnoses relevant and applicable to the case.

23.7 to >20.7 ptsFair
The response contains at least 1 differential diagnosis relevant and applicable to the case.

20.7 to >0 ptsPoor
The response contains few or no differential diagnoses and/or diagnoses are not relevant and applicable to the case NRNP 6552 Week 8 Case studies – A 32-year-old African American woman presents to the clinic for her 24-week check-up..

30 pts

This criterion is linked to a Learning OutcomeFormulates a treatment plan related to case studies based on scientific rationale, evidence- based standards of care, and practice guidelines. Integrates ethical, psychological, physical, financial issues and Social Determinants of Health in plan.

30 to >26.76 ptsExcellent
Formulates a thorough treatment plan including explanations of appropriate diagnostic tests and treatment options. Fully incorporates syntheses representative of knowledge gained from the resources for the module and current credible sources, with no less than 75% of the treatment plan having exceptional depth and breadth. Supported by at least 3 current peer- reviewed, references or professional practice guidelines.

26.76 to >23.7 ptsGood
Formulates a partially complete treatment plan including partial explanations of appropriate diagnostic tests and treatment options. Somewhat incorporates syntheses representative of knowledge gained from the resources for the module and current credible sources with no less than 50% of the treatment plan having exceptional depth and breadth. Supported by at least 3 current peer- reviewed, references or professional practice guidelines.

23.7 to >20.7 ptsFair
Formulates a minimally complete treatment plan including incomplete or vague explanations of appropriate diagnostic tests and treatment options. Lacking in synthesis of knowledge gained from the resources for the module and current credible sources. Supported by at least 2 current peer- reviewed, references or professional practice guidelines.

20.7 to >0 ptsPoor
Formulates a treatment plan that contains incomplete explanations of appropriate diagnostic tests and treatment options and/ or explanations are missing. Lacks synthesis gained from the resources for the module and current credible sources. Supported by 1 or no current peer- reviewed, references or professional practice guidelines.

30 pts

This criterion is linked to a Learning OutcomeWritten Expression and Formatting – English writing standards:

Correct grammar, mechanics, and proper punctuation

5 to >4.45 ptsExcellent
Uses correct grammar, spelling, and punctuation with no errors.

4.45 to >3.95 ptsGood
Contains a few (1 or 2) grammar, spelling, and punctuation errors.

3.95 to >3.45 ptsFair
Contains several (3 or 4) grammar, spelling, and punctuation errors.

3.45 to >0 ptsPoor
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

5 pts

This criterion is linked to a Learning OutcomeWritten Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.

5 to >4.45 ptsExcellent
Uses correct APA format with no errors.

4.45 to >3.95 ptsGood
Contains a few (1 or 2) APA format errors.

3.95 to >3.45 ptsFair
Contains several (3 or 4) APA format errors.

3.45 to >0 ptsPoor
Contains many (≥ 5) APA format errors.

5 pts

Total Points: 100

 

NRNP 6552 Week 8 Case studies 

Case 1

A 48-year-old Asian American woman is concerned about thin bones. Her mother was diagnosed with osteoporosis at the age of 50 and fell at the age of 68 and fractured her hip and spent months in Rehab before being able to return home. The patient has no history of fractures.  The patient presents to the office to have her bones checked to see if she has “thin bones” Patient has no history of previous fractures: Patient states she went through Menopause at the age of 43-44 with no major problems. Patient was diagnosed with hypothyroid at at age 40. Patient does not drink. Smokes 1ppd for 20 yrs. Husband has been out of work for 9 months due to downsizing at his job. Pt works as an administrative assistant for a publisher but does not have health insurance at this time.

Pt had a melanoma removed from her left cheek in 2018; No hospitalizations except for childbirth x2

Family history: Paternal Grandmother died at age 78 due to heart disease. Paternal Grandfather died at age 83 due to heart attack. Maternal Grandmother died at age 82 cause unknown; Maternal Grandfather died from farm accident at age of 56. Mother is 75 alive with Osteoporosis diagnosed at age 50 and HTN diagnosed at age 63. Father is 77 alive with HTN diagnosed at age 45. Pt has two daughters alive and well with no medical problems.

Objective Info

Height 5’2’ Wt 105 lbs; BMI 19.2; 128/78; HR-72/min

•

HEENT: Normocephalic, no lumps/lesions

•

Neck: supple without adenopathy , no thyromegaly.

