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  • NSG 6435

    NSG 6435 Full Course Latest SU

    NSG 6435 Week 1 Discussion

    Discussion: Pediatric Health-Care Services

    This discussion assignment provides a forum for discussing relevant topics for this week based on the course competencies covered.

    For this assignment, make sure you post your initial response to the Discussion Area .

    To support your work, use your course textbook readings and the South University Online Library.As in all assignments, cite your sources in your work and provide references for the citations in APA format.

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    Start reviewing and responding to the postings of your classmates as early in the week as possible.Respond to at least two of your classmates’ initial postings.Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion.Cite sources in your responses to other classmates.Complete your participation for this assignment.

    Using your course textbook readings and the South University Online Library, perform research on the following:

    Sources of pediatric primary care in the United States

    Current status of pediatric health-care services in the United States

    Barriers to health care for children in the United States

    After completing your research, answer the following questions:

    What are the sources of pediatric primary care in the United States? Are these sources sufficient for providing health-care services to the pediatric population? Why or why not?

    Are there certain pediatric populations that lack access to health-care services? Why?

    What are the barriers to children in accessing health-care services in the United States? Why do these barriers exist?

    NSG 6435 Week 2 Discussion

    Discussion: iHuman Case Study – Developmental Assessment and Biological Functioning

    This discussion assignment provides a forum for discussing relevant topics for this week based on the course competencies covered.For this assignment, make sure you post your initial response to the Discussion Area NSG 6435.

    To support your work, use your course textbook readings and the South University Online Library.As in all assignments, cite your sources in your work and provide references for the citations in APA format.

    Start reviewing and responding to the postings of your classmates as early in the week as possible.Respond to at least two of your classmates’ initial postings.Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion.Cite sources in your responses to other classmates.Complete your participation for this assignment .

    For this assignment, you will complete an iHuman case study based on the course objectives and weekly content. iHuman cases emphasize core learning objectives for an evidence-based primary care curriculum. NSG 6435. Throughout your nurse practitioner program, you will use the iHuman case studies to promote the development of clinical reasoning through the use of ongoing assessments and diagnostic skills and to develop patient care plans that are grounded in the latest clinical guidelines and evidence-based practice.

    The iHuman assignments are highly interactive and a dynamic way to enhance your learning.Material from the iHuman cases may be present in the quizzes, the midterm exam, and the final exam.

    Here you can view information on how to access and navigate iHuman.

    This week, complete the iHuman case titled “Buddy (Theodore, Jr.) VE.”

    Apply information from the iHuman Case Study to answer the following questions:

    Why is developmental assessment essential in the provision of primary care for infants, children, and adolescents, and what are the essential components of this assessment on the basis of a child’s age?

    Which tools will you use to assess specific components of development (such as speech, motor skills, social skills, etc.)? Which tools do you think are the most accurate in assessing the developmental components and why? NSG 6435.

    Which components would you consider in assessing the basic biological functioning and well-being of your pediatric patients? Why are these components important in providing primary health-care services to children?

    NSG 6435 Week 3 Discussion

    Discussion: MedU Case Study – Developmental Evaluation and Screening

    This discussion assignment provides a forum for discussing relevant topics for this week based on the course competencies covered.For this assignment, make sure you post your initial response to the Discussion Area.

    To support your work, use your course textbook readings and the South University Online Library.As in all assignments, cite your sources in your work and provide references for the citations in APA format.

    Start reviewing and responding to the postings of your classmates as early in the week as possible.Respond to at least two of your classmates’ initial postings.Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion.Cite sources in your responses to other classmates.Complete your participation for this assignment .

    For this assignment, you will complete a MedU case study based on the course objectives and weekly content.MedU cases emphasize core learning objectives for an evidence-based primary care curriculum.Throughout your nurse practitioner program, you will use the MedU case studies to promote the development of clinical reasoning through the use of ongoing assessments and diagnostic skills and to develop patient care plans that are grounded in the latest clinical guidelines and evidence-based practice. NSG 6435.

    The MedU assignments are highly interactive and a dynamic way to enhance your learning.Material from the MedU cases may be present in the quizzes, the midterm exam, and the final exam.

    Click here for information on how to access and navigate MedU.

    This week, complete the MedU case titled “FmCase 2: Infant well-child (2, 6, and 9 months) – Asia.”

    Apply information from the MedU Case Study to answer the following questions:

    Discuss the history that you would take on this child in preparation for the well-child visit.Include questions regarding her growth and development that are appropriate for her age.

    Describe the developmental tool to be used for Asia, its reliability and validity and how Asia scored developmentally on this tool.Is she developmentally appropriate for her age?

    What immunizations will Asia be given at this visit; what is the patient education and follow-up?

    NSG 6435 Week 4 Discussion

    Discussion: iHuman Case Study – HEENT and Respiratory Infections

    This discussion assignment provides a forum for discussing relevant topics for this week based on the course competencies covered.For this assignment, make sure you post your initial response to the Discussion Area.

    To support your work, use your course textbook readings and the South University Online Library.As in all assignments, cite your sources in your work and provide references for the citations in APA format.

    Start reviewing and responding to the postings of your classmates as early in the week as possible.Respond to at least two of your classmates’ initial postings.Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion.Cite sources in your responses to other classmates.Complete your participation for this assignment.

    For this assignment, you will complete an iHuman case study based on the course objectives and weekly content.iHuman cases emphasize core learning objectives for an evidence-based primary care curriculum.Throughout your nurse practitioner program, you will use the iHuman case studies to promote the development of clinical reasoning through the use of ongoing assessments and diagnostic skills and to develop patient care plans that are grounded in the latest clinical guidelines and evidence-based practice.

    The iHuman assignments are highly interactive and a dynamic way to enhance your learning.Material from the iHuman cases may be present in the quizzes, the midterm exam, and the final exam.

    Here you can view information on how to access and navigate iHuman.

    This week, complete the iHuman case titled “Katherine Harris.”

    Apply information from the iHuman Case Study to answer the following questions NSG 6435:

    Do you recommend a limited or an involved use of antibiotics in treatment of these diseases and other unconfirmed bacterial illnesses and why? What are the standards regarding the use of antibiotics in pediatric population, and what assessment findings would warrant prescribing an antibiotic for Asthma symptoms?

    Using national guidelines and evidence-based literature, develop an Asthma Action Plan for this patient.

    Do the etiology, diagnosis, and management of a child who is wheezing vary according to the child’s age? Why or why not? Which objective of the clinical findings will guide your diagnosis? Why? When is a chest x-ray indicated in this case?

    NSG 6435 Week 5 Discussion

    Discussion: iHuman Case Study – Cardiovascular and Hematologic Disorders in Children

    This discussion assignment provides a forum for discussing relevant topics for this week based on the course competencies covered.For this assignment, make sure you post your initial response to the Discussion Area.

    To support your work, use your course textbook readings and the South University Online Library.As in all assignments, cite your sources in your work and provide references for the citations in APA format.

    Start reviewing and responding to the postings of your classmates as early in the week as possible.Respond to at least two of your classmates’ initial postings.Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion.Cite sources in your responses to other classmates.Complete your participation for this assignment.

    For this assignment, you will complete an iHuman case study based on the course objectives and weekly content.iHuman cases emphasize core learning objectives for an evidence-based primary care curriculum.Throughout your nurse practitioner program, you will use the iHuman case studies to promote the development of clinical reasoning through the use of ongoing assessments and diagnostic skills and to develop patient care plans that are grounded in the latest clinical guidelines and evidence-based practice NSG 6435.

    The iHuman assignments are highly interactive and a dynamic way to enhance your learning.Material from the iHuman cases may be present in the quizzes, the midterm exam, and the final exam.

    Here you can view information on how to access and navigate iHuman.

    This week, complete the iHuman case titled “Robert Ross.”

    Apply information from the iHuman Case Study to answer the following questions:

    Robert Ross is a 17 year-old male who presents with acute chest pain, palpitations, fever and malaise.He has had symptoms suggestive of a viral syndrome for the past week, but otherwise has no significant past medical history.

    What questions would you ask to gather important diagnostic information?

    How would you diagnose and manage this 17 year old male whose symptoms include palpitations, fever and malaise NSG 6435?

    Which diagnostic studies would you recommend for this patient.Include the rationale for ALL diagnostics and Labs?

    What physical exam findings and diagnostic results would be concerning to you and why? What would be three differentials in this case? Identify additional life threatening diagnoses that must be considered when a patient presents with acute chest pain.

    What is the treatment (including rationale) for Robert and education for the family?

    NSG 6435 Week 6 Discussion

    Discussion: iHuman Case Study – Common Pediatric Illnesses

    This discussion assignment provides a forum for discussing relevant topics for this week based on the course competencies covered.For this assignment, make sure you post your initial response to the Discussion Area .

    To support your work, use your course textbook readings and the South University Online Library.As in all assignments, cite your sources in your work and provide references for the citations in APA format. NSG 6435.

    Start reviewing and responding to the postings of your classmates as early in the week as possible.Respond to at least two of your classmates’ initial postings.Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion.Cite sources in your responses to other classmates.Complete your participation for this assignment .

    For this assignment, you will complete an iHuman case study based on the course objectives and weekly content.iHuman cases emphasize core learning objectives for an evidence-based primary care curriculum.Throughout your nurse practitioner program, you will use the iHuman case studies to promote the development of clinical reasoning through the use of ongoing assessments and diagnostic skills and to develop patient care plans that are grounded in the latest clinical guidelines and evidence-based practice.

    The iHuman assignments are highly interactive and a dynamic way to enhance your learning.Material from the iHuman cases may be present in the quizzes, the midterm exam, and the final exam NSG 6435.

    Here you can view information on how to access and navigate iHuman.

    This week, complete the iHuman case titled “Samantha Graves, Gastroenteritis”.

    Apply information from the iHuman Case Study to answer the following questions:

    Which essential questions will you ask a pediatric patient or his or her caregiver when the presenting complaint is bloody diarrhea? Will these questions vary depending upon the child’s age? Why or why not? What clinical or historical findings will indicate the need for diagnostic studies and why? Which diagnostic studies will you initially order and why?

    What would be three differential diagnoses in this case?

    How do the common causes of vomiting differ in infants, children, and adolescents? What clinical or historical findings will indicate the need for diagnostic studies and why? Which diagnostic studies will you initially order and why NSG 6435?

    NSG 6435 Week 8 Discussion

    Discussion: iHuman Case Study – Neurological Disorders and Cognitive Perceptual Problems in Children

    This discussion assignment provides a forum for discussing relevant topics for this week based on the course competencies covered.For this assignment, make sure you post your initial response to the Discussion Area .

    To support your work, use your course textbook readings and the South University Online Library.As in all assignments, cite your sources in your work and provide references for the citations in APA format.

    Start reviewing and responding to the postings of your classmates as early in the week as possible.Respond to at least two of your classmates’ initial postings.Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion.Cite sources in your responses to other classmates.Complete your participation for this NSG 6435 assignment.

    For this assignment, you will complete an iHuman case study based on the course objectives and weekly content.iHuman cases emphasize core learning objectives for an evidence-based primary care curriculum.Throughout your nurse practitioner program, you will use the iHuman case studies to promote the development of clinical reasoning through the use of ongoing assessments and diagnostic skills and to develop patient care plans that are grounded in the latest clinical guidelines and evidence-based practice.

    The iHuman assignments are highly interactive and a dynamic way to enhance your learning.Material from the iHuman cases may be present in the quizzes, the midterm exam, and the final exam NSG 6435.

    Here you can view information on how to access and navigate iHuman.

    This week, complete the iHuman case titled “Timoth Adams, VE”.

    Apply information from the iHuman Case Study to answer the following questions:

    What do you believe is your best course of action for this appointment?

    What clinical or historical findings will indicate the need for diagnostic studies and why? Which diagnostic studies will you initially order and why?What would be three differentials in this case?

    NSG 6435 Week 9 Discussion

    Discussion: Infectious Diseases in Children

    The discussion assignment provides a forum for discussing relevant topics for this week on the basis of the course competencies covered.

    To support your work, use your course and textbook readings and the South University Online Library.As in all assignments, cite your sources in your work and provide references for the citations in APA format.

    Start reviewing and responding to the postings of your classmates as early in the week as possible.Respond to at least two of your classmates’ initial postings.Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion.Cite sources in your responses to your classmates.Complete your participation for this NSG 6435 assignment.

    Using your course and textbook readings and the South University Online Library, perform research on the following:

    Assessment, diagnostic testing, and management of infectious conditions in a pediatric patient

    Differential diagnoses for presentation of symptoms involving infectious diseases in pediatric patients

    After completing your research, consider this scenario:

    An eighteen-month-old child, well-known to your practice, presents with a seven-day history of fever ranging from 101 to 104.7 degrees Fahrenheit.On the fourth day of the fever, the emergency department had performed the following tests:

    A blood and urine culture

    A complete blood count

    A comprehensive metabolic panel

    The culture reports were found to be negative.

    Today, the vitals of the child are the following:

    Temperature: 101.5 degrees Fahrenheit

    Heart rate: 120 beats/minute

    Respiratory rate: 20 breaths/minute

    Blood pressure: 90/40

    Physical examination of the child indicates the following positive findings:

    Injected conjunctiva

    Palmar redness

    Magenta-colored lips

    Red macula

    Excoriating rashes in the diaper area

    On the basis of the above information, respond to the following:

    What will be your differential diagnoses for this patient?

    What specific physical exam findings support these differential diagnoses?

    Of the differential diagnoses you listed, which would be the most concerning?

    What additional diagnostic tests will you recommend? Why?

    What would be your focus for caregiver education?

    NSG 6435 Week 10 Discussion

    Discussion: iHuman Case Study – Adolescent Risk Behaviors

    This discussion assignment provides a forum for discussing relevant topics for this week based on the course competencies covered.For this assignment, make sure you post your initial response to the Discussion Area NSG 6435.

    To support your work, use your course textbook readings and the South University Online Library.As in all assignments, cite your sources in your work and provide references for the citations in APA format.

    Start reviewing and responding to the postings of your classmates as early in the week as possible.Respond to at least two of your classmates’ initial postings.Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion.Cite sources in your responses to other classmates.Complete your participation for this assignment by Wednesday, October 4, 2017.

    For this assignment, you will complete an iHuman case study based on the course objectives and weekly content.iHuman cases emphasize core learning objectives for an evidence-based primary care curriculum.Throughout your nurse practitioner program, you will use the iHuman case studies to promote the development of clinical reasoning through the use of ongoing assessments and diagnostic skills and to develop patient care plans that are grounded in the latest clinical guidelines and evidence-based practice.

    The iHuman assignments are highly interactive and a dynamic way to enhance your learning.Material from the iHuman cases may be present in the quizzes, the midterm exam, and the final exam.

    Here you can view information on how to access and navigate iHuman.

    This week, complete the iHuman case titled “Angela Cotez VE”.

    Apply information from the iHuman Case Study to answer the following questions:

    Describe the evaluation tool and explain why this tool is essential in the care of the adolescent patient population.

    Apply the findings of the scholarly research articles to the use of this evaluation tool and describe its validity and reliability.

