case study

/in /by

MSN 5550 Health Promotion: Prevention of Disease
Case Study Module 8

Instructions: Read the following case study and answer the reflective questions. Please provide
evidence-based rationales for your answers. APA, 7th ed. must be followed.

Due: Saturday by 23:59 pm

CASE STUDY: Active Labor: Susan Wong

Mrs. Wong, a first-time mother, is admitted to the birthing suite in early labor after
spontaneous rupture of membranes at home. She is at 38 weeks of gestation with a history of
abnormal alpha-fetoprotein levels at 16 weeks of pregnancy.

She was scheduled for ultrasonography to visualize the fetus to rule out an open spinal defect
or Down syndrome, but never followed through. Mrs. Wong and her husband disagreed about
what to do (keep or terminate the pregnancy) if the ultrasonography indicated a spinal
problem, so they felt they did not want this information.

Reflective Questions

1. As the nurse, what priority data would you collect from this couple to help define
relevant interventions to meet their needs?

2. How can you help this couple if they experience a negative outcome in the birthing

suite? What are your personal views on terminating or continuing a pregnancy with a
risk of a potential anomaly? What factors may influence your views?

3. With the influence of the recent Human Genome Project and the possibility of

predicting open spinal defects earlier in pregnancy, how will maternity care change in
the future?

mental health

/in /by


Rasmussen University – Mental Health Care Plan

A. Patient identifiers:

Age: Gender: Ht: Wt. Code Status:

Isolation:

Development Stage (Erikson): Give the stage and rationale for your evaluation

Health Status

Date of admission:

Activity level: Diet:

Fall risk (indicate reason)

Client’s description of health status

Allergies: (include type of reaction)

Reason for admission:

Past medical history that relates to admission:

Socio-cultural Orientation

Cultural and Ethnic Background with current practices:

Socialization:

Family system: (Support system)

Spiritual:

Occupation: (across the lifespan)

Patterns of living: (define past and current)

Barriers to independent living:

Healthcare systems elements (continued) ALLERGIES:

Medications: List all medications, dosages, classifications and the rational for the medications prescribed for this patient include major considerations for administration and the possible negative outcomes associated with this medication.

DEFINE 1: What the medications Mechanism of Action AND 2: Why the patient is taking the medication?

Medication Classification Dosage Rationale Possible negative outcomes

Psychiatric Diagnosis and DSM 5 Diagnostic Criteria

History of Present Psychiatric Illness

(Presenting signs & symptoms/ Previous Psychiatric Admission / Outpatient Mental Health Services)

CON
CEPT MAP

Pathophysiology – (to the cellular level)

Medical Diagnosis

Clinical Manifestations (all data subjective and objective: labs, radiology, all diagnostic studies) (What symptoms does your client present with?)

Complications

Treatment (Medical, medications, intervention and supportive)

Risk Factors (chemical, environmental, psychological, physiological and genetic)

Nursing Diagnosis

Problem statement: (NANDA)

Related to: (What is happening in the body to cause the issue?)

Manifested by: (Specific symptoms)

General Appearance

Presenting Appearance (nutritional status, physical deformities, hearing impaired, glasses, injuries, cane)
Basic Grooming and Hygiene (clean, disheveled and whether it is appropriate attire for the weather)

Gait and Motor Coordination (awkward, staggering, shuffling, rigid, trembling with intentional movement or at rest),
posture (slouched, erect),
any noticeable mannerisms or gestures

Level of Participation in the Program/Activity (Group attendance and milieu participation, exercise)

Manner and Approach

Interpersonal Characteristics and Approach to Evaluation (oppositional/resistant, submissive, defensive, open and friendly, candid and cooperative, showed subdued mistrust and hostility, excessive shyness)

Behavioral Approach (distant, indifferent, unconcerned, evasive, negative, irritable, depressive, anxious, sullen, angry, assaultive, exhibitionistic, seductive, frightened, alert, agitated, lethargic, needed minor/considerable reinforcement and soothing).
Coping and stress tolerance.