•

Lungs: Eupneic, CTA

•

CV: RRR, no murmurs, rubs or extra sounds noted; 2+ peripheral pulses, no edema noted

•

Breast: soft, fibrocystic changes bilaterally, without masses, dimpling or discharge

•

Abd: soft, +BS, no tenderness

•

MS: Full ROM in spine and shoulders. No tenderness, no spasms

•

T-Score is -1.2

Case 2

A 46-year-old Caucasian woman presents to the clinic complaining of breast pain. The patient state the pain is intermittent, in the right breast, the pain is sharp and has a burning sensation. She rates the pain as 7/10 at it worst. The patient states the pain sometimes interferes with her sexual activity. She has tried warm compresses, ibuprofen, and support bras with little improvement. Pt is on oral birth control pills and takes a daily vitamin.

Soc hx: Pt reports she sometimes eats nutritious meals, but due to her job and family obligations she does eat fast food frequently. Pt states she is an assistant accountant at a local accounting firm, which

adds to her stress especially at the end of each month and during tax season. She exercises 1-2 times/week by walking around the block. Sometimes the walking causes more pain in her breast. She drinks socially once or twice a month and has 1-2 glasses of wine at that time. She smokes 2 packs/day for last 22 yrs. She has tried to quit but has not been successful. Family history non-contributory.

Objective Info

Height 5’6” Wt 155 lbs; BMI 25; 140/78; HR-72/min

•

HEENT: Normocephalic, no lumps/lesions

•

Neck: supple without adenopathy , no thyromegaly.

•

Lungs: Eupneic, CTA-bilaterally

•

CV: RRR, no murmurs, rubs or extra sounds noted; 2+ peripheral pulses, no edema noted

•

Breast: Macromastia breasts are soft, fibrocystic changes bilaterally noted without masses, dimpling or discharge, no redness or inflammation noted.

Case 3

A 36-year-old Hispanic woman presents to the OB clinic for her Week 24 check-up, gravida 2 para 1. Patient is a full-time homemaker. Pt states she is doing well but is worried about her weight gain. Obstetric history includes a normal spontaneous vaginal delivery (NSVD) 31/2 yrs ago with a viable 9 lb male infant after a 10-hour labor. No complications during pregnancy, delivery or postpartum period. She denies allergies to food, drugs or the environment. Current meds include Prenatal vitamins 1/day and Fe 90 mg/day. Family history significant only for diet-controlled DM in paternal grandfather and an aunt and obesity in both mother and father.

Objective Info

Height 5’2” Wt 170 lbs; BMI 31.1; 140/84 (sitting); HR-92/min

•

HEENT: Normocephalic, no lumps/lesions

•

Neck: supple without adenopathy , no thyromegaly.

•

Lungs: Eupneic, CTA-bilaterally

•

CV: RRR, soft systolic murmur Grade II/VI, no rubs noted; 2+ peripheral pulses, no edema noted

•

Breast: Soft, fibrocystic changes bilaterally noted without masses, dimpling or discharge, no redness or inflammation noted. Breast self-exam reviewed

•

GU: Uterus at umbilicus-approximately 24 wks size and non-tender. FHT present with Doppler

Case 4

A 32-year-old African American woman presents to the clinic for her 24-week check-up. Pt states her morning sickness has resolved. However, she states she seems sad often and does not understand why, as she is happy about the pregnancy.

HPI: Pt is 24 weeks gestation. The patient is having sad moods at least once a day. She also states she is tired all the time, but figures that is just part of being pregnant, but has no energy and does not feel like doing her usual daily chores. She finds it difficult to go to work every day. This moodiness started about a week ago. She tried going to bed earlier but it did not seem to help. Taking 1 prenatal vitamin every day, No known drug, food, or environmental allergies. Family history is significant only for diet-controlled DM in paternal grandfather with onset in mid 40’s, Mother 58 yrs old is healthy; Father 60 yrs old with hx of DM with onset at age 45 and chronic depression which began in early 20s.

Objective Info

Height 5’4” Wt 147 lbs; BMI 25.2; 132/78 (sitting); HR-88/min

•

General: Appears well nourished, hair is in disarray, with flat affect

•

HEENT: Normocephalic, no lumps/lesions

•

Neck: supple without adenopathy , no thyromegaly.

•

Lungs: Eupneic, CTA-bilaterally

•

CV: RRR, soft systolic murmur Grade II/VI, no rubs noted; 2+ peripheral pulses, no edema noted

•

Breast: Soft, enlarged, fibrocystic changes bilaterally noted without masses, dimpling or discharge, no redness or inflammation noted. Breast self-exam reviewed

•

GU: Uterus at umbilicus- approximately 24 wks size and non-tender. FHT present with Doppler

NRNP 6552 Week 8 Case studies – A 32-year-old African American woman presents to the clinic for her 24-week check-up.