    Apply this evaluation tool to a patient situation and summarize your opinion of the results.

    Describe a plan of care for the patient, depending upon the results NSG 6435.

    NSG 6435 All Week Assignments Latest SU

    NSG 6435 Week 1 Assignment 3

    Each week, you are required to enter your patient encounters into eMedley.Your faculty will be checking to ensure you are seeing the right number and mix of patients for a good learning experience.You will also need to include a minimum of one complete SOAP note using the Pediatric SOAP Note template.The SOAP note should be related to the content covered in this week, and the completed note should be submitted to the Dropbox.When submitting your note, be sure to include the reference number from eMedley.

    Submission Details:

    , enter your patient encounters into eMedley and complete at least one SOAP note in the template provided.

    Name your SOAP note document SU_NSG6435_W1_A3_LastName_FirstInitial.doc.

    Include the reference number from eMedley in your document.

    NSG 6435 Week 2 Assignment 2

    Assignment 2: SOAP Note

    Each week, you are required to enter your patient encounters into eMedley.Your faculty will be checking to ensure you are seeing the right number and mix of patients for a good learning experience.You will also need to include a minimum of one complete SOAP note using the Pediatric SOAP Note template.The SOAP note should be related to the content covered in this week, and the completed note should be submitted to the Dropbox.When submitting your note, be sure to include the reference number from eMedley.

    Submission Details:

    enter your patient encounters into eMedley and complete at least one SOAP note in the template provided.

    Name your SOAP note document SU_NSG6435_W2_A2_LastName_FirstInitial.doc.

    Include the reference number from eMedley in your document.

    NSG 6435 Week 3 Assignment 3

    Assignment 3: SOAP Note

    Each week, you are required to enter your patient encounters into eMedley.Your faculty will be checking to ensure you are seeing the right number and mix of patients for a good learning experience.You will also need to include a minimum of one complete SOAP note using the Pediatric SOAP Note template.The SOAP note should be related to the content covered in this week, and the completed note should be submitted to the Dropbox.When submitting your note, be sure to include the reference number from eMedley.

    Submission Details:

    enter your patient encounters into eMedley and submit your Pediatric SOAP note document to the W3 Assignment 3 Dropbox.

    Name your SOAP note document SU_NSG6435_W3_A3_LastName_FirstInitial.doc.

    Include the reference number from eMedley in your document NSG 6435.

    NSG 6435 Week 4 Assignment 4

    Assignment 4: SOAP Note

    Each week, you are required to enter your patient encounters into eMedley.Your faculty will be checking to ensure you are seeing the right number and mix of patients for a good learning experience.You will also need to include a minimum of one complete SOAP note using the Pediatric SOAP Note template.The SOAP note should be related to the content covered in this week, and the completed note should be submitted to the Dropbox.When submitting your note, be sure to include the reference number from eMedley.

    Submission Details:

    enter your patient encounters into eMedley and complete at least one SOAP note in the template provided.

    Name your SOAP note document SU_NSG6435_W4_A4_LastName_FirstInitial.doc.

    Include the reference number from eMedley in your document.

    NSG 6435 Week 5 Assignment 3

    Assignment 3: SOAP Note

    Each week, you are required to enter your patient encounters into eMedley.Your faculty will be checking to ensure you are seeing the right number and mix of patients for a good learning experience.You will also need to include a minimum of one complete SOAP note using the Pediatric SOAP Note template.SOAP note should be related to the content covered in this week, and the completed note should be submitted to the Dropbox.When submitting your note, be sure to include the reference number from eMedley.

    Submission Details:

    enter your patient encounters into eMedley and complete at least one SOAP note in the template provided.

    Name your SOAP note document SU_NSG6435_W5_A3_LastName_FirstInitial.doc.

    Include the reference number from eMedley in your document.

    NSG 6435 Week 6 Assignment 3

    Assignment 3: SOAP Note

    Each week, you are required to enter your patient encounters into eMedley.Your faculty will be checking to ensure you are seeing the right number and mix of patients for a good learning experience.You will also need to include a minimum of one complete SOAP note using the Pediatric SOAP Note template NSG 6435. The SOAP note should be related to the content covered in this week, and the completed note should be submitted to the Dropbox.When submitting your note, be sure to include the reference number from eMedley.

    Submission Details:

    Complete at least one SOAP note in the template provided.

    Name your SOAP note document SU_NSG6435_W6_A3_LastName_FirstInitial.doc.

    Include the reference number from eMedley in your document.

    NSG 6435 Week 7 W7 Assignment 1

    Assignment 1: Comprehensive Case Study

    General Guidelines for Comprehensive Case Study – Week 7 Assignment 1

    Your case study should not be just a SOAP note of a patient encounter—it should be a comprehensive evaluation of an iHuman patient case.

    You will complete a Comprehensive SOAP note on the approved Pediatric SOAP Note template based on the findings of the iHuman case – then major research and discussion of the disease process are presented.

    This case study should be a summative evaluation supported by a minimum of 5 evidence-based articles.

    Evaluation of the case study should be no more than 3-4 substantive paragraphs.A minimum of five evidence-based sources (in addition to your text) should be used for your case study.

    Course texts will not count as a scholarly source; if using data from websites you must go back to the literature source for the information-no secondary sources are allowed, ie, Medscape, UptoDate, etc.

    This week, complete the iHuman case titled “Tommy Acker, Child Abuse”.Click here for information on how to access and navigate iHuman.

    Name your SOAP note document SU_NSG6435_W7_A1_lastname_firstinitial.doc

    i-Human

    i-Human is an interactive cloud based system that provides comprehensive learning that

    integrates clinical experience.The i-Human system helps students develop patient assessment

    and diagnostic reasoning skills at various levels of education.Students will receive online

    guidance, feedback, and coaching during the learning process.

    Student Login Instructions for i-Human

    Logging in to i-Human:

    Log on at:

    http://toolmanagement.next.ecollege.com/tools/thirdparty/blti.ed?launch=LS:iHuman:Patients

    Next Steps:

    1) If you were unable to attend a Student Orientation Webinar, please watch this introduction

    video: https://vimeo.com/185046053/228aea3fc9

    2) Additional tutorial videos can be found on the i-Human home screen under the title “Player

    Screencast Tutorials” NSG 6435.

    3) After attending the webinar or viewing the tutorial you are ready for your first practice

    case.

    4) The i-Human Student Support Center (link on the home screen under the videos) is a

    resource for our most frequently asked questions.The Student Manual is also located here.

    5) If you are having any issues that are not answered through the webinars, videos or support

    center, you can email: support@i-human.com

    NSG 6435 Week 7 Assignment 2

    Assignment 2: SOAP Note

    Each week, you are required to enter your patient encounters into eMedley.Your faculty will be checking to ensure you are seeing the right number and mix of patients for a good learning experience.You will also need to include a minimum of one complete SOAP note using the Pediatric SOAP Note template.The SOAP note should be related to the content covered in this week, and the completed note should be submitted to the Dropbox.When submitting your note, be sure to include the reference number from eMedley NSG 6435.

    Submission Details:

    enter your patient encounters into eMedley and complete at least one SOAP note in the template provided.

    Name your SOAP note document SU_NSG6435_W7_A2_LastName_FirstInitial.doc.

    Include the reference number from eMedley in your document.

    NSG 6435 Week 8 Assignment 3

    Assignment 3: SOAP Note

    Each week, you are required to enter your patient encounters into eMedley.Your faculty will be checking to ensure you are seeing the right number and mix of patients for a good learning experience.You will also need to include a minimum of one complete SOAP note using the Pediatric SOAP Note template.The SOAP note should be related to the content covered in this week, and the completed note should be submitted to the Dropbox.When submitting your note, be sure to include the reference number from eMedley.

    Submission Details:

    enter your patient encounters into eMedley and complete at least one SOAP note in the template provided.

    Name your SOAP note document SU_NSG6435_W8_A3_LastName_FirstInitial.doc.

    Include the reference number from eMedley in your document.

    NSG 6435 Week 9 Assignment 4

    Assignment 4: SOAP Note

    Each week, you are required to enter your patient encounters into eMedley.Your faculty will be checking to ensure you are seeing the right number and mix of patients for a good learning experience.You will also need to include a minimum of one complete SOAP note using the Pediatric SOAP Note template.The SOAP note should be related to the content covered in this week, and the completed note should be submitted to the Dropbox.When submitting your note, be sure to include the reference number from eMedley NSG 6435.

    Submission Details:

    enter your patient encounters into eMedley and complete at least one SOAP note in the template provided.

    Name your SOAP note document SU_NSG6435_W9_A4_LastName_FirstInitial.doc.

    Include the reference number from eMedley in your document.

    NSG 6435 Week 10 Assignment 2

    Assignment 2: SOAP Note

    Each week, you are required to enter your patient encounters into eMedley.Your faculty will be checking to ensure you are seeing the right number and mix of patients for a good learning experience.You will also need to include a minimum of one complete SOAP note using the Pediatric SOAP Note template.The SOAP note should be related to the content covered in this week, and the completed note should be submitted to the Dropbox.When submitting your note, be sure to include the reference number from eMedley.

    Submission Details:

    enter your patient encounters into eMedley and complete at least one SOAP note in the template provided.

    Name your SOAP note document SU_NSG6435_W10_A2_LastName_FirstInitial.doc.

    Include the reference number from eMedley in your document.

    NSG 6435 Week 1 Discussion

    Discussion: Pediatric Health-Care Services

    This discussion assignment provides a forum for discussing relevant topics for this week based on the course competencies covered.

    For this assignment, make sure you post your initial response to the Discussion Area .

    To support your work, use your course textbook readings and the South University Online Library.As in all assignments, cite your sources in your work and provide references for the citations in APA format.

    Start reviewing and responding to the postings of your classmates as early in the week as possible.Respond to at least two of your classmates’ initial postings.Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion.Cite sources in your responses to other classmates.Complete your participation for this assignment.

    Using your course textbook readings and the South University Online Library, perform research on the following:

    Sources of pediatric primary care in the United States

    Current status of pediatric health-care services in the United States

    Barriers to health care for children in the United States

    After completing your research, answer the following questions:

    What are the sources of pediatric primary care in the United States? Are these sources sufficient for providing health-care services to the pediatric population? Why or why not?

    Are there certain pediatric populations that lack access to health-care services? Why?

    What are the barriers to children in accessing health-care services in the United States? Why do these barriers exist?

    NSG 6435 Week 2 Discussion

    Discussion: iHuman Case Study – Developmental Assessment and Biological Functioning

    This discussion assignment provides a forum for discussing relevant topics for this week based on the course competencies covered.For this assignment, make sure you post your initial response to the Discussion Area .

    To support your work, use your course textbook readings and the South University Online Library.As in all assignments, cite your sources in your work and provide references for the citations in APA format.

    Start reviewing and responding to the postings of your classmates as early in the week as possible.Respond to at least two of your classmates’ initial postings.Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion.Cite sources in your responses to other classmates.Complete your participation for this assignment .

    For this assignment, you will complete an iHuman case study based on the course objectives and weekly content.iHuman cases emphasize core learning objectives for an evidence-based primary care curriculum.Throughout your nurse practitioner program, you will use the iHuman case studies to promote the development of clinical reasoning through the use of ongoing assessments and diagnostic skills and to develop patient care plans that are grounded in the latest clinical guidelines and evidence-based practice.

    The iHuman assignments are highly interactive and a dynamic way to enhance your learning.Material from the iHuman cases may be present in the quizzes, the midterm exam, and the final exam.

    Here you can view information on how to access and navigate iHuman.

    This week, complete the iHuman case titled “Buddy (Theodore, Jr.) VE.”

    Apply information from the iHuman Case Study to answer the following questions:

    Why is developmental assessment essential in the provision of primary care for infants, children, and adolescents, and what are the essential components of this assessment on the basis of a child’s age?

    Which tools will you use to assess specific components of development (such as speech, motor skills, social skills, etc.)? Which tools do you think are the most accurate in assessing the developmental components and why?

    Which components would you consider in assessing the basic biological functioning and well-being of your pediatric patients? Why are these components important in providing primary health-care services to children?

    NSG 6435 Week 3 Discussion

    Discussion: MedU Case Study – Developmental Evaluation and Screening

    This discussion assignment provides a forum for discussing relevant topics for this week based on the course competencies covered.For this assignment, make sure you post your initial response to the Discussion Area.

    To support your work, use your course textbook readings and the South University Online Library.As in all assignments, cite your sources in your work and provide references for the citations in APA format.

    Start reviewing and responding to the postings of your classmates as early in the week as possible.Respond to at least two of your classmates’ initial postings.Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion.Cite sources in your responses to other classmates.Complete your participation for this assignment .

    For this assignment, you will complete a MedU case study based on the course objectives and weekly content.MedU cases emphasize core learning objectives for an evidence-based primary care curriculum.Throughout your nurse practitioner program, you will use the MedU case studies to promote the development of clinical reasoning through the use of ongoing assessments and diagnostic skills and to develop patient care plans that are grounded in the latest clinical guidelines and evidence-based practice.

    The MedU assignments are highly interactive and a dynamic way to enhance your learning.Material from the MedU cases may be present in the quizzes, the midterm exam, and the final exam.

    Click here for information on how to access and navigate MedU.

    This week, complete the MedU case titled “FmCase 2: Infant well-child (2, 6, and 9 months) – Asia.”

    Apply information from the MedU Case Study to answer the following questions:

    Discuss the history that you would take on this child in preparation for the well-child visit.Include questions regarding her growth and development that are appropriate for her age.

    Describe the developmental tool to be used for Asia, its reliability and validity and how Asia scored developmentally on this tool.Is she developmentally appropriate for her age?

    What immunizations will Asia be given at this visit; what is the patient education and follow-up?

    NSG 6435 Week 4 Discussion

    Discussion: iHuman Case Study – HEENT and Respiratory Infections

    This discussion assignment provides a forum for discussing relevant topics for this week based on the course competencies covered.For this assignment, make sure you post your initial response to the Discussion Area.

    To support your work, use your course textbook readings and the South University Online Library.As in all assignments, cite your sources in your work and provide references for the citations in APA format.

    Start reviewing and responding to the postings of your classmates as early in the week as possible.Respond to at least two of your classmates’ initial postings.Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion.Cite sources in your responses to other classmates.Complete your participation for this assignment.

    For this assignment, you will complete an iHuman case study based on the course objectives and weekly content.iHuman cases emphasize core learning objectives for an evidence-based primary care curriculum.Throughout your nurse practitioner program, you will use the iHuman case studies to promote the development of clinical reasoning through the use of ongoing assessments and diagnostic skills and to develop patient care plans that are grounded in the latest clinical guidelines and evidence-based practice.

    The iHuman assignments are highly interactive and a dynamic way to enhance your learning.Material from the iHuman cases may be present in the quizzes, the midterm exam, and the final exam.

    Here you can view information on how to access and navigate iHuman.

    This week, complete the iHuman case titled “Katherine Harris.”