Speech (normal rate and volume, pressured, slow, loud, quiet, impoverished)

Expressive Language (no problems expressing self, circumstantial and tangential responses, difficulties finding words, echolalia, mumbling)

Receptive Language (normal, able to comprehend questions,

Orientation, Alertness, and Thought Process

Recall and Memory (recalls recent and past events in their personal history).
Recalls three words (e.g., Cadillac, zebra, and purple)
Orientation (person, place, time, presidents, your name)

Alertness (sleepy, alert, dull and uninterested, highly distractible)
Coherence (responses were coherent and easy to understand, simplistic and concrete, lacking in necessary detail, overly detailed and difficult to follow)

Concentration and Attention (naming the days of the week or months of the year in reverse order, spelling the word “world”, their own last name, or the ABC's backwards)

Thought Processes (loose associations, confabulations, flight of ideas, ideas of reference, illogical thinking, grandiosity, magical thinking, obsessions, perseveration, delusions, reports of experiences of depersonalization).
Values and belief system

Hallucinations and Delusions (presence, absence, denied visual but admitted olfactory and auditory, denied but showed signs of them during testing, denied except for times associated with the use of substances, denied while taking medications)

Judgment and Insight (based on explanations of what they did, what happened, and if they expected the outcome, good, poor, fair, strong)

Mood and Affect

Mood or how they feel most days (happy, sad, despondent, melancholic, euphoric, elevated, depressed, irritable, anxious, angry).
Affect or how they felt at a given moment (comments can include range of emotions such as broad, restricted, blunted, flat, inappropriate, labile, consistent with the content of the conversation.

Rapport (easy to establish, initially difficult but easier over time, difficult to establish, tenuous, easily upset)
Facial and Emotional Expressions (relaxed, tense, smiled, laughed, became insulting, yelled, happy, sad, alert, day-dreamy, angry, smiling, distrustful/suspicious, tearful, pessimistic, optimistic)

Response to Failure on Test Items (unaware, frustrated, anxious, obsessed, unaffected)
Impulsivity (poor, effected by substance use)
Anxiety (note level of anxiety, any behaviors that indicated anxiety, ways they handled it)

Lab

Range

Value

Reason Obtained

Risk Assessment:

Suicidal and Homicidal Ideation

(ideation but no plan or intent, clear/unclear plan but no intent) Self-Injurious Behavior (cutting, burning) Hypersexual, Elopement, Non-adherence to treatment

Discharge Plans and Instruction: Placement, outpatient treatment, partial hospitalization, sober living, board and care, shelter, long term care facility, 12 step program

Teaching Assessment and Client / Family Education:

(Disease process, medication, coping, relaxation, diet, exercise, hygiene) Include barriers to learning and preferred learning styles

NRS DX:

Problem Statement:

R/T: (What is the cause of the symptom?)

Manifested by: (specific symptoms)

Short term goal: Create a SMART goal that relates to hospital stay.

Long term goal: Create a SMART goal that is appropriate for discharge.

This is specific to the patient that you are caring for. A list of planned actions that will assist the patient to achieve the desired goal. (i.e. obtain foods that the patient can eat/ likes)

Identify what the patients response or “outcome is to the goal or care that you have provided. i.e. patient ate 45% of lunch)

Was it met or not met there is no partially met.

References:

advance directives

/in /by

Part I

The Advance Health Care Directive  

Locate a copy of an advanced directive (AD) that complies with the laws of the state in which you work. The organization in which you work should have a copy of an advance directive that is given to patients. If not, download your state’s Advance Directives here http://www.caringinfo.org/i4a/pages/index.cfm?pageid=3289.Links to an external site.

 Part I: 

  1. Identify where you obtained the AD and explain its compliance with state law.
  2. Conduct research (1-2 sources) to learn more about the AD in your state and explain how it works.    
  3. Discuss how easy or difficult it was to complete the AD. Your comments should be specific and both objective and subjective. For example, when you state your personal feelings, you must relate them to the literature (textbook and research) that discusses this process and the difficulties that many people face when completing an advance directive. 

(Cite/ reference any sources you use to explore these questions, including your texts.) 

Part II

Physician Orders for Life-Sustaining Treatment (POLST) Form 

  1. What is a Physician Orders for Life-Sustaining Treatment (POLST) formLinks to an external site.?
  2. When should this form be completed?
  3. Who can complete the form?
  4. Who needs to sign the form to make it a legal document?

(Cite/reference any sources you use to explore these questions, including your texts.) 

Part III

Tie the two first sections together by writing a summary and conclusion. 

This section should address:

1. the differences between an Advance Health Care Directive and the POLST,

2. the RN’s important role in assuring the patient’s right to autonomy in choosing the healthcareinterventions the patient does or does not want.

____________________________________________

assingment 7-1

/in /by

please follow all directions

fundamentals M 1

/in /by

Roles of the Professional Nurse

Top of Form

Bottom of Form

Module 01 Content

1.

Top of Form

Using the
NUR2115 Module 01 Written Assignment template, determine your strengths and weaknesses for each role. You must have specific examples of strengths and weaknesses for each role. Describe at least two strategies for how you can overcome each weakness.