N3345 Transition to
 
Profes
sional
 
Nursing – Personal Philosophy of Nursing Essay Example

My Personal Philosophy of Nursing

Introduction

My personal philosophy stems from my understanding of nursing as a profession, practice, and science. It is rooted in the knowledge that nursing involves helping people pursue health goals. It extends beyond simply caring about a patient’s health to caring about other stakeholders like family, peers, and self. It encompasses pursuing professional goals and career growth, advancing the idea that the nurse can do more for nursing practice, profession, and science. It requires planning to examine the past, present, and future issues that inform nursing. I consider it an honor and a privilege to pursue a career in nursing, and I will continuously hold myself accountable.

Choice of Nursing

The choice to pursue a nursing education and career was not difficult. It is informed by the desire to make a difference, help others, and personal fulfillment. As a nurse, I will be able to make a difference in the lives of others by offering support, comfort, and hope. In addition, practicing as a nurse will enable me to provide care and support to my patients and their families, especially during difficult times when dealing with illness and other associated factors. Besides that, becoming a nurse is a personal fulfillment as nursing is a rewarding career that provides a sense of purpose (Harrison et al., 2021).

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When becoming a nurse, one expects to receive significant benefits. First, there is job security, as there is a shortage of nurses and practitioners in high demand. Nurses enjoy good job security. Second, there are travel opportunities, as nurses can work in various settings and locations. Ongoing changes in nurse licensing and credentialing and compacts provide travel opportunities for nurses capable of practicing across states. Third, there are opportunities for career advancement in nursing and other fields, such as care providers, healthcare managers, policy development, nurse educators, etc. Nurses develop transferable clinical and soft skills useful in different areas (Harrison et al., 2021).

Essence of Nursing

Historical developments, ethical principles, and political involvement guide nursing. First, historical developments have guided nursing, as noted by the distinction between early and modern nursing. Nursing has its roots in the concepts of healing, expertise, and compassion from ancient civilizations. It has evolved from care provided on a religious basis to a medical focus. Early nursing can be traced to the 4
th
century, when it was documented as a charitable practice involving nuns providing care in religious places, such as monasteries. Modern nursing emerged with advancements and innovations that turned nursing into a profession and career that emphasized evidence-based practice, compassion, and cleanliness, linked health with environmental factors, developed nursing standards and principles, and provided nursing education (DeNisco, 2023).

Second,
ethical principles guide nursing
, as nurses have responsibilities to other stakeholders. They guide how they think, act, and make decisions. The American Nurses Association developed the first formal code of ethics in the 1950s, presenting provisions to guide nurses in daily practice. Since then, ethics has become a core feature in nursing, with nurses required to consider the consequences of their actions when making decisions. Additionally, there is an expectation that nurses would participate in advocacy to promote patient rights and safety (DeNisco, 2023).

Third, political factors influence nursing by creating an environment where nurses practice through legislation and policies. This has primarily been seen in political-ethical conflicts requiring nurses to choose between patient care, job, and personal ideals, such as abortion. In addition, political involvement has been influential in nursing. Nurses use it as a guide to evaluate issues, plan for activism, and assess the effectiveness of strategies applied in demanding change within the healthcare system (DeNisco, 2023).

Beliefs and Values

As an individual, I have a set of beliefs and values that guide me in daily interactions with others. First, I have beliefs about patients. They should be viewed as partners in their healthcare journey and treated with respect and dignity as individuals with unique preferences and needs. Each patient’s autonomy should be recognized while providing personalized care tailored to the patient’s specific situation, even while fostering a trusting relationship based on empathy and open communication (Walsh, 2020).

Second, I have beliefs about the patient’s family and significant others. They are the patient’s relatives, friends, neighbors, and other important individuals. In addition, they are conceptualized as the relationships, reciprocity, and interaction between multiple systems. Besides that, they are a unit of care, and their involvement as care partners is vital to providing quality healthcare since they can be involved in various supporting roles as proxy/surrogate decision-makers, care providers, emotional support, and accompany the patient to healthcare appointments and procedures (Walsh, 2020).

Third, I have beliefs about fellow healthcare providers. They should be collaborative partners in delivering patient care. Each provider brings unique expertise into play and may present varying perceptions depending on workplace dynamics and individual experiences. However, all healthcare providers have a shared goal of delivering the best possible treatment for each patient and prioritizing mutual respect and open communication (Walsh, 2020).

