Nursing

/in /by

1. Identify a local, national, or global crisis that has occurred in the past 10 years. 

2. What are key strategies to address your specified crisis (search and reference disaster management strategies used by WHO, CDC, State Department of Health, and/or Public Health Emergency Preparedness Agency (national, state, or local community).

3. For your specified crisis, describe applicable health and safety hazards of disasters and public health emergencies. 

4. Emergency preparedness brings up rights of the individual versus the good of all (ethics/social justice). Identify and discuss an issue from the course resources that illustrate this potential conflict related to your specified crisis.

5. As nurses you will be on the front line in emergency preparedness. Describe moral/ethical issues that may arise for you personally/professionally related to responding to crises? Refer to course content.

Disscusion Boards

/in /by

Discussion Board 1.

Specifically define the role of the registered nurse in patient advocacy. Describe situations in which nursing advocacy can assist patients within the healthcare environment. Defend why nurses are, or are not, adequately prepared, in pre-licensure education, to act as patient advocates. 

Compose at least 2-3 paragraphs all in APA format with proper references.

Discussion Board 2.

The ANA Code of Ethics currently emphasizes the word “patient” instead of the word “client” in referring to nursing care recipients. Do you agree with this change? Why or why not? Review the ANA Code of Ethics for Nurses.

Compose at least 2-3 paragraphs all in APA format with proper references.

Diary of Medical Mission Trip”

/in /by

Watch the “Diary of Medical Mission Trip” videos dealing with the catastrophic earthquake in Haiti in 2010. Reflect on this natural disaster by answering the following questions:

  1. Propose one example of a nursing intervention related to the disaster from each of the following levels: primary prevention, secondary prevention, and tertiary prevention. Provide innovative examples that have not been discussed by previous students.
  2. Under which phase of the disaster do the three proposed interventions fall? Explain why you chose that phase.
  3. What people or agencies would you work with in facilitating the proposed interventions and why?

Evidence-Based Patient-Centered Needs Assessment

/in /by

Scenario

The purpose of a needs assessment is to identify priorities of a community or patient population. The findings of a needs assessment can be an extremely useful tool to help organize and plan care decisions for a specific patient or group. By conducting a needs assessment, a nurse can then use the best evidence to guide the interventions selected to meet the identified needs and improve patient engagement. 

Full instructions in attachment “Assessment 1 Instructions_Evidence-Based Patient-Centered”

another

/in /by

Introduction

Whether you are a nurse, a public health professional, a health care administrator, or in another role in the health care field, you must base your decisions on a set of ethical principles and values. Your decisions must be fair, equitable, and defensible. Each discipline has established a professional code of ethics to guide ethical behavior. In this assessment, you will practice working through an ethical dilemma as described in a case study. Your practice will help you develop a method for formulating ethical decisions.

Instructions

Note: The requirements outlined below correspond to the grading criteria in the scoring guide. At a minimum, be sure to address each point. In addition, you are encouraged to review the performance-level descriptions for each criterion to see how your work will be assessed.

For this assessment, develop a solution to a specific ethical dilemma faced by a health care professional. In your assessment:

1. Access the 

Ethical Case Studies
 media piece to review the case studies you will be using for this assessment.

· Select the case most closely related to your area of interest and use it to complete the assessment.

·
Note: The case study may not supply all of the information you need. In such cases, you should consider a variety of possibilities and infer potential conclusions. However, please be sure to identify any assumptions or speculations you make.

· Include the selected case study in your reference list, using proper APA style and format. Refer to the 

Evidence and APA
 section of the Writing Center for guidance.

2. Summarize the facts in a case study and use the three components of an ethical decision-making model to analyze an ethical problem or issue and the factors that contributed to it.

· Identify which case study you selected and briefly summarize the facts surrounding it. Identify the problem or issue that presents an ethical dilemma or challenge and describe that dilemma or challenge.

· Identify who is involved or affected by the ethical problem or issue.

· Access the 

Ethical Decision-Making Model
 media piece and use the three components of the ethical decision-making model (moral awareness, moral judgment, and ethical behavior) to analyze the ethical issues.

· Apply the three components outlined in the Ethical Decision-Making Model media.