DEVELOPING ORGANIZATIONAL POLICIES AND PRACTICES

/in /by

Due Sunday by 10:59pm Points 100 Submitting a text entry box or a file upload
Attempts 0 Allowed Attempts 2

Start Assignment

Back to Module at a Glance
(https://waldenu.instructure.com/courses/80551/modules/items/2436554)

Competing needs arise within any organization as employees seek to meet their targets and leaders
seek to meet company goals. As a leader, successful management of these goals requires establishing
priorities and allocating resources accordingly.

Within a healthcare setting, the needs of the workforce, resources, and patients are often in conflict.
Mandatory overtime, implementation of staffing ratios, use of unlicensed assisting personnel, and
employer reductions of education benefits are examples of practices that might lead to conflicting needs
in practice.

Leaders can contribute to both the problem and the solution through policies, action, and inaction. In this
Assignment, you will further develop the white paper you began work on in Module 1 by addressing
competing needs within your organization.

To Prepare:

DEVELOPING ORGANIZATIONAL POLICIES
AND PRACTICES

RESOURCES

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES (https://waldenu.instructure.com/courses/80551/modules/items/2436568)

Review the national healthcare issue/stressor you examined in your Assignment for Module 1, and
review the analysis of the healthcare issue/stressor you selected.
Identify and review two evidence-based scholarly resources that focus on proposed policies/practices
to apply to your selected healthcare issue/stressor.
Reflect on the feedback you received from your colleagues on your Discussion post regarding
competing needs.

The Assignment (1-2 pages):

Developing Organizational Policies and Practices

Add a section to the 2-3 page paper you submitted in Module 1. The new section should address the
following in 1-2 pages:

Identify and describe at least two competing needs impacting your selected healthcare
issue/stressor.
Describe a relevant policy or practice in your organization that may influence your selected
healthcare issue/stressor.
Critique the policy for ethical considerations, and explain the policy’s strengths and challenges in
promoting ethics.
Recommend one or more policy or practice changes designed to balance the competing needs of
resources, workers, and patients, while addressing any ethical shortcomings of the existing policies.
Be specific and provide examples.
Cite evidence that informs the healthcare issue/stressor and/or the policies, and provide two
scholarly resources in support of your policy or practice recommendations.
Due to the nature of this assignment, your instructor may require more than 7 days to provide you
with quality feedback.

Submit your revised paper.

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.

1. To submit your completed assignment, save your Assignment as
WK3Assgn_LastName_Firstinitial

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

BY DAY 7 OF WEEK 3

SUBMISSION INFORMATION

600 w 6 p2

/in /by

Write aof 2-3 pages about the proposed interventions for your problem/issue supported by evidence collected by conducting a literature search and review. Integrate the information into your project.

The assignment should include:

  1. The extent of evidence-based data for proposed interventions.
  2. Comprehensive description of factors that might influence the use of proposed interventions.
  3. Identify the barriers related to the proposed interventions.
  4. Detailed list of resources that will be needed.
  5. Detailed steps, or sequence of events, or specific implementation activities that will be required to implement the intervention.
  6. Monitoring, tracking and ongoing review.
  7. Performance of tasks required for implementation. Staff responsible in the implementation of the interventions and their qualifications.
  8. Strategies that facilitate the implementation of the proposed intervention.
  9. Timeline.
  10. Expected outcomes to be achieved by your project.

Expectations

  • use US sources and project is nurse retention and the role of leadership in this
  • Length: 2-3 pages
  • Format: APA 7th ed.
  • Research: At least one peer reviewed reference within the last 5 years

Discusssion

/in /by

Resources:

 Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Jones & Bartlett Learning.

 

To Prepare:

  • Review the Resources and reflect on the mission of state/regional boards of nursing as the protection of the public through the regulation of nursing practice.
  • Consider how key regulations may impact nursing practice.
  • Review key regulations for nursing practice of your state’s/region’s board of nursing and those of at least one other state/region and select at least two APRN regulations to focus on for this Discussion.

Post a comparison of at least two APRN board of nursing regulations in your state/region with those of at least one other state/region. Describe how they may differ. Be specific and provide examples. Then, explain how the regulations you selected may apply to Advanced Practice Registered Nurses (APRNs) who have legal authority to practice within the full scope of their education and experience. Provide at least one example of how APRNs may adhere to the two regulations you selected.