Fourth, I have beliefs about my own health. I desire to be well, and this responsibility enhances my well-being and allows me to support others in their health journeys. My health decisions and behaviors are influenced by my perception of my current health status, including confidence in my ability to manage my health through specific actions, severity of potential health risks, and perceived susceptibility to illness (Walsh, 2020).

Vision for the Future

As a nurse, my vision for the next two years is to fully master basic nursing skills, confidently manage my patient load, effectively communicate with patients, their families, and healthcare team members, and develop leadership abilities by taking on additional responsibilities at work. I will also start exploring further education options and nursing specializations while seeking out opportunities to learn advanced procedures.

In five years,
I envision myself as an experienced and skilled nurse
. I will have identified a specialized area of practice and will actively seek assignments in units that specialize in that area. In addition, I envision myself taking on leadership roles to improve nursing practice and advocate for patients within the healthcare system, actively participating in healthcare decision-making, and utilizing advanced technologies to optimize patient care plans.

In ten years, I envision myself having obtained advanced professional qualifications, licensure, and certification as a specialist. I expect to develop into a highly skilled and versatile healthcare provider specializing in a specific nursing area like telehealth or critical care, utilizing advanced technologies to deliver personalized care, and being involved in patient advocacy. In addition, I will be actively participating in leadership roles to address the social determinants of health, prioritize holistic patient care, improve healthcare access, and shape the future of nursing.

Summary

As an individual, I have key strengths that will support achieving my professional goals. I have perseverance and the ability to overcome difficulties and complete assigned tasks. This personality trait enables me to complete tasks regardless of the challenges encountered, indicating commitment when facing obstacles. The perseverance trait helps encourage positive change by promoting improvements through completion. In addition, I am patient, a personality trait that is beneficial in the nursing profession. Patience is essential when working with patients who may not show immediate results. Being patient allows me to pursue professional goals, mitigate automatic responses, and improve relationships with others. Besides that, I am a problem solver, a strength that helps me identify issues and brainstorm, test, and implement solutions. I apply creativity and critical thinking in analyzing problems and imagining possible solutions. This will enable me to be adaptive and flexible in pursuing professional goals. N3345 Transition to Professional Nursing –
Personal Philosophy
of Nursing Essay Example Additionally, I can plan and organize my space and time, a strength that allows me to maintain an orderly space, meet deadlines, and prioritize work. This will enable me to manage my efforts in pursuing the set goals, estimate the time required to complete the goals accurately and prioritize activities to ensure the goals are achieved.

I must overcome limitations to achieve my professional goals. First, I must
address knowledge and skills
gaps, as the lack of required skills will limit my professional opportunities. This will be addressed through continuous education and training to acquire the necessary skills. Second, I must address the lack of experience. A lack of relevant work experience makes it difficult to take on desired roles. This will be addressed through volunteer work and relevant projects. Third, limited networking, as not building strong professional relationships, can hinder opportunities for professional growth and referrals. This will be addressed by contacting other professionals and participating in professional events and networking groups. Addressing the mentioned limitations is important because they identify areas where I might fall short, enable me to proactively develop needed skills, and adjust my career path to align with my strengths, maximizing my professional growth and success while minimizing stagnation and frustration.

References

DeNisco, S. M. (2023).
Advanced Practice Nursing: Essential Knowledge for the Profession
(5th ed.). Jones & Bartlett Learning, LLC.

Harrison, H., Mills, J., & Birks, M. (Eds.) (2021).
Transition to Nursing Practice: From Student to Professional
. Oxford University Press.

Walsh, D. (2020). 
The Nurse Mentor’s Handbook: Supporting Students in Clinical Practice
(3rd ed.). McGraw-Hill Education.

 

N3345 Transition to
 
Profes
sional
 
Nursing – Personal Philosophy of Nursing Essay ExampleRubric

Content
 
Criteria

Section
 
or

Section
 
Title

Description

How-To
 
and
 
Tips
 
Use

Entire
 
paper

●1″margins all around

●Double-spaced

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Fonts:

 

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●  10-point Lucida Sans Unicode  ·12-point   Times   New   Roman

●  11-point Georgia

·10-point Computer Modern 1

●Professional grammar, spelling, and

punctuation, and paragraphs composed

of at least 3 well-written sentences each

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·Select  Format-Paragraph..

·Select View-Header and Footer..