    Apply information from the iHuman Case Study to answer the following questions:

    Do you recommend a limited or an involved use of antibiotics in treatment of these diseases and other unconfirmed bacterial illnesses and why? What are the standards regarding the use of antibiotics in pediatric population, and what assessment findings would warrant prescribing an antibiotic for Asthma symptoms?

    Using national guidelines and evidence-based literature, develop an Asthma Action Plan for this patient.

    Do the etiology, diagnosis, and management of a child who is wheezing vary according to the child’s age? Why or why not? Which objective of the clinical findings will guide your diagnosis? Why? When is a chest x-ray indicated in this case?

    NSG 6435 Week 5 Discussion

    Discussion: iHuman Case Study – Cardiovascular and Hematologic Disorders in Children

    This discussion assignment provides a forum for discussing relevant topics for this week based on the course competencies covered.For this assignment, make sure you post your initial response to the Discussion Area.

    To support your work, use your course textbook readings and the South University Online Library.As in all assignments, cite your sources in your work and provide references for the citations in APA format.

    Start reviewing and responding to the postings of your classmates as early in the week as possible.Respond to at least two of your classmates’ initial postings.Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion.Cite sources in your responses to other classmates.Complete your participation for this assignment.

    For this assignment, you will complete an iHuman case study based on the course objectives and weekly content.iHuman cases emphasize core learning objectives for an evidence-based primary care curriculum.Throughout your nurse practitioner program, you will use the iHuman case studies to promote the development of clinical reasoning through the use of ongoing assessments and diagnostic skills and to develop patient care plans that are grounded in the latest clinical guidelines and evidence-based practice.

    The iHuman assignments are highly interactive and a dynamic way to enhance your learning.Material from the iHuman cases may be present in the quizzes, the midterm exam, and the final exam.

    Here you can view information on how to access and navigate iHuman.

    This week, complete the iHuman case titled “Robert Ross.”

    Apply information from the iHuman Case Study to answer the following questions:

    Robert Ross is a 17 year-old male who presents with acute chest pain, palpitations, fever and malaise.He has had symptoms suggestive of a viral syndrome for the past week, but otherwise has no significant past medical history.

    What questions would you ask to gather important diagnostic information?

    How would you diagnose and manage this 17 year old male whose symptoms include palpitations, fever and malaise?

    Which diagnostic studies would you recommend for this patient.Include the rationale for ALL diagnostics and Labs?

    What physical exam findings and diagnostic results would be concerning to you and why? What would be three differentials in this case? Identify additional life threatening diagnoses that must be considered when a patient presents with acute chest pain.

    What is the treatment (including rationale) for Robert and education for the family?

    NSG 6435 Week 6 Discussion

    Discussion: iHuman Case Study – Common Pediatric Illnesses

    This discussion assignment provides a forum for discussing relevant topics for this week based on the course competencies covered.For this assignment, make sure you post your initial response to the Discussion Area .

    To support your work, use your course textbook readings and the South University Online Library.As in all assignments, cite your sources in your work and provide references for the citations in APA format.

    Start reviewing and responding to the postings of your classmates as early in the week as possible.Respond to at least two of your classmates’ initial postings.Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion.Cite sources in your responses to other classmates.Complete your participation for this assignment .

    For this assignment, you will complete an iHuman case study based on the course objectives and weekly content.iHuman cases emphasize core learning objectives for an evidence-based primary care curriculum.Throughout your nurse practitioner program, you will use the iHuman case studies to promote the development of clinical reasoning through the use of ongoing assessments and diagnostic skills and to develop patient care plans that are grounded in the latest clinical guidelines and evidence-based practice.

    The iHuman assignments are highly interactive and a dynamic way to enhance your learning.Material from the iHuman cases may be present in the quizzes, the midterm exam, and the final exam.

    Here you can view information on how to access and navigate iHuman.

    This week, complete the iHuman case titled “Samantha Graves, Gastroenteritis”.

    Apply information from the iHuman Case Study to answer the following questions:

    Which essential questions will you ask a pediatric patient or his or her caregiver when the presenting complaint is bloody diarrhea? Will these questions vary depending upon the child’s age? Why or why not? What clinical or historical findings will indicate the need for diagnostic studies and why? Which diagnostic studies will you initially order and why?

    What would be three differential diagnoses in this case?

    How do the common causes of vomiting differ in infants, children, and adolescents? What clinical or historical findings will indicate the need for diagnostic studies and why? Which diagnostic studies will you initially order and why?

    NSG 6435 Week 8 Discussion

    Discussion: iHuman Case Study – Neurological Disorders and Cognitive Perceptual Problems in Children

    This discussion assignment provides a forum for discussing relevant topics for this week based on the course competencies covered.For this assignment, make sure you post your initial response to the Discussion Area .

    To support your work, use your course textbook readings and the South University Online Library.As in all assignments, cite your sources in your work and provide references for the citations in APA format.

    Start reviewing and responding to the postings of your classmates as early in the week as possible.Respond to at least two of your classmates’ initial postings.Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion.Cite sources in your responses to other classmates.Complete your participation for this assignment.

    For this assignment, you will complete an iHuman case study based on the course objectives and weekly content.iHuman cases emphasize core learning objectives for an evidence-based primary care curriculum.Throughout your nurse practitioner program, you will use the iHuman case studies to promote the development of clinical reasoning through the use of ongoing assessments and diagnostic skills and to develop patient care plans that are grounded in the latest clinical guidelines and evidence-based practice.

    The iHuman assignments are highly interactive and a dynamic way to enhance your learning.Material from the iHuman cases may be present in the quizzes, the midterm exam, and the final exam.

    Here you can view information on how to access and navigate iHuman.

    This week, complete the iHuman case titled “Timoth Adams, VE”.

    Apply information from the iHuman Case Study to answer the following questions:

    What do you believe is your best course of action for this appointment?

    What clinical or historical findings will indicate the need for diagnostic studies and why? Which diagnostic studies will you initially order and why?What would be three differentials in this case?

    NSG 6435 Week 9 Discussion

    Discussion: Infectious Diseases in Children

    The discussion assignment provides a forum for discussing relevant topics for this week on the basis of the course competencies covered.

     

    To support your work, use your course and textbook readings and the South University Online Library.As in all assignments, cite your sources in your work and provide references for the citations in APA format.

    Start reviewing and responding to the postings of your classmates as early in the week as possible.Respond to at least two of your classmates’ initial postings.Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion.Cite sources in your responses to your classmates.Complete your participation for this assignment.

    Using your course and textbook readings and the South University Online Library, perform research on the following:

    Assessment, diagnostic testing, and management of infectious conditions in a pediatric patient

    Differential diagnoses for presentation of symptoms involving infectious diseases in pediatric patients

    After completing your research, consider this scenario:

    An eighteen-month-old child, well-known to your practice, presents with a seven-day history of fever ranging from 101 to 104.7 degrees Fahrenheit.On the fourth day of the fever, the emergency department had performed the following tests:

    A blood and urine culture

    A complete blood count

    A comprehensive metabolic panel

    The culture reports were found to be negative.

    Today, the vitals of the child are the following:

    Temperature: 101.5 degrees Fahrenheit

    Heart rate: 120 beats/minute

    Respiratory rate: 20 breaths/minute

    Blood pressure: 90/40

    Physical examination of the child indicates the following positive findings:

    Injected conjunctiva

    Palmar redness

    Magenta-colored lips

    Red macula

    Excoriating rashes in the diaper area

    On the basis of the above information, respond to the following:

    What will be your differential diagnoses for this patient?

    What specific physical exam findings support these differential diagnoses?

    Of the differential diagnoses you listed, which would be the most concerning?

    What additional diagnostic tests will you recommend? Why?

    What would be your focus for caregiver education?

    NSG 6435 Week 10 Discussion

    Discussion: iHuman Case Study – Adolescent Risk Behaviors

    This discussion assignment provides a forum for discussing relevant topics for this week based on the course competencies covered.For this assignment, make sure you post your initial response to the Discussion Area .

    To support your work, use your course textbook readings and the South University Online Library.As in all assignments, cite your sources in your work and provide references for the citations in APA format.

    Start reviewing and responding to the postings of your classmates as early in the week as possible.Respond to at least two of your classmates’ initial postings.Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion.Cite sources in your responses to other classmates.Complete your participation for this assignment by Wednesday, October 4, 2017.

    For this assignment, you will complete an iHuman case study based on the course objectives and weekly content.iHuman cases emphasize core learning objectives for an evidence-based primary care curriculum.Throughout your nurse practitioner program, you will use the iHuman case studies to promote the development of clinical reasoning through the use of ongoing assessments and diagnostic skills and to develop patient care plans that are grounded in the latest clinical guidelines and evidence-based practice.

    The iHuman assignments are highly interactive and a dynamic way to enhance your learning.Material from the iHuman cases may be present in the quizzes, the midterm exam, and the final exam.

    Here you can view information on how to access and navigate iHuman.

    This week, complete the iHuman case titled “Angela Cotez VE”.

    Apply information from the iHuman Case Study to answer the following questions:

    Describe the evaluation tool and explain why this tool is essential in the care of the adolescent patient population.

    Apply the findings of the scholarly research articles to the use of this evaluation tool and describe its validity and reliability.

    Apply this evaluation tool to a patient situation and summarize your opinion of the results.

    Describe a plan of care for the patient, depending upon the results.

    NSG 6435 All Week Assignments Latest SU

    NSG 6435 Week 1 
     Assignment 3

    Each week, you are required to enter your patient encounters into eMedley.Your faculty will be checking to ensure you are seeing the right number and mix of patients for a good learning experience.You will also need to include a minimum of one complete SOAP note using the Pediatric SOAP Note template.The SOAP note should be related to the content covered in this week, and the completed note should be submitted to the Dropbox.When submitting your note, be sure to include the reference number from eMedley.

    Submission Details:

    , enter your patient encounters into eMedley and complete at least one SOAP note in the template provided.

    Name your SOAP note document SU_NSG6435_W1_A3_LastName_FirstInitial.doc.

    Include the reference number from eMedley in your document.

     

    NSG 6435 Week 2 
     Assignment 2

    Assignment 2: SOAP Note

    Each week, you are required to enter your patient encounters into eMedley.Your faculty will be checking to ensure you are seeing the right number and mix of patients for a good learning experience.You will also need to include a minimum of one complete SOAP note using the Pediatric SOAP Note template.The SOAP note should be related to the content covered in this week, and the completed note should be submitted to the Dropbox.When submitting your note, be sure to include the reference number from eMedley.

    Submission Details:

    enter your patient encounters into eMedley and complete at least one SOAP note in the template provided.

    Name your SOAP note document SU_NSG6435_W2_A2_LastName_FirstInitial.doc.

    Include the reference number from eMedley in your document.

     

    NSG 6435 Week 3 Assignment 3

    Assignment 3: SOAP Note

    Each week, you are required to enter your patient encounters into eMedley.Your faculty will be checking to ensure you are seeing the right number and mix of patients for a good learning experience.You will also need to include a minimum of one complete SOAP note using the Pediatric SOAP Note template.The SOAP note should be related to the content covered in this week, and the completed note should be submitted to the Dropbox.When submitting your note, be sure to include the reference number from eMedley.

    Submission Details:

    enter your patient encounters into eMedley and submit your Pediatric SOAP note document to the W3 Assignment 3 Dropbox.

    Name your SOAP note document SU_NSG6435_W3_A3_LastName_FirstInitial.doc.

    Include the reference number from eMedley in your document.

    NSG 6435 Week 4 
     Assignment 4

    Assignment 4: SOAP Note

    Each week, you are required to enter your patient encounters into eMedley.Your faculty will be checking to ensure you are seeing the right number and mix of patients for a good learning experience.You will also need to include a minimum of one complete SOAP note using the Pediatric SOAP Note template.The SOAP note should be related to the content covered in this week, and the completed note should be submitted to the Dropbox.When submitting your note, be sure to include the reference number from eMedley.

    Submission Details:

    enter your patient encounters into eMedley and complete at least one SOAP note in the template provided.

    Name your SOAP note document SU_NSG6435_W4_A4_LastName_FirstInitial.doc.

    Include the reference number from eMedley in your document.

     

    NSG 6435 Week 5 
     Assignment 3

    Assignment 3: SOAP Note

    Each week, you are required to enter your patient encounters into eMedley.Your faculty will be checking to ensure you are seeing the right number and mix of patients for a good learning experience.You will also need to include a minimum of one complete SOAP note using the Pediatric SOAP Note template.SOAP note should be related to the content covered in this week, and the completed note should be submitted to the Dropbox.When submitting your note, be sure to include the reference number from eMedley.

    Submission Details:

    enter your patient encounters into eMedley and complete at least one SOAP note in the template provided.

    Name your SOAP note document SU_NSG6435_W5_A3_LastName_FirstInitial.doc.

    Include the reference number from eMedley in your document.

     

    NSG 6435 Week 6 
     Assignment 3

    Assignment 3: SOAP Note

    Each week, you are required to enter your patient encounters into eMedley.Your faculty will be checking to ensure you are seeing the right number and mix of patients for a good learning experience.You will also need to include a minimum of one complete SOAP note using the Pediatric SOAP Note template.The SOAP note should be related to the content covered in this week, and the completed note should be submitted to the Dropbox.When submitting your note, be sure to include the reference number from eMedley.

    Submission Details:

    Complete at least one SOAP note in the template provided.

    Name your SOAP note document SU_NSG6435_W6_A3_LastName_FirstInitial.doc.

    Include the reference number from eMedley in your document.

     

    NSG 6435 Week 7  
     W7 Assignment 1

    Assignment 1: Comprehensive Case Study

    General Guidelines for Comprehensive Case Study – Week 7 Assignment 1

    Your case study should not be just a SOAP note of a patient encounter—it should be a comprehensive evaluation of an iHuman patient case.

    You will complete a Comprehensive SOAP note on the approved Pediatric SOAP Note template based on the findings of the iHuman case – then major research and discussion of the disease process are presented.

    This case study should be a summative evaluation supported by a minimum of 5 evidence-based articles.

    Evaluation of the case study should be no more than 3-4 substantive paragraphs.A minimum of five evidence-based sources (in addition to your text) should be used for your case study.

    Course texts will not count as a scholarly source; if using data from websites you must go back to the literature source for the information-no secondary sources are allowed, ie, Medscape, UptoDate, etc.

    This week, complete the iHuman case titled “Tommy Acker, Child Abuse”.Click here for information on how to access and navigate iHuman.

     

    Name your SOAP note document SU_NSG6435_W7_A1_lastname_firstinitial.doc

    i-Human

    i-Human is an interactive cloud based system that provides comprehensive learning that

    integrates clinical experience.The i-Human system helps students develop patient assessment

    and diagnostic reasoning skills at various levels of education.Students will receive online

    guidance, feedback, and coaching during the learning process.

    Student Login Instructions for i-Human

    Logging in to i-Human:

    Log on at:

    http://toolmanagement.next.ecollege.com/tools/thirdparty/blti.ed?launch=LS:iHuman:Patients

    Next Steps:

    1) If you were unable to attend a Student Orientation Webinar, please watch this introduction

    video: https://vimeo.com/185046053/228aea3fc9

    2) Additional tutorial videos can be found on the i-Human home screen under the title “Player

    Screencast Tutorials”

    3) After attending the webinar or viewing the tutorial you are ready for your first practice

    case.