· Analyze the factors that contributed to the ethical problem or issue identified in the case study.

· Describe the factors that contributed to the problem or issue and explain how they contributed.

3. Apply academic peer-reviewed journal articles relevant to an ethical problem or issue as evidence to support an analysis of the case.

· In addition to the readings provided, use the Capella library to locate at least one academic peer-reviewed journal article relevant to the problem or issue that you can use to support your analysis of the situation. The 

NHS-FPX4000: Developing a Health Care Perspective Library Guide
 will help you locate appropriate references.

· Cite and apply key principles from the journal article as evidence to support your critical thinking and analysis of the ethical problem or issue.

· Review the 

Think Critically About Source Quality
 resource.

· Assess the credibility of the information source.

· Assess the relevance of the information source.

4. Discuss the effectiveness of the communication approaches present in a case study.

· Describe how the health care professional in the case study communicated with others.

· Assess instances where the professional communicated effectively or ineffectively.

· Explain which communication approaches should be used and which ones should be avoided.

· Describe the consequences of using effective and non-effective communication approaches.

5. Discuss the effectiveness of the approach used by a professional to deal with problems or issues involving ethical practice in a case study.

· Describe the actions taken in response to the ethical dilemma or issue presented in the case study.

· Summarize how well the professional managed professional responsibilities and priorities to resolve the problem or issue in the case.

· Discuss the key lessons this case provides for health care professionals.

6. Apply ethical principles to a possible solution to an ethical problem or issue described in a case study.

· Describe the proposed solution.

· Discuss how the approach makes this professional more effective or less effective in building relationships across disciplines within his or her organization.

· Discuss how likely it is the proposed solution will foster professional collaboration.

7. Write clearly and logically, with correct use of spelling, grammar, punctuation, and mechanics.

· Apply the principles of effective composition.

· Determine the proper application of the rules of grammar and mechanics.

8. Write using APA style for in-text citations, quotes, and references.

· Determine the proper application of APA formatting requirements and scholarly writing standards.

· Integrate information from outside sources into academic writing by appropriately quoting, paraphrasing, and summarizing, following APA style.

Example Assessment: You may use the following to give you an idea of what a Proficient or higher rating on the scoring guide would look like:

·

Assessment 3 Example [PDF]


 Download Assessment 3 Example [PDF]
.

Additional Requirements

Your assessment should also meet the following requirements:

·
Length: 3–5 typed, double-spaced pages, not including the title page and reference page.

·
Font and font size: Times New Roman, 12 point.

·
APA tutorial: Use the 

APA Style Paper Tutorial [DOCX]
 for guidance.

·
Written communication: Use correct spelling, grammar, and punctuation.

·
References: Integrate information from outside sources to include at least two references (the case study and an academic peer-reviewed journal article) and three in-text citations within the paper.

·
APA format: Follow current APA guidelines for in-text citation of outside sources in the body of your paper and also on the reference page.

Nursing Research

/in /by

  

  

Assignment

The background and significance (B&S) paper is a five (5) page paper in APA format (excluding title page, abstract, references and appendices) that could form the introductory section of your clinical scholarly project. 

The B&S will introduce a clinical problem and the clinical context that led you to identify the clinical question. You will review the relevant background literature and theory related to the problem. You will discuss the relevance of this review to a local clinical setting at the unit, organizational, metropolitan, state, national, and international levels as applicable. 

You will discuss the potential benefits and challenges of addressing the clinical question in the local setting, and explore the larger contextual impact related to this problem. 

Please note, this paper will discuss the introductory background literature and theoretical basis related to a clinical problem. 

Clinical Topic Assigned: The Prevalence of Depression and Suicide Ideation Among Adolescents.

Nursing 9-1

/in /by

 In a 5–7 page written assessment, define the patient, family, or population health problem that will be the focus of your capstone project 

STRATEGIES FOR ACADEMIC PORTFOLIOS

/in /by

To Prepare:

  • Reflect on strategies that you can pursue in developing portfolios or portfolio elements that focus on academic achievements.
  • Review one or more samples from your own research of resources focused on portfolio development.

BY DAY 3

Post an explanation of at least two strategies for including academic activities and accomplishments into your professional development goals. Then, explain how those goals may align with the University’s emphasis on social change. Be specific and provide examples.