(Refer to the MS Word “Help and

How To”links if you need help with any of these tasks.) N3345 Transition to Professional Nursing – Personal Philosophy of Nursing Essay Example

Title
 
Page

·The title page should contain the title of the paper (Bold),the
student’s

name,

and the
institutiona
l
 
affiliation
.

●Type your t
itle
 in upper and lowercase

letters centered in the upper half of the page.The title should be centered and

written in boldface

 

·Your title may take up one or two lines

● A student paper should also include th
e
 
course
 
number
 
and

name, instructor
 
name,

and
the 
assignment
 
due
 
dat
e.

 

 

 

 

 

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FLigAmraNyc                         cm

 

 

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Introduction

Overview of the paper(1-2 paragraphs)

*just a note,do not use an abstract, just type a formal introduction.

Put title of paper at the top of this

page: centered, bold,and in Title Case.

No section title for the introduction just start paragraphs(Remember to

indent each paragraph and double space)

 

 

 

Choice
 
of
 
Nursing

Why did you choose nursing?(2-3 paragraphs)

Insert Section title, centered, bolded, and Title Case.

Then start paragraphs.

Essence
 
of
 
Nursing

What do you believe the core of nursing is and should be? Correlate historical, ethical, and political factors influencing professional nursing practice.Y
ou
 
must
 
answer
 
all
 
3

factors
 
for
 
full
 
credit
(2-3  paragraphs)

Insert Section title,centered, bolded,and Title Case.

Then start paragraphs.

(Do not start a new page;just

continue in regular double-spaced body.)

Beliefs
 
and
 
Values

What do you believe about patients?(1 paragraph)

What do you believe 
about the patient’s

family and significant others?(1 paragraph)

What do you believe about your fellow health care providers?

(1 paragraph)

What do you believe about your own health?(1 paragraph)

Insert Section title, centered, bolded, and Title Case.

Then start paragraphs.

(Do not start a new page; just

continue in regular double-spaced body.)

Vision
 
for
 
the
 
Future

What do you want to be doing in 2 years? (1 paragraph)5 years?(1 paragraph)10

years?(1 paragraph)

Insert Section title, centered, bolded, and Title Case.

Then start paragraphs
.

(Do not start a new page;just

continue in regular double-spaced body.)

Summary

What strengths do you have that will support your achievement of your

professional goals?(1 paragraph)

What limitations will you need to overcome to achieve your professional goals?(1

paragraph)

Insert Section title, centered, bolded, and Title Case.

Then start paragraphs.

(Do not start a new page;just

continu
e
 
in regular
 
double-s
paced body.)

References

References

centered on top of page

·At least 2 professional references.

·Put references in alphabetical order by author’s name.

“References”should be centered at the top of the page just below the header, bold.

 

 

Save your N3345 Transition to Professional Nursing – Personal
Philosophy of Nursing
Essay Example assignment document in MS Word 2010 version  and above. Open Office and Office 360 documents will need to be saved as MS Word 2010

Case 1

A 48-year-old Asian American woman is concerned about thin bones. Her mother was diagnosed with osteoporosis at the age of 50 and fell at the age of 68 and fractured her hip and spent months in Rehab before being able to return home. The patient has no history of fractures.  The patient presents to the office to have her bones checked to see if she has “thin bones” Patient has no history of previous fractures: Patient states she went through Menopause at the age of 43-44 with no major problems. Patient was diagnosed with hypothyroid at at age 40. Patient does not drink. Smokes 1ppd for 20 yrs. Husband has been out of work for 9 months due to downsizing at his job. Pt works as an administrative assistant for a publisher but does not have health insurance at this time.

Pt had a melanoma removed from her left cheek in 2018; No hospitalizations except for childbirth x2

Family history: Paternal Grandmother died at age 78 due to heart disease. Paternal Grandfather died at age 83 due to heart attack. Maternal Grandmother died at age 82 cause unknown; Maternal Grandfather died from farm accident at age of 56. Mother is 75 alive with Osteoporosis diagnosed at age 50 and HTN diagnosed at age 63. Father is 77 alive with HTN diagnosed at age 45. Pt has two daughters alive and well with no medical problems.

Objective Info

Height 5’2’ Wt 105 lbs; BMI 19.2; 128/78; HR-72/min

•

HEENT: Normocephalic, no lumps/lesions

•

Neck: supple without adenopathy , no thyromegaly.