    4) The i-Human Student Support Center (link on the home screen under the videos) is a

    resource for our most frequently asked questions.The Student Manual is also located here.

    5) If you are having any issues that are not answered through the webinars, videos or support

    center, you can email: support@i-human.com

    NSG 6435 Week 7 
     Assignment 2

    Assignment 2: SOAP Note

    Each week, you are required to enter your patient encounters into eMedley.Your faculty will be checking to ensure you are seeing the right number and mix of patients for a good learning experience.You will also need to include a minimum of one complete SOAP note using the Pediatric SOAP Note template.The SOAP note should be related to the content covered in this week, and the completed note should be submitted to the Dropbox.When submitting your note, be sure to include the reference number from eMedley.

    Submission Details:

    enter your patient encounters into eMedley and complete at least one SOAP note in the template provided.

    Name your SOAP note document SU_NSG6435_W7_A2_LastName_FirstInitial.doc.

    Include the reference number from eMedley in your document.

     

    NSG 6435 Week 8 
     Assignment 3

    Assignment 3: SOAP Note

    Each week, you are required to enter your patient encounters into eMedley.Your faculty will be checking to ensure you are seeing the right number and mix of patients for a good learning experience.You will also need to include a minimum of one complete SOAP note using the Pediatric SOAP Note template.The SOAP note should be related to the content covered in this week, and the completed note should be submitted to the Dropbox.When submitting your note, be sure to include the reference number from eMedley.

    Submission Details:

    enter your patient encounters into eMedley and complete at least one SOAP note in the template provided.

    Name your SOAP note document SU_NSG6435_W8_A3_LastName_FirstInitial.doc.

    Include the reference number from eMedley in your document.

     

    NSG 6435 Week 9 
     Assignment 4

    Assignment 4: SOAP Note

    Each week, you are required to enter your patient encounters into eMedley.Your faculty will be checking to ensure you are seeing the right number and mix of patients for a good learning experience.You will also need to include a minimum of one complete SOAP note using the Pediatric SOAP Note template NSG 6435.The SOAP note should be related to the content covered in this week, and the completed note should be submitted to the Dropbox.When submitting your note, be sure to include the reference number from eMedley.

    Submission Details:

    enter your patient encounters into eMedley and complete at least one SOAP note in the template provided.

    Name your SOAP note document SU_NSG6435_W9_A4_LastName_FirstInitial.doc.

    Include the reference number from eMedley in your document.

     

    NSG 6435 Week 10 
     Assignment 2

    Assignment 2: SOAP Note

    Each week, you are required to enter your patient encounters into eMedley.Your faculty will be checking to ensure you are seeing the right number and mix of patients for a good learning experience.You will also need to include a minimum of one complete SOAP note using the Pediatric SOAP Note template.The SOAP note should be related to the content covered in this week, and the completed note should be submitted to the Dropbox.When submitting your note, be sure to include the reference number from eMedley.

    Submission Details:

    enter your patient encounters into eMedley and complete at least one SOAP note in the template provided.

    Name your SOAP note document SU_NSG6435_W10_A2_LastName_FirstInitial.doc.

    Include the reference number from eMedley in your NSG 6435 document.

  • PEDIATRIC FILLABLE SOAP NOTE TEMPLATE – 7 year old Caucasian male

    PEDIATRIC FILLABLE SOAP NOTE TEMPLATE – 7 year old Caucasian male

    STUDENT NAME: Amy Brown

    DATE OF ASSIGNMENT: 03/12/2019

    Patient Initials: M.L.

    Date of Encounter: 03/07/2019

    Sex: Male

    Age/DOB/Place of Birth:

    7 year old male

    11/21/2011

    Cape Coral, FL

    SUBJECTIVE

    Historian:  Mother

    Present Concerns/CC
    : 7 year old Caucasian male accompanied by his mother with complaints of seeing lights and spacing out.  The mother states that her son stares into space and she tries to snap him out of it and nothing works.

    ORDER A PLAGIARISM-FREE PAPER HERE

    Child Profile:
    Child attends public school and is doing well according to his mother.

    HPI:
    O:
    Child has been having episodes where he stares into space x6 months.

    L:
    There is no specific location as the child does not know it is happening

              D:
    Per the mother the episodes usually last 10-30 seconds

              C:
    No specific character, the child is non responsive

              A:
    Per the mother there does not seem to be any aggravating factors

              R:
    No relieving factors, the child eventually snaps out of it

              T:
    It does not occur at any specific time of the day

              S:
    The episodes do not vary in severity

     

    Medications: 
    None

    PEDIATRIC FILLABLE SOAP NOTE TEMPLATE – 7 year old Caucasian male

     

    PMH:
    The child has been diagnosed with mild ADHD and there has been question whether or not the patient is autistic.  He is currently receiving behavioral therapy for the ADHD and his mother states that it seems to be working well.

    Allergies:
    None

    Medication Intolerances:
    None noted

    Chronic Illnesses/Major traumas:
    none

    Hospitalizations/Surgeries:
    none

    Immunizations:
    up to date

     

     

    PEDIATRIC FILLABLE SOAP NOTE TEMPLATE

     

     

    Eyes: No drainage from eyes. Denies any pain or itching to bilateral eyes. Patient does not use eye glasses.

     

    2|
    PEDIATRIC SOAP NOTE

    PEDIATRIC FILLABLE SOAP NOTE TEMPLATE

    OBJECTIVE (plot height/weight/head circumference along with noting percentiles) PEDIATRIC FILLABLE SOAP NOTE TEMPLATE – 7 year old Caucasian male

    Attach growth chart

    Weight: 34.47 kg

    Temp 98.4

    BP 98/62

    Height 124.46 cm

    Pulse 82

    Resp 22

    OBJECTIVE:
    Physical Examination reveals a well-nourished male, well developed for age. Temp: 98.4 HR 82, RR 22, O2 and blood pressure 98/62 Weight: 34.47kg, height 124.46 cm.  Normal neurological exam performed in the office, no signs or symptoms of seizures.  Child does not fall over during the episodes nor does he remember them.

    General Appearance and parent
    –
    child interaction:
    Maternal/Child both appear well kept and are in clean clothing, interaction is normal, mother is very attentive to child needs.

    Skin
    General skin overview reveals no significant rash or other lesion

    HEENT
    Normocephalic, PERRL, Conjunctiva clear with no drainage noted. Tympanic membrane normal on right ear and bulging on left ear, no exudation noted in right but left with exudation in ear canal, nasal passages clear, no gross oropharyngeal lesions, oral mucosa wet, no adenopathy noted.

    Cardiovascular
    regular rate, capillary refill < 3sec. No gallop or murmur noted. Respiratory Breath sounds equal bilaterally.  Equal chest rise and fall. Gastrointestinal Bowel sounds heard in all four quadrants. Soft, no tenderness or distention noted upon palpation. Patient negative for rebound tenderness. Negative for Murphy’s sign, Rovsing’s sign or tenderness at McBurney’s point. Breast Deferred PEDIATRIC FILLABLE SOAP NOTE TEMPLATE – 7 year old Caucasian male Genitourinary: No dysuria, urinary frequency, or urgency; No evidence of UTI, hematuria, pelvic pain, bleeding, no vulvar itching, pain or rash. Musculoskeletal: Musculoskeletal- Patient demonstrates full range of motion with no signs of pain. PEDIATRIC FILLABLE SOAP NOTE TEMPLATE Neurological Alert and appropriate for age. No signs of focal motor or sensory deficit.  Appropriate neurological exam for age. Psychiatric Patient’s reactions are appropriate for age. Pediatric/Adolescent Assessment Tools: Neurological assessment performed, all cranial nerves appear to be intact   ASSESSMENT (Diagnosis – 3 Differentials and Primary) Ø Include at least three differential diagnoses with ICD-10 codes. (Includes Primary dx and 2 differentials) PEDIATRIC FILLABLE SOAP NOTE TEMPLATE – 7 year old Caucasian male Ø Document Evidence based Rationale for ROS and each differential with pertinent positives and negatives Ø Primary diagnosis ü Is #1 on list of differentials ü Evidence for primary diagnosis should be supported in the Subjective and Objective exams. 1) Transient alteration of awareness  IDC 10: R40.4 2) Seizure      ICD-10:  G40.909 3) Autism         ICD-10:  F84.0 PEDIATRIC FILLABLE SOAP NOTE TEMPLATE PLAN: Refer to neurology for further evaluation. Education:  Have mother keep a journal of when episodes occur, what is going on around him and how long they last. True absence seizures (“petit mal”) are seizures that cannot be predictably interrupted by calling the child’s name or by tactile stimulation.  It appears as if the person is having staring spells or behavioral lacity or basically “spacing out”.  This condition is very common in children who have been previously diagnosed with attention deficit hyperactivity disorder (ADHD).  When an absence seizure occurs it usually occurs during conversation or physical activity and looks as if they are daydreaming. PEDIATRIC FILLABLE SOAP NOTE TEMPLATE – 7 year old Caucasian male. These seizures usually happen multiple times a day (Wilfong, Nordli Jr, & Eichler, 2018). Follow up after he sees neurologist.  If child has seizure prior to visit with neurology go to nearest emergency room.     References American Academy of Pediatrics. (2018). Screening tools. Retrieved from https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Screening/Pages/Screening-Tools.aspx Charles Y. Hu. (2019, February 27). MedCalc: Interactive Growth Charts: Front Page. Retrieved from http://www.medcalc.com/growth/?fbclid=IwAR33JR9Z91rWZrWzp0Xvals3w0S4MT-9ZzjmmHe2JpWNPt9sZUlUDleFS5Q Chiocca, E., RNC, MSN, CPNP.  Advanced Pediatric Assessment, Second Edition . [South University]. Retrieved from https://digitalbookshelf.southuniversity.edu/#/books/9780826161765/ Wilfong, MD, A., Nordli Jr, MD, D., & Eichler, MD, MPH, A. (2018, September 23). Seizures and epilepsy in children: Classification, etiology, and clinical features. Retrieved from https://www.uptodate.com/contents/seizures-and-epilepsy-in-children-classification-etiology-and-clinical-features PEDIATRIC FILLABLE SOAP NOTE TEMPLATE – 7 year old Caucasian male

  • NURS-6521 Advanced Pharmacology quiz

    NURS-6521 Advanced Pharmacology quiz

    A home health nurse notes that there have been changes to a patient’s oral drug regimen. The nurse will closely monitor the new drug regimen to

    Response Feedback:    correct

    Changes in the drug regimen may cause changes in drug absorption and thereby decrease the anticipated drug effect. This decrease is due to the prevention of binding and loss of absorption and overall drug effectiveness. A change in the drug regimen would not help a nurse to track the route of metabolism or determine the speed of chelation. If any adverse effect were to occur as a result of a drug regimen change, it would not necessarily be immunotoxicity; it could also be nephrotoxicity, ototoxicity, or cardiotoxicity.

    ORDER A PLAGIARISM-FREE PAPER HERE

    In light of her recent high blood pressure readings, a patient has been started on a thiazide diuretic and metoprolol (Lopressor), which is a beta-adrenergic blocker. What is the most likely rationale for using two medications to address the patient’s hypertension?

    Response Feedback: correct

    A synergistic effect occurs when two or more “unlike” drugs (in terms of therapeutic effect or mechanism of action) are used together to produce a combined effect, and the outcome is a drug effect greater than either drug’s activity alone. As a result, the patient’s hypertension may be better treated than with a single drug. This does not necessarily reduce the risk of adverse reactions or increase compliance with the regimen.

    A patient has been prescribed an oral drug that is known to have a high first-pass effect. Which of the following measures has the potential to increase the amount of the free drug that is available to body cells?

    Response Feedback:

    Unlike oral medications, drugs that are given intravenously do not initially pass through the liver. As a result, the first-pass effect is mitigated and more of the drug is available to cells. Frequent oral doses, low protein intake, and administration with food do not reduce the first-pass effect NURS-6521 Advanced Pharmacology quiz. Correct

     

    The nurse is caring for a patient receiving an aminoglycoside (antibiotic) that can be nephrotoxic. Which of the following will alert the nurse that the patient may be experiencing nephrotoxicity?

    Response Feedback:    correct

    Decreased urinary output, elevated blood urea nitrogen, increased serum creatinine, altered acid–base balance, and electrolyte imbalances can occur with nephrotoxicity. Ringing noise in the ears (tinnitus) is an indication of possible ototoxicity. Visual disturbances can suggest neurotoxicity, and yellowing of the skin (jaundice) is a sign of hepatotoxicity.

     

    A nurse is instructing a patient concerning a newly prescribed drug. Which of the following should be included to help improve patient compliance and safety?

    Response Feedback:    correct

    If patients are aware of certain adverse effects and how to alleviate or decrease the discomfort, they are more likely to continue taking the medication and providing for safe administration. A list of pharmacies can be useful information, but will not improve safety or compliance. Knowing the cost of the brand versus the generic could also be helpful to the patient. However, a substitution may not be allowed, and the cost of a drug does not improve patient safety. Most patients are not concerned with statistics regarding drug testing, and the testing is usually not discussed with patients.

     

    An unconscious patient has been brought to the hospital, and the physician has prescribed a life-saving drug to be administered parenterally. Which of the following methods would be the most appropriate for the nurse to use when administering the medication?

    Response Feedback:    correct

    Intravenous infusion is the preferred method for use in emergency situations when rapid drug effects are desired. Absorption is considered to be instantaneous, as the drug is placed directly into the bloodstream. The subcutaneous and intramuscular routes could be used but would not ensure rapid drug effects. Intrathecal administration is usually done by a physician or a specially trained health care provider.

    A 60-year-old African-American man lives with a number of chronic health problems. Genetic factors are likely to influence his etiology and/or treatment of

    Response Feedback:

    The incidence of hypertension is significantly higher among African-Americans than other ethnic groups. As well, African Americans respond to some antihypertensive drugs differently than whites.  Correct

     

    n which of the following patients would a nurse expect to experience alterations in drug metabolism?

    Response Feedback:    correct

    The liver is the most important site for drug metabolism. If the liver is not functioning effectively, as with cirrhosis, drugs will not be metabolized normally and toxic levels could develop. Drug dosage will have to be altered to ensure normal levels in the body. The patient with kidney stones and the patient in acute renal failure would most likely have alterations in drug excretion. If there are no complications with the cervical cancer patient, there should be no alterations in drug therapy NURS-6521 Advanced Pharmacology quiz.

    During a clinic visit, a patient complains of having frequent muscle cramps in her legs. The nurse’s assessment reveals that the patient has been taking over-the-counter laxatives for the past 7 years. The nurse informed the patient that prolonged use of laxatives

    Response Feedback:

    Long-term intake of laxatives, antidepressants, and antibiotics has been found to deprive a person of most essential nutrients, such as vitamins. Prolonged use of laxatives is not known to turn urine acidic, cause urinary tract infections, counter the effect of other drugs, or inhibit the biotransformation of drugs. correct

    A patient with a variety of chronic health problems is being seen by her nurse practitioner, who is currently reviewing the patient’s medication regimen. Which of the patient’s medications should prompt the nurse to teach her to avoid drinking grapefruit juice?