powerpoint presentation

/in /by

As a practicing professional, you are likely to present educational in-services or training to staff pertaining to quality improvement (QI) measures of safety improvement interventions. Such in-services and training sessions should be presented in a creative and innovative manner to hold the audience’s attention and promote knowledge acquisition and skill application that changes practice for the better. The teaching sessions may include a presentation, audience participation via simulation or other interactive strategy, audiovisual media, and participant learning evaluation.The use of in-services and/or training sessions has positive implications for nursing practice by increasing staff confidence when providing care to specific patient populations. It also allows for a safe and nonthreatening environment where staff nurses can practice their skills prior to a real patient event. Participation in learning sessions fosters a team approach, collaboration, patient safety, and greater patient satisfaction rates in the health care environment (Patel & Wright, 2018).As you prepare to complete the assessment, consider the impact of in-service training on patient outcomes as well as practice outcomes for staff nurses. Be sure to support your thoughts on the effectiveness of educating and training staff to increase the quality of care provided to patients by examining the literature and established best practices.You are encouraged to explore the AONE Nurse Executive Competencies Review activity before you develop the Improvement Plan In-Service Presentation. This activity will help you review your understanding of the AONE Nurse Executive Competencies—especially those related to competencies relevant to developing an effective training session and presentation. This is for your own practice and self-assessment, and demonstrates your engagement in the course.
For this assessment, build on the safety quality Patient Identification Errors in Healthcare and create an agenda and PowerPoint of an educational in-service session that would help a specific staff audience learn, provide feedback, and understand their roles and practice new skills related to the safety improvement plan you created.
The final deliverable for this assessment will be a PowerPoint presentation with detailed presenter’s notes representing the material you would deliver at an in-service session to raise awareness of your chosen safety improvement initiative focusing on a specific patient safety issue and to explain the need for such an initiative. Additionally, you must educate the audience as to their role and importance to the success of the initiative. This includes providing examples and practice opportunities to test out new ideas or practices related to the safety improvement initiative.Be sure that your presentation addresses the following, which corresponds to the grading criteria in the scoring guide. Please study the scoring guide carefully so you understand what is needed for a distinguished score.

  • Describe the purpose and goals of an in-service session focusing on a specific patient safety issue.
  • Explain the need for and process to improve safety outcomes related to a specific patient safety issue.
  • Explain to the audience their role and importance of making the improvement plan successful.
  • Create resources or activities to encourage skill development and process understanding related to a safety improvement initiative.
  • Communicate with nurses in a respectful and informative way that clearly presents expectations and solicits feedback on communication strategies for future improvement.

There are various ways to structure an in-service session; below is just one example:

  • Part 1: Agenda and Outcomes.
    • Explain to your audience what they are going to learn or do, and what they are expected to take away.
  • Part 2: Safety Improvement Plan.
    • Give an overview of the current problem focusing on a specific patient safety issue, the proposed plan, and what the improvement plan is trying to address.
    • Explain why it is important for the organization to address the current situation.
  • Part 3: Audience’s Role and Importance.
    • Discuss how the staff audience will be expected to help implement and drive the improvement plan.
    • Explain why they are critical to the success of the improvement plan focusing on a specific patient safety issue.
    • Describe how their work could benefit from embracing their role in the plan.
  • Part 4: New Process and Skills Practice.
    • Explain new processes or skills.
    • Develop an activity that allows the staff audience to practice and ask questions about these new processes and skills.
    • In the notes section of your PowerPoint, brainstorm potential responses to likely questions or concerns.
  • Part 5: Soliciting Feedback.
    • Describe how you would solicit feedback from the audience on the improvement plan and the in-service.
    • Explain how you might integrate this feedback for future improvements.

    Note: Presentation length: There is no required length; use just enough slides to address all the necessary elements. Remember to use short, concise bullet points on the slides and expand on your points in the presenter’s notes. If you use 2 or 3 slides to address each of the parts in the above example, your presentation would be at least 10 slides and no more than 15 slides (not including the title, conclusion, or references slides).

  • Speaker notes: Speaker notes (located under each slide) should reflect what you would actually say if you were delivering the presentation to an audience. This presentation does NOT require audio or a transcript. Another presenter would be able to use the presentation by following the speaker’s notes.
  • APA format: Use APA formatting for in-text citations. Include an APA-formatted reference slide at the end of your presentation.
  • Number of references: Cite a minimum of 3 sources of scholarly or professional evidence to support your assertions. Resources should be no more than 5 years old.

250 word discussion Evidence Base Nursing

/in /by

Due 9/20  6 pm EST

250 Words APA not including Title and references

 

Critical appraisals are used to broaden understanding and summarize evidence. This helps determine if research evidence is ready for practice. There are certain steps to conducting critical appraisals.

  • Locate a scholarly journal article and apply the steps of critical analysis found in your textbook.

Responses need to address all components of the question, demonstrate critical thinking and analysis and include peer-reviewed journal evidence to support the student’s position.

Please be sure to validate your opinions and ideas with citations and references in APA format.

  All posts should be supported by a minimum of one scholarly resource, ideally within the last 5 years. Journals and websites must be cited appropriately. Citations and references must adhere to APA format.