•

Lungs: Eupneic, CTA

•

CV: RRR, no murmurs, rubs or extra sounds noted; 2+ peripheral pulses, no edema noted

•

Breast: soft, fibrocystic changes bilaterally, without masses, dimpling or discharge

•

Abd: soft, +BS, no tenderness

•

MS: Full ROM in spine and shoulders. No tenderness, no spasms

•

T-Score is -1.2

 

Case 4

A
32-year-old African American woman presents to the clinic for her 24-week check-up
. Pt states her morning sickness has resolved. However, she states she seems sad often and does not understand why, as she is happy about the pregnancy.

HPI: Pt is 24 weeks gestation. The patient is having sad moods at least once a day. She also states she is tired all the time, but figures that is just part of being pregnant, but has no energy and does not feel like doing her usual daily chores. She finds it difficult to go to work every day. This moodiness started about a week ago. She tried going to bed earlier but it did not seem to help. Taking 1 prenatal vitamin every day, No known drug, food, or environmental allergies. Family history is significant only for diet-controlled DM in paternal grandfather with onset in mid 40’s, Mother 58 yrs old is healthy; Father 60 yrs old with hx of DM with onset at age 45 and chronic depression which began in early 20s.

Objective Info

Height 5’4” Wt 147 lbs; BMI 25.2; 132/78 (sitting); HR-88/min

 

Case # (1, 2, 3 or 4) and Description of the Case Chosen:

 

Case 1

Case 2

Case 3

Case 4

 

 

 

Outline Subjective data.

 

Identify data provided in your chosen case and any additional data needed.

Outline

Objective findings.

 

Identify findings provided in your chosen case and any additional data needed.

Identify diagnostic tests, procedures, laboratory work indicated.

 

Describe the rationale for each test or intervention with supporting references.

Distinguish at least three differential diagnoses.

 

Describe the rationales for your choice of each diagnosis with supporting references.

Identify appropriate medications, treatments or other interventions associated with each differential diagnosis.

 

Describe rationales and supporting references for each.

 

Explain key

Social Determinants of Heath (SDoH) for your chosen case.

Describe collaborative care referrals and patient education needs for your chosen case.

 

Describe rationales and supporting references for each.

The Camera’s Impact on 19
th
Century Art

The invention of the camera in the 19th century changed the ways of the arts, breaking the rules of traditional arts and creating new branches of arts. Artists feared that photography would rob painting of its raison d’être, which helped art go forward (Nemnom, 2021). The camera’s ability to capture reality with such precision forced painters to try and abstract and feel, and take the camera’s point of view as a new perspective, resulting in movements like Impressionism.

Artists like Claude Monet were very influenced by photography and were very much an impressionist artist. Monet’s Impression, Sunrise (1872), reflects the fleeting moments of light and color as a camera does to freeze time. There was also a quality of spontaneity, of movement, inspired by the types of movement and acts implied by the photographic techniques. Photographer Henri Cartier-Bresson states, “Photography is the simultaneous recognition in a fraction of a second of the significance of an event.” Impressionists found this idea of capturing the ‘decisive moment’ to ring true, as they wanted to capture the transient effect of light and atmosphere (Patey, 2022).

The camera also changed the subject of art (Smith et al., 2019). With no longer any realistic representation to adhere to, artists began to let go of form and perspective, breeding the way for modern art. Therefore, the camera did not replace art but opened new doors for art and its possibilities.

References

Nemnom, C. (2021). 
Losing Sight to Gain Vision: The Eye in European Surrealist Painting
 (Doctoral dissertation, Concordia University).
https://spectrum.library.concordia.ca/id/eprint/988992/

Patey, D. L. S. (2022). Photography in the virtual (Master’s thesis).
https://www.duo.uio.no/handle/10852/96267

Smith, M. L., Smith, L. N., & Hansen, M. F. (2021). The quiet revolution in machine vision-a state-of-the-art survey paper, including historical review, perspectives, and future directions. 
Computers in Industry
, 
130
, 103472.
https://www.sciencedirect.com/science/article/pii/S0166361521000798

 

The Camera’s Impact on 19th Century Art

Option 1: In the 19th century, the camera was a revolutionary invention, and many artists were concerned about the effect that photographs would have on the art world.

Did the invention of the camera change the arts? Why or why not?

Choose an artistic movement that you believe was influenced by the camera and discuss how the movement was affected.

Include at least one example of an artist and artwork in your response.

Include a statement from a current photographer or critic to support your points.

Option 2: In the 21st century, the smartphone camera changed the way we use and view photography. In addition, apps and social media have changed the way we share photography.