    Response Feedback:    correct

    Metabolism of many varied drugs such as calcium channel blockers (used to treat hypertension), statins (used to lower blood lipid levels), and antihistamines (used to prevent allergic reactions) is affected by grapefruit juice.

     

    A nurse has been administering a drug to a patient intramuscularly (IM). The physician discontinued the IM dose and wrote an order for the drug to be given orally. The nurse notices that the oral dosage is considerably higher than the parenteral dose and understands that this due to

    Response Feedback:    correct

    The first-pass effect involves drugs that are given PO and absorbed from the small intestine directly into the portal venous system, which delivers the drug molecules to the liver. Once in the liver, enzymes break the drug into metabolites; they may become active or may be deactivated and readily excreted from the body NURS-6521 Advanced Pharmacology quiz. A large percentage of the oral dose is usually destroyed and never reaches tissues. Oral dosages account for this phenomenon to ensure an appropriate amount of the drug in the body to produce a therapeutic action. Passive diffusion is the major process through which drugs are absorbed into the body. Active transport is a process that uses energy to actively move a molecule across a cell membrane and is often involved in drug excretion in the kidney. Glomerular filtration is the passage of water and water-soluble components from the plasma into the renal tubule.

    A nurse is discussing with a patient the efficacy of a drug that his physician has suggested, and he begin taking. Efficacy of a drug means which of the following?

    Response Feedback:

    Efficacy indicates how well a drug produces its desired effect. Different drugs have different strengths of attraction or affinity for receptor sites. A drug’s ability to stimulate its receptor is called its intrinsic activity, and the amount of a drug that must be given to produce a particular response is called the potency of a drug.correct NURS-6521 Advanced Pharmacology quiz

    A nurse is caring for a patient who has had part of her small intestine removed due to cancer. She has also now developed hypertension and has been prescribed a new medication to decrease her blood pressure. While planning the patient’s care, the nurse should consider a possible alteration in which of the following aspects of pharmacokinetics?

    Response Feedback:

    Because absorption takes place mostly in the small intestine, there could be possible alterations with this process. Distribution takes place in the blood vessels; metabolism in the liver; and elimination via the kidneys. Because these systems are not affected by her surgery, these phases of pharmacokinetics would not be altered. Correct

     

    In order to promote therapeutic drug effects, the nurse should always encourage patients to

    Response Feedback:

    Taking a drug at the appropriate time will help the patient maintain therapeutic drug levels. Not all medications should be taken with food, which can alter the absorption of some drugs. A patient should never increase or decrease a medication dosage without checking with the prescriber. Alternative therapy should only be used if the patient has discussed the therapy with the prescriber and they are in agreement. Correct

     

    Talwin given in combination with Vistaril diminishes the adverse effects of nausea caused by the Talwin. This drug interaction affecting the pharmacodynamics of the Talwin is

    Response Feedback:    incorrect

    An antagonistic drug interaction results in a therapeutic effect that is less than the effect of either drug alone because the second drug either diminishes or cancels the effects of the first drug. An additive effect occurs when two or more “like” drugs are combined and the result is the sum of the drugs’ effects. A synergistic effect occurs when two or more “unlike” drugs are used together to produce a combined effect and the outcome is a drug effect greater than either drug’s activity alone. Potentiation is an interaction in which the effect of only one of the two drugs is increased.

     

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    NURS-6521N-19,Advanced Pharmacology.2016 Fall Qtr 08/29-11/20-PT27    Quizzes  Review Test Submission: Week 1 – Quiz

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    NURS-6521N-19,Advanced Pharmacology.2016 Fall Qtr 08/29-11/20-PT27

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    Review Test Submission: Week 1 – Quiz

    User     Judy Thiessen

    Course NURS-6521N-19,Advanced Pharmacology.2016 Fall Qtr 08/29-11/20-PT27

    Test     Week 1 – Quiz

    Started            9/2/16 12:36 AM

    Submitted        9/2/16 5:34 AM

    Status  Needs Grading

    Attempt Score 32 out of 40 points

    Time Elapsed  4 hours, 57 minutes out of 1 hour and 40 minutesOVER TIME

    Instructions

    Please answer each question below and click Submit when you have completed the Quiz.

    Results Displayed        Feedback

    Question 1

    1 out of 1 points

    A home health nurse notes that there have been changes to a patient’s oral drug regimen. The nurse will closely monitor the new drug regimen to

    Response Feedback:

    Changes in the drug regimen may cause changes in drug absorption and thereby decrease the anticipated drug effect. This decrease is due to the prevention of binding and loss of absorption and overall drug effectiveness NURS-6521 Advanced Pharmacology quiz. A change in the drug regimen would not help a nurse to track the route of metabolism or determine the speed of chelation. If any adverse effect were to occur as a result of a drug regimen change, it would not necessarily be immunotoxicity; it could also be nephrotoxicity, ototoxicity, or cardiotoxicity.

    Question 2

    1 out of 1 points

    In light of her recent high blood pressure readings, a patient has been started on a thiazide diuretic and metoprolol (Lopressor), which is a beta-adrenergic blocker. What is the most likely rationale for using two medications to address the patient’s hypertension?

    Response Feedback:

    A synergistic effect occurs when two or more “unlike” drugs (in terms of therapeutic effect or mechanism of action) are used together to produce a combined effect, and the outcome is a drug effect greater than either drug’s activity alone. As a result, the patient’s hypertension may be better treated than with a single drug. This does not necessarily reduce the risk of adverse reactions or increase compliance with the regimen.

    Question 3

    1 out of 1 points

    A patient has been prescribed an oral drug that is known to have a high first-pass effect. Which of the following measures has the potential to increase the amount of the free drug that is available to body cells?

    Response Feedback:

    Unlike oral medications, drugs that are given intravenously do not initially pass through the liver. As a result, the first-pass effect is mitigated and more of the drug is available to cells. Frequent oral doses, low protein intake, and administration with food do not reduce the first-pass effect NURS-6521 Advanced Pharmacology quiz.

    Question 4

    1 out of 1 points

    Tylenol 325 mg/tablet, patient needs 650 mg; how many tables should patient take?

    Question 5

    1 out of 1 points

    The nurse is caring for a patient receiving an aminoglycoside (antibiotic) that can be nephrotoxic. Which of the following will alert the nurse that the patient may be experiencing nephrotoxicity?

    Response Feedback:

    Decreased urinary output, elevated blood urea nitrogen, increased serum creatinine, altered acid–base balance, and electrolyte imbalances can occur with nephrotoxicity. Ringing noise in the ears (tinnitus) is an indication of possible ototoxicity. Visual disturbances can suggest neurotoxicity, and yellowing of the skin (jaundice) is a sign of hepatotoxicity.

    Question 6

    1 out of 1 points

    A nurse is instructing a patient concerning a newly prescribed drug. Which of the following should be included to help improve patient compliance and safety?

    Response Feedback:

    If patients are aware of certain adverse effects and how to alleviate or decrease the discomfort, they are more likely to continue taking the medication and providing for safe administration. A list of pharmacies can be useful information, but will not improve safety or compliance. Knowing the cost of the brand versus the generic could also be helpful to the patient. However, a substitution may not be allowed, and the cost of a drug does not improve patient safety. Most patients are not concerned with statistics regarding drug testing, and the testing is usually not discussed with patients. NURS-6521 Advanced Pharmacology quiz

    Question 7

    1 out of 1 points

    An unconscious patient has been brought to the hospital, and the physician has prescribed a life-saving drug to be administered parenterally. Which of the following methods would be the most appropriate for the nurse to use when administering the medication?

    Response Feedback:

    Intravenous infusion is the preferred method for use in emergency situations when rapid drug effects are desired. Absorption is considered to be instantaneous, as the drug is placed directly into the bloodstream. The subcutaneous and intramuscular routes could be used but would not ensure rapid drug effects. Intrathecal administration is usually done by a physician or a specially trained health care provider.

    Question 8

    1 out of 1 points

    A 60-year-old African-American man lives with a number of chronic health problems. Genetic factors are likely to influence his etiology and/or treatment of

    Response Feedback:

    The incidence of hypertension is significantly higher among African-Americans than other ethnic groups. As well, African Americans respond to some antihypertensive drugs differently than whites.

    Question 9

    1 out of 1 points

    In which of the following patients would a nurse expect to experience alterations in drug metabolism?

    Response Feedback:

    The liver is the most important site for drug metabolism. If the liver is not functioning effectively, as with cirrhosis, drugs will not be metabolized normally and toxic levels could develop. Drug dosage will have to be altered to ensure normal levels in the body. The patient with kidney stones and the patient in acute renal failure would most likely have alterations in drug excretion. If there are no complications with the cervical cancer patient, there should be no alterations in drug therapy.

    Question 10

    1 out of 1 points

    A patient with a variety of chronic health problems is being seen by her nurse practitioner, who is currently reviewing the patient’s medication regimen. Which of the patient’s medications should prompt the nurse to teach her to avoid drinking grapefruit juice?

    Response Feedback:

    Metabolism of many varied drugs such as calcium channel blockers (used to treat hypertension), statins (used to lower blood lipid levels), and antihistamines (used to prevent allergic reactions) is affected by grapefruit juice.

    Question 11

    1 out of 1 points

    During a clinic visit, a patient complains of having frequent muscle cramps in her legs. The nurse’s assessment reveals that the patient has been taking over-the-counter laxatives for the past 7 years. The nurse informed the patient that prolonged use of laxatives

    Response Feedback:

    Long-term intake of laxatives, antidepressants, and antibiotics has been found to deprive a person of most essential nutrients, such as vitamins. Prolonged use of laxatives is not known to turn urine acidic, cause urinary tract infections, counter the effect of other drugs, or inhibit the biotransformation of drugs.

    Question 12

    1 out of 1 points

    A nurse has been administering a drug to a patient intramuscularly (IM). The physician discontinued the IM dose and wrote an order for the drug to be given orally. The nurse notices that the oral dosage is considerably higher than the parenteral dose and understands that this due to

    Response Feedback:

    The first-pass effect involves drugs that are given PO and absorbed from the small intestine directly into the portal venous system, which delivers the drug molecules to the liver. Once in the liver, enzymes break the drug into metabolites; they may become active or may be deactivated and readily excreted from the body. A large percentage of the oral dose is usually destroyed and never reaches tissues. Oral dosages account for this phenomenon to ensure an appropriate amount of the drug in the body to produce a therapeutic action. Passive diffusion is the major process through which drugs are absorbed into the body. Active transport is a process that uses energy to actively move a molecule across a cell membrane and is often involved in drug excretion in the kidney. Glomerular filtration is the passage of water and water-soluble components from the plasma into the renal tubule.

    Question 13

    1 out of 1 points

    A nurse is discussing with a patient the efficacy of a drug that his physician has suggested, and he begin taking. Efficacy of a drug means which of the following?

    Response Feedback:

    Efficacy indicates how well a drug produces its desired effect. Different drugs have different strengths of attraction or affinity for receptor sites. A drug’s ability to stimulate its receptor is called its intrinsic activity, and the amount of a drug that must be given to produce a particular response is called the potency of a drug.

    Question 14

    1 out of 1 points

    A nurse is caring for a patient who has had part of her small intestine removed due to cancer. She has also now developed hypertension and has been prescribed a new medication to decrease her blood pressure. While planning the patient’s care, the nurse should consider a possible alteration in which of the following aspects of pharmacokinetics?

    Response Feedback:

    Because absorption takes place mostly in the small intestine, there could be possible alterations with this process. Distribution takes place in the blood vessels; metabolism in the liver; and elimination via the kidneys. Because these systems are not affected by her surgery, these phases of pharmacokinetics would not be altered.

    Question 15

    1 out of 1 points

    In order to promote therapeutic drug effects, the nurse should always encourage patients to

    Response Feedback:

    Taking a drug at the appropriate time will help the patient maintain therapeutic drug levels. Not all medications should be taken with food, which can alter the absorption of some drugs. A patient should never increase or decrease a medication dosage without checking with the prescriber. Alternative therapy should only be used if the patient has discussed the therapy with the prescriber and they are in agreement.

    Question 16

    0 out of 1 points

    Talwin given in combination with Vistaril diminishes the adverse effects of nausea caused by the Talwin. This drug interaction affecting the pharmacodynamics of the Talwin is

    Response Feedback:

    An antagonistic drug interaction results in a therapeutic effect that is less than the effect of either drug alone because the second drug either diminishes or cancels the effects of the first drug. An additive effect occurs when two or more “like” drugs are combined and the result is the sum of the drugs’ effects. A synergistic effect occurs when two or more “unlike” drugs are used together to produce a combined effect and the outcome is a drug effect greater than either drug’s activity alone. Potentiation is an interaction in which the effect of only one of the two drugs is increased.

    Question 17

    1 out of 1 points

    A patient who has ongoing pain issues has been prescribed meperidine (Demerol) IM. How should the nurse best administer this medication?

    Response Feedback:

    The ventrogluteal site is the preferred site for intramuscular injection. IM injections necessitate the use of a larger gauge needle than is required for subcutaneous injections.

    Question 18

    1 out of 1 points

    A nurse is caring for a patient who has recently moved from Vermont to south Florida. The patient has been on the same antihypertensive drug for 6 years and has had stable blood pressures and no adverse effects. Since her move, however, she reports “dizzy spells and weakness” and feels that the drug is no longer effective. The nurse suspects that the change in the effectiveness of the drug is related to

    Response Feedback:

    Antihypertensive drugs work to decrease blood pressure. When a patient goes to a climate that is much warmer than usual, blood vessels dilate and the blood pressure decreases. If a patient is taking an antihypertensive drug and enters a warmer climate, there is a chance that the patient’s blood pressure will drop too low, resulting in dizziness and a feeling of weakness. After several years on an antihypertensive drug, the effects of that drug are known; therefore, the placebo effect should not be an issue. Most antihypertensives are metabolized and excreted and do not accumulate in the body. The patient has not given the nurse any information that would indicate that she has not been compliant with her drug regimen due to the move.

    Question 19

    1 out of 1 points

    The nurse’s assessment of a community-dwelling adult suggests that the client may have drug allergies that have not been previously documented. What statement by the client would confirm this?

    Response Feedback:

    True allergic reactions include formation of rash or hives, itching, redness, swelling, difficulty breathing, and anaphylactic shock. Nausea and vomiting, however, are adverse effects of drug therapy. Similarly, an unsafe drop in blood pressure and gastric bleeding from aspirin use are adverse drug effects, not allergic reactions.

    Question 20

    1 out of 1 points

    An older adult patient with a history of Alzheimer’s disease and numerous chronic health problems has been prescribed several medications during his current admission to hospital and recent declines in the patient’s cognition have impaired his ability to swallow pills. Which of the following medications may the nurse crush before administering them to this patient?