A little about me: I am a behavioral health nurse with 6 years of experience, currently completing my masters in psychiatry nursing 

ASSESSING THE GENITALIA AND RECTUM

/in /by

 

Using evidence-based resources from your search, answer the following questions and support your answers using current evidence from the literature.

  • Analyze the subjective portion of the note. List additional information that should be included in the documentation.
  • Analyze the objective portion of the note. List additional information that should be included in the documentation.
  • Is the assessment supported by the subjective and objective information? Why or why not?
  • Would diagnostics be appropriate for this case, and how would the results be used to make a diagnosis?
  • Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature.

reply1,2

/in /by

·
List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.

When assessing this patient, it's important to ask questions that will help the provider understand the underlying causes and potential treatment options. Given the patient's recent loss and significant life changes, it's crucial to approach the assessment with sensitivity. Here are three questions I'd like to ask, along with their rationales:

1. Have you observed any changes in your sleep pattern, mood, or feelings since your husband passed away?

Rationale: This question allows the patient to provide insight into the nature and duration of her sleep disturbances and changes in her mood or feelings. Understanding the onset and progression of depression symptoms can related to her recent bereavement following her husband's passing.

2. Could you describe your emotions and have you ever experienced thoughts of self-harm or suicide?

Rationale: This question aims to comprehend a person's emotional state and evaluate the presence of suicidal thoughts or self-harm ideation. It's important to ask such questions without delay in treatment. Since the patient has a history of major depressive disorder (MDD), and her depression has worsened, it's crucial to explore her emotional state.

3. How have you been coping with the loss of your husband, and have you sought support or counseling to help you through this difficult time?

Rationale: Inquiring about coping strategies and support systems is essential for assessing the patient's resilience and identifying potential sources of assistance. Grief counseling or therapy can be invaluable in helping individuals navigate the complex emotions associated with loss. Additionally, it's important to assess whether the patient has been utilizing any resources to manage her depression.

·
Identify people in the patient's life you would need to speak to or get feedback from to further assess the patient's situation. Include specific questions you might ask these people and why.

To gain a more comprehensive understanding of the patient's situation and evaluate her social support network, I would identify individuals in the patient's life, such as family members or close friends. Engaging in conversations with these individuals can be beneficial because they may have insights into the patient's emotional well-being and daily functioning. I would ask Questions like: “Could you please share any observations regarding alterations you may have noticed in the patient's behavior, mood, or sleep patterns following her husband's passing?” Family members and close friends are often the first to detect significant shifts in a person's behavior and emotional state. Their observations can offer valuable insights into the patient's emotional condition and the way the loss of her husband has affected her daily life.

·
Explain what, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used.

In evaluating a 75-year-old patient with a chief complaint of insomnia and depression, diabetes (DM), and hypertension (HTN), a thorough assessment should include both physical exams and diagnostic tests: A physical examination should include checking blood pressure, heart rate, heart sounds, peripheral pulses, respiratory rate, and temperature. It should also involve assessing the patient's overall appearance and evaluating their general health.  In addition, assessing mental status, cognitive function, and neurological signs can help identify any neurological issues that may be contributing to sleep disturbances. Consider arranging a sleep study, also known as polysomnography (PSG). This medical test monitors various physiological functions while a person sleeps.

Diagnostic Tests include the following Blood Tests: Complete Blood Count (CBC) will check for anemia or other blood-related issues that can affect sleep and overall health; a Comprehensive Metabolic Panel (CMP), assess kidney and liver function, electrolytes, and glucose levels; The HbA1c (Glycated Hemoglobin) test can monitor her long-term blood glucose control, can provide valuable insights into her diabetes management. The results of these exams and tests will inform a comprehensive treatment plan tailored to the patient's specific needs.

·
List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.

When assessing a patient with insomnia, along with chronic medical conditions like diabetes and hypertension, this patient likely has Major Depressive Disorder (MDD). She had no history of MDD before her husband's passing, and the current worsening of her depression may be attributed to his death. Although anxiety can cause insomnia problems, MDD with Bereavement seems most likely. However, we need to ensure there aren't other underlying causes, such as sleep problems or medical issues. To do that, we should conduct thorough assessments and laboratory tests. She needs to seek help from both her regular doctor and a mental health professional to find the right treatment and support.