How has the invention of the smartphone camera changed photography?

How have apps and social media changed the way we share photos? Are they positive and/or negative changes? Explain.

Include a statement from a current photographer or critic to support your points The Camera’s Impact on 19th Century Art

Laura is a 16-year-old Caucasian G1P0. She presents to your office after missing her second period.

Case #1. Teresa.

History of Present Illness (HPI):
Teresa is a 34-year-old Hispanic G2P2002
. She presents to your office today at 10-weeks post-partum (PP) for her 6-week PP check. She underwent a C-section for failure to progress following a 20-hour labor with Pitocin augmentation. She was discharged from the hospital on

day 2 post-partum without complications. Teresa has had difficulty with breast feeding due to discomfort in her suture line and terrible pain in her right breast since her discharge from the hospital. She reports occasional chills- she has not measured her temperature at home. Teresa was seen by the lactation consultant while in the hospital but “nothing is working” and her son “cries all the time”. She is afraid to feed her son formula as her mother-in-law wants her to “keep trying to breastfeed”. Teresa tells you she feels as if she has failed her son- “it was so easy with my first baby, I know my husband thinks I am a bad mother”.

Prior medical history: None. Prior surgical history: Appendectomy (2000)

Current medications: Prenatal vitamins, stool softener. Allergies: None

OB- GYN History: NSVD (2019) healthy female 7lb 10oz; C-section healthy male 8 lbs. 8 oz as per HPI.

Menarche age 12, cycle length- 5 days- frequency every 28 days- 4-5 tampons per day. No history of sexually transmitted infections (STDs). History of abnormal pap smear in 2019 which was followed by a normal colposcopy. Last pap (during recent prenatal care) reported normal. HIV negative.

LMP: First PP menstrual cycle last week. Has not resumed sexual activity PP. Contraception history: Oral contraceptives, condoms.

Social history: Lives with husband, mother- in- law, and children. Stay at home mom. Denies EtOH or recreational drug use, never smoker. Her family speaks Spanish at home; she is fluent in English.

Family history: Unremarkable.

Review of Systems (ROS): Negative except as noted in HPI.

Physical Exam (PE)

VS: BP: 110/70, P: 90, RR: 18, T: 38.4, Weight: 132 lbs.

Teresa’s C-section suture line is healing well without erythema or tenderness. No vaginal discharge or lesions, no cervical motion tenderness (CMT), uterus normal size firm and non-tender. On breast exam, you do note an erythematous, swollen, and painful area to the right breast. Her physical exam is otherwise unremarkable.

Case #4. Laura.

History of Present Illness (HPI): Laura is a 16-year-old Caucasian G1P0. She presents to your office after missing her second period. She is “worried” as she “always gets her period on time”. She is in high school- about to enter the 11th grade. She lives with her grandmother and 2 older siblings. Her urine

pregnancy test in clinic today is positive.

Laura is sexually active with her boyfriend; they do not use condoms. He “pulls out” as birth control. She reports being treated at the health department for chlamydia and gonorrhea earlier this year. She thinks her boyfriend was treated but he is not answering her calls since she told him about the missed

periods a few weeks ago. She reports daily nausea, vomiting and dysuria for the past 2 weeks.

Prior medical history: None. Prior surgical history: None

Current medications: None. Allergies: None

OB- GYN History: Menarche age 12, cycle length-7 days- frequency every 30 days- 2 tampons per day.

History of chlamydia and gonorrhea (GC) in the past year. Last pap reported normal at the time of

chlamydia/ GC diagnosis. Has not received Human Papillomavirus (HPV) vaccine.

LMP: Approximately 2 months ago. Contraception history: Withdrawal

Social history: Lives with her grandmother, siblings. Denies EtOH or recreational drug use. Currently

smoking 1 pack of cigarettes/ day

Family history: Mother deceased at age 42- drug overdose. Father unknown.

Review of Systems (ROS): Unremarkable with exception of as noted in HPI.

Physical Exam (PE)

VS: BP: 110/68, P: 80, RR: 18, T: 37.1 Weight: 110 lbs. (states usual weight 120 lbs.).

Physical exam is unremarkable with exception of a cloudy, yellow mucoid cervical discharge on speculum

exam; friable appearance of the cervix with cervical motion tenderness (CMT). You palpate an 8-week

size uterus on bimanual.

Laura’s urine reveals 2+ ketones, 2+ nitrates, and 3+ leukocytes.

Case 5: Denise.