    Response Feedback:

    A tablet that is designed for immediate release into the gastric environment is normally safe to crush and administer to the patient. Enteric coated and sustained release tablets may not be crushed because doing so compromising the delayed release into the GI tract that is intended with these medications. Sublingual medications should be placed under the tongue to dissolve rather than swallowed.

    Question 21

    1 out of 1 points

    A patient who has been admitted to the hospital for a mastectomy has stated that she has experienced adverse drug effects at various times during her life. Which of the following strategies should the nurse prioritize in order to minimize the potential of adverse drug effects during the patient’s stay in the hospital?

    Response Feedback:

    In an effort to minimize the potential of adverse drug effects, it is necessary to closely monitor the patient. It would be inappropriate for the nurse to alter the route or frequency of administration or to encourage herbal remedies that also carry the potential for adverse effects.

    Question 22

    1 out of 1 points

    For which of the following patients would a nasogastric tube most likely be considered to aid in the administration of medications?

    Response Feedback:

    The use of an NG tube for medication administration requires a functioning GI tract. An NG tube would not be used if a patient is vomiting frequently or has had recent bowel surgery. Similarly, an NG tube would not be used in the case of a competent adult who wishes to discontinue his or her medications.

    Question 23

    0 out of 1 points

    Which of the following statements best defines how a chemical becomes termed a drug?

    Response Feedback:

    Even though all the responses are correct, a chemical must undergo a series of tests to determine its therapeutic value and efficacy without severe toxicity or damaging properties before it is termed a drug. Test results are reported to the FDA, which may or may not give approval.

    Question 24

    0 out of 1 points

    In response to a patient’s nausea, the nurse has mixed a dose of an antiemetic with 50 mL of sterile normal saline and will administer the dose by IV piggyback. What is the rationale for the use of IV piggyback?

    Response Feedback:

    When the patient receives continuous IV fluids and is also receiving intermittent IV drug therapy, the drug is normally given through a secondary IV tubing. When a secondary IV tubing is used to administer an IV drug, the tubing is added to the main line tubing, usually at a Y port. Adding secondary tubing is called “piggybacking” because the tubing with the drug rides on top of the primary fluid tubing. Failure to adhere to a prescribed regimen, unstable electrolyte levels, and need for continuous monitoring are not rationales for the use of an IV piggyback.

    Question 25

    1 out of 1 points

    30 ml = _______________tbsp

    Question 26

    1 out of 1 points

    A 79-year-old patient in a long-term care facility is to receive an intravenous fat emulsion. Which of the following lab values would be a priority for the nurse to assess before administration?

    Response Feedback:

    Triglycerides are the predominant dietary lipids. Fats should supply no more than 25% to 30% of the total intake of a well-balanced diet. It would be most important for the nurse to know the triglyceride level before administration of the fat emulsion and to monitor the levels as appropriate. In the older adult, sodium and potassium levels are important to monitor due to decrease in cardiac function and the likelihood of this patient taking cardiac drugs. Also, due to age it would be important to monitor glucose levels. However, it would be most important in this patient to monitor the triglyceride levels, as well as the cholesterol and phospholipid levels since he or she is to receive a fat emulsion.

    Question 27

    0 out of 1 points

    A nurse is teaching an older adult patient about polypharmacy. Which of the following statements best describe this term?

    Response Feedback:

    Polypharmacy is defined as taking several drugs at the same time. The other options are false statements.

    Question 28

    0 out of 1 points

    A 70-year-old woman is starting on an acidic drug. The nurse is aware that food and nutrient intake can affect drug excretion by changing the urinary pH. About which of the following will the nurse question the patient concerning her diet?

    Response Feedback:

    The nurse will assess for the amount of meat and vegetables in the woman’s diet. A diet rich in meat or in vegetables may influence the urine pH—either acidic or basic. The renal excretion of drugs may be changed significantly because drugs are generally either weak organic acids or bases. Grapefruit juice and certain drugs may cause an interaction that leads to an increase in bioavailability of the drug, which increases the serum drug level. Diminished protein status results in lower amounts of plasma proteins that can substantially increase the concentration of free drug available. This increase of free drug can increase the drug’s effect and the risk of adverse effects. A significant decrease of dietary sodium can alter the reabsorption of some drugs in the renal tubule, resulting in higher circulating levels of the drug and potential drug toxicity.

    Question 29

    1 out of 1 points

    An 80-year-old man has been prescribed oxycodone for severe, noncancer, chronic pain. He tells the nurse that he has difficulty swallowing and asks if he can crush the tablet before swallowing. The nurse will advise the patient that

    Response Feedback:

    The nurse should caution the patient against crushing the tablet before ingesting it. Crushing allows an extremely high dose of the drug to be available all at once, instead of being released slowly over time. Severe adverse effects are possible when it is used in this manner. The other options are false statements.

    Question 30

    1 out of 1 points

    Mr. Lacuna is an 83-year-old resident of a long-term care facility who has a diagnosis of moderate Alzheimer disease. Mr. Lacuna’s physician recently prescribed oral rivastigmine, but he was unable to tolerate the drug due to its gastrointestinal effects. As a result, he has been ordered the transdermal patch form of the medication. When administering this form of rivastigmine, the nurse should

    Response Feedback:

    In patients with moderate dementia, it may be necessary to place the patch on the back where it cannot be removed in settings where a nurse will be reapplying the patch. A patient with moderate dementia would not normally self-manage medications. The dosage of rivastigmine is not increased during a short-term exacerbation of symptoms. Transdermal patches are never applied to mucous membranes.

    Question 31

    1 out of 1 points

    A 75-year-old woman is prescribed magnesium hydroxide for constipation. The nurse’s assessment reveals that the patient is being treated for rheumatoid arthritis and hypertension. The patient lives in assisted living and is on a low-sodium diet. Before the magnesium hydroxide therapy begins, it will be most important for the nurse to assess the patient’s

    Response Feedback:

    Magnesium hydroxide interacts with many drugs, increasing the effects of some and decreasing the effects of others. Therefore, the nurse should check for drug interactions to avoid adverse effects. Factors such as the patient’s home environment, diet, and activity level should be assessed and could contribute to the patient’s constipation. However, it would be most important to assess the medications that could be affected by the administration of magnesium hydroxide.

    Question 32

    1 out of 1 points

    A 70-year-old woman with a history of atrial fibrillation has been admitted with a lower gastrointestinal bleed. During the nurse’s admission assessment, the nurse realizes that the patient has been taking ginkgo biloba supplements in addition to her prescribed warfarin, a combination that has resulted in bleeding. What nursing diagnosis should the nurse identify when planning this patient’s care?

    Response Feedback:

    The woman has experienced an adverse health effect due to the interaction between her prescribed therapy (warfarin) and a herb (ginkgo biloba). The woman’s health problem is not a direct consequence of excessive use of the herb or protein levels and malnutrition.

    Question 33

    0 out of 1 points

    A 90-year-old frail, elderly woman has arrived at the emergency department with a broken hip and in acute respiratory distress. Succinylcholine will be used because of the need for rapid endotracheal intubation, and then the woman will be sent to surgery. Due to the woman’s frail condition, she is at risk for skin breakdown. Which of the following nursing diagnoses would be most appropriate?

    Response Feedback:

    The nursing diagnosis that directly relates to possible skin breakdown is Impaired Physical Mobility related to drug-induced paralysis. Patients who are unable to speak, move, or breathe unassisted can quickly develop pressure sores (decubitus ulcers). It is the responsibility of the nurse to help keep the patient positioned correctly to avoid skin breakdown. The nurse will plan interventions to prevent skin breakdown based on how long the patient will be immobilized. Impaired Spontaneous Ventilation is related to respiratory paralysis. Fear is related to paralysis and helplessness, and Disturbed Sensory Perception is related to CNS depression secondary to drugs used during anesthesia.

    Question 34

    1 out of 1 points

    A nurse is caring for a 70-year-old patient who is taking desmopressin (DDAVP). The patient has a history of cardiovascular disease. The nurse will prioritize the assessment of which of the following?

    Response Feedback:

    Desmopressin should be used with caution in patients with conditions associated with fluid and electrolyte imbalance, such as cystic fibrosis or renal or cardiovascular diseases, because these patients are especially prone to hyponatremia. When administered to either pediatric or geriatric individuals, fluid intake should be adjusted downward to limit the risk of hyponatremia and water intoxication. The drug has no effect on the weight or the temperature of the patient. There is no risk for dehydration.

    Question 35

    1 out of 1 points

    An elderly man has been admitted to a residential care facility and the nurse has conducted a medication reconciliation. The man has taken numerous drugs in the past, including a course of bicalutamide (Casodex) several years earlier. The nurse recognizes this drug as being an antiandrogen and is consequently justified in presuming that the man has a history of what disease?

    Response Feedback:

    In male patients, antiandrogens are used to treat prostate cancer. They are not included in treatment of lymphomas, skin cancer, or lung cancer.

    Question 36

    0 out of 1 points

    A 70-year-old woman has experienced peripheral edema and decreasing stamina in recent months and has sought care from her primary care provider. The patient’s subsequent diagnostic workup has resulted in a diagnosis of chronic heart failure. The woman has been prescribed digoxin and the nurse has begun patient education. What should the nurse teach the patient about her new medication?

    Response Feedback:

    Digoxin is used to maintain clinical stability and improve symptoms, quality of life, and exercise tolerance in patients with all phases of CHF; it does not decrease mortality from CHF or cure the disease. Digoxin increases urine production but its therapeutic effect is not primarily gained from diuresis or blood pressure reduction NURS-6521 Advanced Pharmacology quiz.

    Question 37

    1 out of 1 points

    Hacioğlu, S. K., Doğu, M. H., Sarı, İ., & Keskin, A. (2015). Successful Treatment of Refractory Gastrointestinal Bleeding by Systemic (Oral) Ankaferd Blood Stopper in a Patient with Glanzmann Thrombasthenia.
    Balkan Medical Journal
    ,
    32
    (2), 218-220. doi:10.5152/balkanmedj.2015.15734

    A 67-year-old man is admitted to the hospital with pneumonia. He reports to the nurse that he has chronic arthritis and circulation problems. Further assessment by the nurse reveals that the patient has a history of mild hypertension. He explains that he owns a business and lives alone. The nurse determines that he is within the normal weight range for his height and age but has a fondness for spicy foods and sweets. Which of the mentioned patient variables will have the greatest impact on the effectiveness of the patient’s drug therapy?

    Response Feedback:

    Vascular impairment would have the greatest implication on drug therapy for the patient. Blood flow can affect the rate of absorption. Patients who have impaired circulatory systems absorb drugs less rapidly than those with normally functioning systems. Distribution depends on blood flow to the tissues, the drug’s ability to leave the blood, and the drug’s ability to enter cells. Once a drug is absorbed, it is transported to the tissues and cells through the circulatory system. Pathophysiologic changes in the vascular system impair the distribution of drug molecules, which may decrease the therapeutic effectiveness of the drug. Vascular system impairment can affect liver functioning by decreasing drug metabolism, which can lead to increased circulating levels of the drug, possibly causing more adverse effects. Also, vascular system impairment can affect the capillary network and could lead to increased circulating blood levels of a drug. This could cause more adverse effects to occur. The other variables such as mild hypertension and chronic arthritis should also be considered but would not strongly affect drug therapy. Dietary habits would not significantly affect this patient’s drug therapy NURS-6521 Advanced Pharmacology quiz.

    Question 38

    1 out of 1 points

    A 79-year-old woman has been admitted to the hospital with a gastrointestinal bleed. She is currently receiving a transfusion of packed red blood cells as well as an infusion of pantoprazole (Protonix), a proton-pump inhibitor, to help stop her bleeding. What care setting is most appropriate for this patient?

    Response Feedback:

    Blood transfusions and continuous infusions of intravenous medications require the vigilant assessment and monitoring that can be provided in an acute care setting; this is not normally possible in an ARU or transitional care setting and would be impossible in an outpatient environment.

    Question 39

    1 out of 1 points

    A 66-year-old woman has a complex medical history that includes poorly-controlled type 1 diabetes, renal failure as a result of diabetic nephropathy and chronic heart failure (CHF). Her care provider has recently added spironolactone (Aldactone) to the woman’s medication regimen. The nurse should consequently assess for signs and symptoms of

    Response Feedback:

    Spironolactone (Aldactone) and eplerenone (Inspra) are potassium-sparing diuretics, so their use increases serum potassium levels NURS-6521 Advanced Pharmacology quiz. Spironolactone is not known to contribute to dysrhythmias, leukocytosis, or thrombophlebitis.

    Question 40

    0 out of 1 points

    A nurse is caring for a 78-year-old patient with renal insufficiency and chronic heart failure who is receiving rapid infusions of high-dose furosemide. It will be a priority for the nurse to monitor for

    Response Feedback:

    Ototoxicity can occur with rapid intravenous administration, especially in patients with poor renal function and in those receiving high doses of furosemide. Although usually transient, ototoxicity may result in permanent damage. Rapid infusions of high-dose furosemide would not place the patient at risk for hepatic encephalopathy. Excessive diuresis from furosemide can result in dehydration and vascular thrombosis, but they would not be the priority in this case NURS-6521 Advanced Pharmacology quiz.

  • NURS 6531 : Practice Care of Adults – Practicum Experience Journal

    NURS 6531 : Practice Care of Adults – Practicum Experience 
    Journal

    Practicum Experience Journal

     
    Student Name: Jxx

    E-mail Address:

    Practicum Placement Agency’s Name:

    Preceptor’s Name:

    Preceptor’s Telephone:

    Preceptor’s E-mail Address:

    As I begin my practicum, I believe it is important to familiarize myself with and utilize established nursing theories to maximize the experience. As I pondered on which theory to use I thought about what theory I would want a healthcare provider to use as they are caring for me. I feel that Paterson & Zderad’s Humanistic Nursing Theory will assist me and guide my practicing. It portrays the potential to mold me into the practitioner I hope to become. NURS 6531 : Practice Care of Adults – Practicum Experience Journal.

    The Humanistic Nursing Theory rose up out of Paterson’s and Zderad’s desire for an approach to improve things for healthcare professionals and their patients as they interacted with and performed the day to day activities of nursing practice (Parker & Smith, 2010). They felt the need to offer a method for reacting to the call of human needs NURS 6531 : Practice Care of Adults – Practicum Experience Journal. At the point when a healthcare professional reacts to a call of a health-related concern, she enters the universe of another, offering to, figuratively, experiences existence with that individual. From these experiences, they can encourage patients or their friends and family to be as much as they can be in the circumstances in which they are in. Humanistic Nursing Theory offers nurses an approach to light up the qualities and implications central to their lived encounters, so they may impart them to other healthcare providers and coordinate them into their nursing practice (Parker & Smith, 2010) NURS 6531 : Practice Care of Adults – Practicum Experience Journal.

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    Practicum Objectives

    The accompanying objective for this practicum encounter are framed from the Humanistic Nursing Theory while including the professionals seven domains of practice.