·
List two pharmacologic agents and their dosing that would be appropriate for the patient's antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.

When selecting pharmacologic agents for this 75-year-old patient, the choice of antidepressant therapy should consider pharmacokinetics and pharmacodynamics. Reduced kidney and liver function in elderly individuals can potentially affect both pharmacokinetics and pharmacodynamics.

SSRIs, such as sertraline (Zoloft) and escitalopram (Lexapro), are two preferred for elderly patients. They are generally well-tolerated and have a lower risk of certain side effects, such as sedation or anticholinergic effects, which can be problematic for older adults. Sertraline (Zoloft) 150mg once daily or Escitalopram (Lexapro) 20 mg daily would be appropriate for this patient.

The patient has been taking Sertraline (Zoloft), her start dose was 100mg daily; increase slowly, no more than a maximum Dose of 200 mg once daily; sertraline increases serotonin levels and can be effective in treating depression. Escitalopram is considered perhaps the best-tolerated SSRI, with the fewest cytochrome P450 (CYP450)-mediated drug interactions. (Stahl, 2021). Escitalopram (Lexapro) 20 mg daily is also the appropriate choice.

·
For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on ethical prescribing or decision-making. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals based on ethical prescribing guidelines or decision-making?

When prescribing antidepressant therapy, it's important to consider drug contraindications and alterations. For the selected antidepressant, escitalopram (Lexapro), don't use it with MAOIs or within 14 days after stopping an MAOI to prevent serotonin syndrome. This is a contraindication due to the risk of serotonin syndrome, a potentially life-threatening condition characterized by agitation, confusion, rapid heart rate, and other symptoms. Escitalopram is primarily metabolized in the liver; it should be used with caution in patients with severe hepatic impairment or elderly with decreased liver function. In such cases, a lower initial dose and slower titration may be considered, as drug clearance may be reduced.

In all cases, ethical prescribing involves a thorough assessment of the patient's medical history, medication history, and potential contraindications. Dosing adjustments, when necessary, should be made to maximize therapeutic benefits while minimizing risks and adverse effects.

·
Include any “checkpoints” (i.e., follow-up data at Week 4, 8, 12, etc.), and indicate any therapeutic changes that you might make based on possible outcomes that may happen given your treatment options chosen.

In depression treatment, scheduled follow-up appointments are vital for assessing progress, managing side effects, and adjusting treatment. Common intervals are every 4 weeks. At the checkpoint, like follow-up data at weeks 4, 8, 12, etc., make treatment decisions based on the patient's response, side effects, and goals. If there's significant improvement with few side effects, stick with the current dose. If there's limited improvement or major side effects, consider increasing the dose (if not already at the maximum) or trying a different antidepressant. In cases of long-term remission with a low risk of recurrence, think about tapering or discontinuing the medication.

At Week 4 (four weeks after initiating treatment), it's the time to evaluate the patient's initial response to medication. Inquire about changes in mood, sleep patterns, energy levels, and any side effects.

At Week 8 (eight weeks after starting treatment), it's time to reassess the patient's mood and overall well-being. Keep an eye on side effects, whether they're taking the medication as prescribed, any changes in their medical conditions, and any suicidal ideation.

At Week 12 (12 weeks after starting treatment), continue monitoring the patient's mood and how they're responding to treatment. Check for any signs that their depression might be coming back or getting worse.

Ongoing Follow-up (Regularly, every 3-6 months): Continue to monitor the patient's mental health, medication adherence, and any emerging side effects. Evaluate the need for ongoing treatment.

 


Reference:

Levenson JC, Kay DB, Buysse DJ. The pathophysiology of insomnia. Chest. 2015 Apr;147(4):1179-1192. doi: 10.1378/chest.14-1617. PMID: 25846534; PMCID: PMC4388122.

Stahl, S. M. (2021). Stahl's essential psychopharmacology: Neuroscientific basis and practical applications (5th Ed.) Cambridge University Press.

Lexapro Labeling-508; Reference ID: 4036381 https://www.fda.gov/media/135185/download