Denise is a 30-year-old Black female G0 with a history of seizure disorder who presents to clinic for her annual well visit. She is excited to tell you that she is getting married in 2 months and they are planning to start a family “right away”. Denise went to see her gynecologist last month who told her she was “young and healthy- not to worry, everything will work out fine”. No labs were done at the gyn visit; she hasn’t started prenatal vitamins. She comes to see you today as she “wants to be sure that she is up to date on everything she needs” before the wedding.

Prior medical history: Seizure disorder (diagnosed at age 18). Prior surgical history: None

Current medications: Levetiracetam 500mg 2 times a day. Allergies: None

Reports she believes she has had all childhood vaccinations. Has not received COVID or influenza vaccines. She is not sure about Hepatitis B or Tdap.

OB- GYN History: G0. Menarche age 14, cycle length-5 days- frequency every 28 days- 2-3 pads per day. No history of sexually transmitted infection. Last PAP 2020, no history of abnormal PAP. Has not received Human Papillomavirus (HPV) vaccine. Her only sexual partner is her current fiancé (male). LMP was approximately 2 weeks ago. Contraception history: Condoms.

Social history: Sixth grade teacher. Lives with her fiancé. Denies EtOH or recreational drug use. Has never smoked cigarettes or vaped.

Family history: Mother (age 56) alive and well. Father deceased at age 50 from lung cancer (smoker). Sister aged 21- healthy. Maternal grandmother alive age 88 (hysterectomy for fibroid uterus). Maternal grandfather deceased age 78 (unknown cause). Paternal grandparents- unknown.

Review of Systems (ROS).

Constitutional: No Weight Change, No Fever, No Chills, No Night Sweats, No Fatigue, No Malaise

ENT/Mouth: No Hearing Changes, No Ear Pain, No Nasal Congestion, No Sinus Pain, No Hoarseness, No sore throat, No Rhinorrhea, No Swallowing Difficulty

Eyes: No Eye Pain, No Swelling, No Redness, No Foreign Body, No Discharge, No Vision Changes

Cardiovascular: No Chest Pain, No SOB, No Dyspnea on Exertion, No Orthopnea, No Claudication, No Edema, No Palpitations

Respiratory: No Cough, No Sputum, No Wheezing, No Smoke Exposure, No Dyspnea

Gastrointestinal: No Nausea, No Vomiting, No Diarrhea, Occasional Constipation (managed with diet), No Pain, No Heartburn, No Anorexia, No Dysphagia, No Hematochezia, No Melena, No Flatulence, No Jaundice

Genitourinary: No Dysmenorrhea, No Abnormal Vaginal Bleeding, No Dyspareunia, No Dysuria, No Urinary Frequency, No Hematuria, No Urinary Incontinence, No Urgency, No Flank Pain, No Urinary Flow Changes, No Hesitancy

Musculoskeletal: No Arthralgias, No Myalgias, No Joint Swelling, No Joint Stiffness, No Back Pain, No Neck Pain, No Injury History

Skin: No Skin Lesions, No Pruritis, No Hair Changes, No Breast/Skin Changes, No Nipple Discharge

Neuro: No Weakness, No Numbness, No Paresthesia, No Loss of Consciousness, No Syncope, No Dizziness, No Headache, No Coordination Changes. Last reported seizure was 10 years ago. Followed by neurologist- last seen in 2023.

Psych: No Anxiety/Panic, No Depression, No Insomnia. No Memory Changes. Denies Violence/Abuse, No Eating Concerns

Heme/Lymph: No Bruising, No Bleeding, No Transfusion History, No Lymphadenopathy

Endocrine: No Polyuria, No Polydipsia, No Temperature Intolerance

Physical Exam (PE).

VS: BP: 130/84, P: 80, RR: 18, T: 37.1, Weight: 118 lbs. BMI 19.0

General: Awake, alert, and oriented. No acute distress. Well developed, hydrated, and nourished. Appears stated age.

Skin: Skin in warm, dry, and intact without rashes or lesions. Appropriate color for ethnicity. Nailbeds pink with no cyanosis or clubbing.

Head: The head is normocephalic and atraumatic without tenderness, visible or palpable masses, depressions, or scarring. Hair is of normal texture and evenly distributed.

Eyes: Conjunctivae are clear without exudates or hemorrhage. Sclera is non-icteric. No signs of nystagmus. Eyelids are normal in appearance without swelling or lesions.

Ears: The external ear and ear canal are non-tender and without swelling.

Laura is a 16-year-old Caucasian G1P0. She presents to your office after missing her second period.