     
    Objective 1 – Scientific Foundation Competence

    Demonstrate competence in the utilization of scientific foundation. This objective will be fulfilled by thinking critically, pondering on research information, applying this evidence to enhancing practice methods and improving patient outcomes NURS 6531 : Practice Care of Adults – Practicum Experience Journal.

    Objective 2 – Leadership Competencies

               
    Demonstrate competence in application of leadership skills. This objective will be fulfilled by embracing leadership skills to facilitate change, establish a working relationship with an interdisciplinary team and other parties to improve healthcare, and portraying the ability to effectively communicate.

    Objective 3 – Quality Care Competencies

               
    Demonstrate competence in the application of quality care. this objective will be fulfilled by applying the best and most contemporary research discoveries to clinical practice, tailor care to each situation and utilize intercessions as necessary, and thinks about the complex connections between cost, safety, access, and quality in healthcare conveyance. NURS 6531 : Practice Care of Adults – Practicum Experience Journal.

    Objective 4 – Ethical Competencies

    Demonstrate competence in the application of ethics. This objective will be fulfilled by using ethics in decision-making, analyzing the ethical impact of all decisions, and comprehending moral complexities in healthcare conveyance to people and populaces.

    Objective 5 – Health Delivery System Competencies

               
    Demonstrate competence in the understanding of health care delivery system. This objective will be fulfilled by minimizing patient/provider risks, developing culturally competent care, dissecting effect of health care on all partners, incorporating knowledge of associations and systems to enhance healthcare and working with others to enhance the continuum of healthcare.

    Objective 6 – Policy Competencies

               
    Demonstrate competence in the application of health policy. This objective will be fulfilled by understanding the association of clinical practice and policy, analyzing cross-disciplinary effect of approach, and elevating ethical ways to deal with enhancing access, cost, and quality.

    Objective 7 – Technology & Information Literacy Competencies

    Demonstrate competence in the application of technology. This objective will be fulfilled by appropriately using technology to manage information, to evaluate the care delivered and translate health information to other members of the healthcare team.

     

    Weekly Goals

    The following are goals that I hope to adequately achieve during this practicum experience over these next ten weeks.

     

    Week 1
    – Establish a relationship with preceptor, develop an understanding of the expectations of the clinical site, observe basic workflow and population of patients seen and set realistic and achievable goals with preceptor.

    Week 2
    – Demonstrate the ability to adequately communicate with preceptor and other members of the health care team at clinical site.

    Week 3
    – Begin to effectively demonstrate the ability to perform a physical assessment on patients and document findings within the electronic medical record.

    Week 4
    – Demonstrate the capacity to successfully evaluate patient side effects, determine the conceivable intercessions required and apply those indications to justifications for interventions.

    Week 5
    – Demonstrate the capacity to perform a problem centered appraisal and aid in the patient specific care plan development NURS 6531 : Practice Care of Adults – Practicum Experience Journa.

    Week 6
    – Demonstrate the ability to apply assessment findings to a treatment plan and document interventions/plan

    Week 7
    – Demonstrate the ability to assess and give suitable recommendations to interventions and additional treatments.

    Week 8
    – Assess objectives/goals set with preceptor and have effectively finished or partially finished 80% of those objective/goals.

    Week 9
    –
    Conduct thorough assessment and documentation of an established/returning individual and suggest fitting treatment or mediations.

    Week 10
    – Perform and document a complete and thorough assessment of a patient that is new to the clinical site and suggest suitable medications and additional intercessions.

     

    References

    Consensus Model for ARNP Regulation. Retrieved from

    http://www.nursecredentialing.org/APRNConsensusModelReport.aspx

    Parker, M. E., & Smith, M. C. (2010). Nursing theories & nursing practice. 3rd ed.

    Philadelphia: F.A. Davis Co.

    The National Organization of Nurse Practitioner Faculties. (2017). Nurse practitioner

    core competencies content. Retrieved from https://cdn.ymaws.com/www.nonpf.

    org/resource/resmgr/competencies/2017_NPCoreComps_with_Curric.pdf NURS 6531 : Practice Care of Adults – Practicum Experience Journal

  • Nursing Concept Analysis Paper – Grit in Nursing Sample Essay

    Nursing Concept Analysis Paper – Grit in Nursing Sample Essay

    Concept Analysis Paper

    This assignment is designed for the student to examine the antecedents, attributes, and consequences of a concept. The student will identify a strong definition of this concept. If there is none, the student will develop one. The student will explore a concept, and then analyze that descriptive word and its use in literature. Steps from Wilson’s Concept and Analysis will be used (Walker & Avant, 2011).

    The body of the paper should not exceed 10 pages.

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    Follow these steps while completing the project:

    1. Introduction

    2. Select a concept relevant to nursing.

    3. Determine the purposes of analysis.

    4. Identify the uses of the concept (Literature Review).

    5. Determine the concept’s defining attributes, antecedents, and consequences.

    6. Construct a model case.

    7. Conclusion

    Nursing Concept Analysis Paper – Grit in Nursing Sample Essay

    Grit in Nursing: Concept Analysis

    Grit is a relatively new concept. Some researchers see it as similar to other constructs, but it is unique. This paper explores the concept of grit in nursing. The concept analysis utilizes steps from Wilson’s Concept Analysis. Purposes of the analysis are identified for nursing practice, education, and research. Its uses, and definitions are outlined based on the available literature. Based on the literature review, there are five defining attributes of grit in nursing: resilience, perseverance, passion, conscientiousness, and compassion. Antecedents of nursing grit include discovery of interest, setting the goal, and presence of adversity. Consequences of nursing grit are excellence in practice, personal growth, and happiness. A model case is presented for a better illustration of grit in nursing.

    Purposes of the Grit Analysis

    The purpose of this concept analysis is to explore the meaning of grit in the context of nursing. The enhanced understanding will then contribute to its use in nursing education, practice, and research. Improved awareness of the concept will enable nurses to exercise and grow their grit to provide excellent care to their patients. It will help nursing educators to incorporate methods to foster grit in nursing students. Researchers report that grit can be taught, but there is lack of evidence about what interventions may be helpful. It addition, it may prompt researchers to develop evidence-based recommendations about fostering grit. Nursing administrators may seek grittier nurses to achieve better patients’ outcomes.

                                                                    The Uses of Grit

    A thorough data research using keywords
    grit
    ,
    grit in nursing
    was performed. Major databases CINAHL, ProQuest, and Google Scholar were utilized. According to Merriam-Webster dictionary (2018),
    grit
    is a “sand, gravel”, “a hard sharp granule (as of sand), “any of several sandstones”, “the structure of a stone that adapts it to grinding”, “firmness of mind or spirit: unyielding courage in the face of hardship or danger”.

    Psychologist Duckworth has been studying grit. According to her definition, grit is a “perseverance and passion for long-term goals” (Duckworth et al., 2007, para. 1). Sustained interest gives motivation for achieving long-term goals. People with grit are consistent with their goals, they do not give up and trade them in the face of difficulties and failure. Grit, not talent or intellect, is a predictor of high achievements in different fields like education, military, sports or any professional development. Grit predicts personal success. Conscientiousness implies self-control in a given moment, grit represents pursuing long-term goals, persistency and consistency of grit differ it from other similar constructs. To achieve their long-term goals, gritty people choose more effective methods to practice over more enjoyable but less effective activities (Duckworth et al., 2007).

    Maddi, Matthews, Kelly, Villarreal, and White (2012) characterize grit as “a sustained pursuit of a given interest or goal” (p.23). They measured grit by the grit scale developed by Duckworth and Quinn, which includes assessment of two main factors of grit: consistency of interests and perseverance of effort. Among other variables that were measured, grit had a more predictive value than other variables on retention in difficult circumstances (Maddi et al., 2012).

    Cosgrove, Chen, and Castelli (2018) use the Duckworth definition of grit as well. Grit is viewed as a measure of behavior and goal achievement that leads to outstanding behavioral outcomes. Grit is a stable, but modifiable persistence toward long-term goals. Higher grit predicted better academic scores, but it did not predict higher fitness testing (Cosgrove et al., 2018).

    Stoffel and Cane (2018) also define grit as sustained commitment toward achieving long-term objectives despite obstacles, failures and setbacks. Grit Scales by Duckworth are used to compare academic performance of students, the total grit score was a predictor for a higher grade point average (Stoffel & Cane, 2018). Robinson uses the Grit Scale to evaluate the relationship between grit and nursing student academic engagement and found association of higher grit and stronger course engagement (as cited in Stoffel & Cane, 2018). Measuring grit is very challenging because it is based on self-reporting and has social desirability bias (Stoffel & Cane, 2018).

    Hellman and Gwinn (2017) also characterize grit as perseverance and passion for long-term goals, which can be significantly increased along with other character strengths (zest, self-control, optimism, gratitude, social intelligence, and curiosity) after brief hope intervention. Bolton, Praetorius, and Smith-Osborne (2016) associate grit with nine themes: frailty (ability to adapt to physical impairments positively), determination (the will to survive and refusal to be defeated, refusal to be helpless), perseverance, self-reliance, head-on approach to challenges, moving forward with life, will to live, strengths that buffer the impact of well-being, and anticipating one’s future losses. Crede, Tynan, and Harms (2017) have conducted a meta-analysis of grit research and have found that grit is strongly related to conscientiousness. Perseverance has a stronger effect on performance than consistency of interests (Crede et al., 2017).

    Vainio and Daukantait (2016) state that grit positively relates to well-being factors: psychological well-being, satisfaction with life and harmony in life since people are naturally motivated to realize their highest potential. Substance of grit is not a strict determination to pursue goals no matter the costs, but to pursue the goals that are consistent with one’s inner values relying on consistency of self (Vainio & Daukantait, 2016).

    Jin and Kim (2017) have also explored how grit relates to the subjective side of life, such as well-being. They state that “grit means dedication to long-term goals with enthusiasm, which is closely related to success in objective terms” (para. 1). Grit increases satisfying the autonomy and competence needs, autonomy then reduces depression, and competence increases life satisfaction, and both in turn lead to better well-being (Jin & Kim, 2017).

    Payne (2017) suggests that grit in nursing is about looking forward, setting and achieving goals, seeking excellence rather than perfection. Nurses express passion and love for their work as they find joy in helping patients to recover or being there for them at their death or bringing a new life into the world, being able to support patients and families in crisis. When nurses go back to school, there is excitement about learning new things, becoming technically proficient, reinforcing, and expanding skills. Gritty nurses have goals, courage (managing fear of failure), they take risks every day, conscientious (meticulous attention to detail, counting on each other) while moving from novice to expert. Nurses with grit are resilient in bouncing back from failures or problems. Nursing ethics are about purpose as well as supporting good decisions, which also promote resilience. Grit is a mindset or an attitude about striving for something good and virtuous like nursing (Payne, 2017).

    McCabe (2016) emphasizes that grit has a great benefit to nursing practice. Nurses with grit practice with excellence, determination, and compassion. She suggests that grit in nurses develops with more clinical experience and role modeling and that grit can be nurtured through communication with experienced nurses and reflecting on own experiences. She believes that characteristics of grit (conscientiousness, establishment of long-term goals, resiliency, and excellence) can be developed in nursing students and new nurses (McCabe, 2016).

    Attributes, Antecedents, and Consequences  

    Attributes

    Walker and Avant (2011) define attributes as the most frequent characteristics associated with the concept. The attributes of grit in nursing are: resilience, perseverance, passion, conscientiousness, and compassion.

    Resilience is one’s ability to go on after negative experiences and adversity (Stoffel & Cane, 2018). Traditional resilience is applied to severe psychological trauma and adversary experience, but current society has used the term resilience in broader and less extreme context, such as daily setbacks, negative experiences (Stoffel & Cane, 2018). Protective factors are influences that change responses to negative experiences from maladaptive to adaptive outcomes (Stoffel & Cane, 2018). Protective factors may include coping mechanisms, social and family support, role modeling and mentorship, and intellectual stimulation (Stoffel & Cane, 2018) Nursing Concept Analysis Paper – Grit in Nursing Sample Essay. Resilient nurses have an ability to withstand, adapt, and learn something positive from barriers and adversity (Meyer & Shatto, 2018). Maturity and drive are factors for greater resilience (Meyer & Shatto, 2018).

    Perseverance is working hard, finishing what was started, or mastering skill despite adversity or discouragement (Duckworth et al., 2007). Being passionate towards long-term goals is when one is focused on projects that take years to finish without losing interest or being distracted (Duckworth et al., 2007). Conscientiousness is a personality trait of being “self-controlled, responsible to others, hardworking, orderly, and rule abiding” (Roberts, Lejuez, Krueger, Richards, & Hill, 2014, para. 2).

    Compassion is an attribute mentioned only in studies of nursing grit. Nursing is a righteous endeavor, a profession of compassion. Nursing Concept Analysis Paper – Grit in Nursing Sample Essay Nurses with grit strive to provide excellent care. Excellent nursing care is possible only with compassion. There is no true nursing without compassion.

    Antecedents

    Antecedents are the events that must take place before the concept can occur and they cannot also be the defining attribute for the concept (Walker & Avant, 2011). The first antecedent of grit is discovery and development of consistent interests. Then, based on the consistent interests, the second antecedent is understanding and setting the long-term vision or goal. For development of grit, there must be some adverse circumstances or barriers present. It is impossible to reach long-term goals that take years to accomplish without some barriers, boredom, or negative circumstances.Nursing Concept Analysis Paper – Grit in Nursing Sample Essay So, the third antecedent is setbacks, boredom, or barriers in achieving the goal.

    Consequences

    Consequences are the events that happen as a result of the concept occurrence and also cannot be defining attributes (Walker & Avant, 2011). The outcomes of grit in nursing are excellence, personal growth, and happiness. Nursing Concept Analysis Paper – Grit in Nursing Sample Essay.

    Nurses with high grit have a better potential to reach excellence. Excellence in nursing practice is related to practical wisdom based on scientific knowledge (Flaming, 2002). The grittier the nurse, the more motivated she/he is to be an excellent nurse, the more years of hard work is invested into it, the more potential she/he would have to do it.

    Personal growth is a reflection of a person’s development. Gritty nurses have positive attitudes, higher expectations about themselves, their lives and the nursing profession. These nurses view adversities and difficulties differently from those with low grit, which improves their subjective well-being. They lead a more meaningful and engaged life that makes them happier people than those with lower grit. Grit improves life satisfaction (Vainio & Daukantait, 2016)

    Model Case

    A model case demonstrates how the concept is used with all the defining attributes at display (Walker & Avant, 2011). Ann’s mom was diagnosed with breast cancer when Ann was 12 years old. What followed were two years of fighting, hope and desperation. By the age of 14 Ann was left without her mother Nursing Concept Analysis Paper – Grit in Nursing Sample Essay. Somewhere along those two years Ann had decided that she wanted to be a nurse, not just a nurse, but a nurse who makes a real difference in the lives of people and families, who eases their pain, supports them in their decisions, and understands what they are going through. After finishing high school Ann went to a community college for an associate degree in nursing while working full time to help her father financially with bringing up her two little sisters and her education. Nursing school was tough with full time work, evening classes and clinicals. But it did not discourage her, she worked through it, meticulously finishing all her homework and assignments, and looking forward to an ultimate goal to become an excellent nurse. After graduation, she started working in a hospital on a medical-surgical unit. It was an urban hospital, nursing staffing ratios were unfair, patient acuity was high, and supplies were scarce. Ann was the only new graduate who did not quit during the first year of employment on that unit. She found support and guidance in one of the experienced nurses who was like a mentor to Ann. After a year she got involved in the hospital governance, she joined a quality improvement committee and advocated for safe staffing and better working conditions to be able to provide quality patient care. After several years of working as a nurse, she decided to go back to school and earn her baccalaureate degree in nursing and get her certification in oncology nursing. Nursing Concept Analysis Paper – Grit in Nursing Sample Essay. Over the years, her knowledge and expertise grew along with her curiosity to know more. Ann is still a compassionate nurse, she loves what she does, she cares about her patients and families, and she has expertise from the years of nursing practice. In retrospective, Ann realizes that she has been “fortunate” to discover her passion to nursing early on in life, it is her calling. Her work has a purpose beyond herself.

    Conclusion 

    Grit is relatively new and confusing concept. This paper about grit in nursing has a purpose to improve understanding of the concept. Enhanced understanding may lead to wider awareness and use of grit in nursing practice, education, and research. Literature review showed that the concept is well defined in psychology, but not in nursing. Further research related to grit in nursing and how to foster grit in nurses would be beneficial since consequences of grit include excellence in practice, personal growth and happiness. There are five attributes of grit in nursing: resilience, perseverance, passion, conscientiousness, and compassion. Compassion is a unique attribute of nursing grit. Nursing Concept Analysis Paper – Grit in Nursing Sample Essay In order for grit in nursing to happen, the following antecedents are needed: discovery of the field of interest for future passion, understanding and setting the long-term goal, and finally, some setbacks or barriers in the path to the goal. Nursing grit is characterized by sustained interest and passion for nursing and working with perseverance towards excellent and compassionate care throughout the years, which is reflected in the constructed model case.

     

    References

    Bolton, K. W., Praetorius, R. T., & Smith-Osborne, A. (2016). Resilience protective factors in an older adult population: A qualitative interpretive meta-synthesis.
    Social Work Research
    ,
    40
    (3), 171-182. doi: 10.1093/swr/svw008

    Cosgrove, J. M., Chen, Y. T., & Castelli, D. M. (2018). Physical fitness, grit, school attendance, and academic performance among adolescents.
    Biomed Research International
    , 1-7. doi:10.1155/2018/9801258 Nursing Concept Analysis Paper – Grit in Nursing Sample Essay

    Credé, M., Tynan, M. C., & Harms, P. D. (2017). Much ado about grit: A meta-analytic synthesis of the grit literature.
    Journal of Personality and Social Psychology, 113
    (3), 492-511. doi: http://dx.doi.org.ezproxy.wilkes.edu/10.1037/pspp0000102

    Duckworth, A. L., Peterson, C., Matthews, M. D., & Kelly, D. R. (2007). Grit: Perseverance and passion for long-term goals.
    Journal of Personality and Social Psychology, 92
    (6), 1087-1101. doi: http://dx.doi.org.ezproxy.wilkes.edu/10.1037/0022-3514.92.6.1087

    Flaming, D. (2002). Using nursing science does not guarantee nursing excellence.
    Research and Theory for Nursing Practice, 16
    (3), 147-59. Retrieved from https://ezproxy.wilkes.edu/login?url=https://search-proquest-com.ezproxy.wilkes.edu/docview/207665858?accountid=62703

    Jin, B., & Kim, J. (2017). Grit, basic needs satisfaction, and subjective well-being.
    Journal of Individual Differences, 38
    (1), 29-35. doi: http://dx.doi.org.ezproxy.wilkes.edu/10.1027/1614-0001/a000219

    Hellman, C., & Gwinn, C. (2017). Camp HOPE as an intervention for children exposed to domestic violence: A program evaluation of hope, and strength of character.
    Child & Adolescent Social Work Journal
    ,
    34
    (3), 269-276. doi: 10.1007/s10560-016-0460-6

    Maddi, S. R., Matthews, M. D., Kelly, D. R., Villarreal, B., & White, M. (2012). The role of hardiness and grit in predicting performance and retention of USMA cadets.
    Military Psychology (Taylor & Francis Ltd)
    ,
    24
    (1), 19-28. doi: 10.1080/08995605.2012.639672

    McCabe, E. (2016). Can grit be nurtured in undergraduate nursing students?
    NASN School Nurse, 31
    (3), 144-146. doi: 10.1177/1942602X16634440

    Merriam-Webster. (2018). Grit. Retrieved from https://www.merriam-webster.com/dictionary/grit Nursing Concept Analysis Paper – Grit in Nursing Sample Essay

    Meyer, G., & Shatto, B. (2018). Resilience and transition to practice in direct entry nursing graduates.
    Nurse Education in Practice, 28
    , 276-279. doi: http://dx.doi.org.ezproxy.wilkes.edu/10.1016/j.nepr.2017.10.008

    Payne, K. (2017). Grit: Passion and perseverance in nursing.
    Tennessee Nurse
    ,
    80
    (4), 12. Retrieved from
    http://web.b.ebscohost.com.ezproxy.wilkes.edu/ehost/pdfviewer/pdfviewer?vid=0&sid=56eba355-9c12-41f4-9894-eb34683e31cd%40sessionmgr101

    Roberts, B. W., Lejuez, C., Krueger, R. F., Richards, J. M., & Hill, P. L. (2014). What is conscientiousness and how can it be assessed?
    Developmental Psychology, 50
    (5), 1315-1330. doi: http://dx.doi.org.ezproxy.wilkes.edu/10.1037/a0031109

    Stoffel, J. M., & Cain, J. (2018). Review of grit and resilience literature within health professions education.
    American Journal of Pharmaceutical Education, 82
    (2), 124-134. Retrieved from https://ezproxy.wilkes.edu/login?url=https://search-proquest-com.ezproxy.wilkes.edu/docview/2051219775?accountid=62703

    Vainio, M. M., & Daukantait, D. (2016). Grit and different aspects of well-being: Direct and indirect relationships via sense of coherence and authenticity.
    Journal of Happiness Studies, 17
    (5), 2119-2147. doi: http://dx.doi.org.ezproxy.wilkes.edu/10.1007/s10902-015-9688-7

    Walker, L. O., & Avant, K. C. (2011).
    Strategies for theory construction in nursing
    (5
    th
    ed.). Upper Saddle River, NJ: Prentice Hall. Nursing Concept Analysis Paper – Grit in Nursing Sample Essay,

  • Health Issues and Advocacy Assignment Sample Essay – Sweetened Beverages

    Health Issues and Advocacy Assignment Sample Essay – Sweetened Beverages

    Health Issue and Advocacy Assignment

    The purpose of this assignment is to identify a health issue requiring advocacy from the nursing

    profession on a local, regional, state, national, or international level. This topic can be related to

    health promotion, population health, disease management, or patient safety in the community or

    other healthcare setting. You are assuming the role of advocate in various capacities. The topic

    you select for this paper will be the subject of your Policy Brief and Advocacy Letter

    Assignment. Therefore, research thoroughly your topic of interest to ensure that it can be applied

    across both assignments. Health Issues and Advocacy Assignment Sample Essay – Sweetened Beverages.

    In this paper you will identify a health issue which may or may not already be represented in the

    form of legislation or health policy. Individuals may just take a position on an issue affecting

    local policy with decision makers.

    ORDER A PLAGIARISM-FREE PAPER HERE

    An example of this with legislation includes:

    • Health issue: primary care access for patients

    • Health policy: increasing primary care providers using nurse practitioners; support of PA

    HB 765 for CRNP independent practice

    An example of this without legislation includes:

    • Health issue: increased chronic back pain from integration of technology in healthcare

    • Health policy: ergonomic evaluation of work environments for all employees; letter of

    support to employers for new healthcare organization policy

    This assignment is worth 25% of your grade. Using APA format and criteria from the Grading

    Rubric for Written Assignments, in 5 double spaced pages (excluding the title page and reference

    page) present the following details:

    Criteria for Your Advocacy as a Nursing Professional

    Introduction

    Outline of health issue and existing or necessary health policy

    and/or politics. Why is this significant to nursing?

    List and discuss any other stake holders who would be concerned

    with the health issue, in favor or opposition.

    Propose a plan on this health issue advocacy:

    • Effect of the health issue on health policy and politics

    • Interventions to be implemented in this advocacy to enact

    change; incorporate health politics as pertinent

    • Identify opposition which can be encountered.

    Conclusion

    Sweetened Beverages: The Health Issue

    There is growing concern for the overall health of the United States.  Despite advances in medicine and the increasing amount of money expended on healthcare in the United States, chronic diseases are prevalent.  Not only do chronic diseases result in preventable premature death and reduce the quality of life of those who experience them, they place an economic burden on our healthcare system (Centers for Disease Control and Prevention, 2009).  According to the Centers for Disease Control and Prevention, (2009) 75% of health care costs are spent treating chronic and most frequently preventable conditions.  The incidence of chronic diseases are proportionally higher amongst minority groups. Health Issues and Advocacy Assignment Sample Essay – Sweetened Beverages

    Excessive consumption of sweetened beverages is linked with obesity, diabetes, hypertriglyceridemia, cardiovascular diseases, amongst others (Centers for Disease Control and Prevention, 2010).  Diabetes is linked to many other health complications including kidney failure, amputations, and blindness (Centers for Disease Control and Prevention, 2009).  Excessive consumptions of sweetened beverages is also proportionally higher amongst certain demographic and ethnic groups including adolescents, non-Hispanic blacks, Mexican-Americans, those of low socioeconomic status, and those who are obese.  It is estimated that amongst these groups up to 16% of daily total caloric income is from sweetened beverages (Centers for Disease Control and Prevention, 2010).

    Prevention of chronic and preventable disease, such as those mentioned above, has been the focus of attention for the healthcare community and our policy makers in an effort to make our healthcare system more affordable and increase the quality of life of Americans.

    Public Policy to Address Issue

    On June 16, 2016 the City of Philadelphia passed the, “Sugar-Sweetened Beverage Tax,” which amended Title 19 of the Philadelphia Code, Finance, Taxes and Collections (City of Philadelphia, 2016).  Philadelphia has modeled its new policy on other cities and countries that have enacting similar policy measures aimed at improving the health of the country including; Arkansas, Tennessee, Virginia, and West Virginia (Drenkard, S., 2011).  This policy attaches and additional one and one-half cent per fluid ounce tax to be paid to the city of Philadelphia for the purchase of all beverages sweetened with the following ingredients: sucrose, glucose, or high fructose corn syrup.  Health Issues and Advocacy Assignment Sample Essay – Sweetened Beverages  The tax also includes sugar substitutes including: stevia, aspartame, sucralose, neotame, Ace-K, saccharin, and advantame (The City of Philadelphia, 2016).  This includes non-alcoholic syrups that contain any of the above sweeteners.  Excluded from this tax are baby formula, “medical food,” products that are more than 50% milk, juices that are more than 50% fresh fruit or vegetable juice (The City of Philadelphia, 2016).

    The Effect of Consumption of Sweetened Beverages on Politics and Policy

    Based on the above public health concerns including the overwhelming stress chronic disease places on the healthcare systems, policy makers are exploring methods of reducing the public’s consumption of products that are correlated with chronic disease and obesity when consumed regularly through taxation.  These taxes are likened to sin taxes placed on items such as alcohol and tobacco products (Letcher, Frisvold, & Tefft, 2011).

    Contrary to other sales tax whose profits are considered general revenue for the city and state, the City of Philadelphia and Mayor Kenny, a supporter of the policy, pledge to use the revenue to support publically funded universal pre-kindergarten programs (Kennedy, 2016).  In fact Mayor Jim Kenney was quoted The Christian Science Monitor (2016, para. 4) as attributing the successful passing of the legislation to his plans for the revenue, “if you want to tax something and people know where the money’s going to, then it’s easier for them to get behind it.”  Interestingly the use of the revenue for the tax does not appear in the body of the legislation.

    Opposition to Plan

    There are numerous critiques of such legislation.  Developing policy aimed to reduce rates of obesity is difficult to measure.  Research connecting improved health outcomes associated with the excise tax seems controversial.  Research generated from places that already introduced the tax has not yet been able to establish a connection between reduced sweetened beverage purchases and improved health outcomes (Shekhtman, 2016; Fletcher et al., 2011; & Colchero, Popkin, Rivera, & Wen Ng, 2016).  Berkeley, California passed a similar policy in 2014, however it has not yet been established that this has reduced obesity rates (Shekhtman, 2016).

    Cabera Escobar, Veerman, Tollman, Bertram, & Hofman (2013) in their meta-analysis found only 6 articles based on research conducted in the United States that supported a possible connection between decreased purchasing of Sugar-Sweetened Beverages and a reduction in BMI.  However, none of these studies were not able to establish a statistically significant reduction in BMI when rates of purchasing sweetened beverages fell (Cabera Escobar et al., 2013).   Fletcher et al., (2011) examined current obesity trends in the United States and compared that data to areas of the country that have enacted such taxes.  Their research revealed a positive correlation between obesity rates and a sweetened beverage tax, however, the reduction in obesity rates were only minimal. Health Issues and Advocacy Assignment Sample Essay – Sweetened Beverages,

    Research has also been done to examine the impact of similar taxation in Mexico.  This is distinguished from the Philadelphia legislation in that it is a federal tax.  Mexico, too, was interested in creating a tax in effort to reduce consumption of sugary beverages and its associated health problems.  Mexico not only has high rates of overweigh and obese individuals; 33% in the 2-18 age group and 70% in the over 18 age-group.  Between 2000 and 2006 rates of obesity increased another 12% throughout the country (Colchero et al., 2016).  Mexico also rendered the highest consumption of soft drinks by 2011. Colchero et al. (2016
    )
    compared consumption in 2012 and again in 2014.  By December of 2014 the average monthly purchase for sugary beverages decreased by 12%.  The tax in Mexico resulted in an approximate 10% increase in price for sugary beverages.  The Mexican government invested the revenue to programs that decreased health disparities in their country, which may potentially service to expand the impact of the program on the overall health of the Mexican population (Colchero et al., 2016).  This study also has limited impact, as it does not make a correlation in the reduction of the purchase of sugary beverages to improved health outcomes Health Issues and Advocacy Assignment Sample Essay – Sweetened Beverages.

    Opponents also argue that the tax is regressive, meaning it will affect the lower income individuals and families more heavily that it will affect the affluent population. This is due to the fact that a larger portion of their income is spent on food products. While this may be true, it is also important to note that because Sugar-Sweetened beverages are not necessary to sustain life.  Proponents also argue that because obesity and diabetes affect the lower income in greater proportions that population will benefit the most (Wang, n.d.).

    Interventions

    The introduction of the excise tax on Sugar-Sweetened Beverages is an effort of the government to discourage the excessive consumption of sweetened beverages such as soft drinks.  Proponents believe this change in eating behavior will cause individuals to have improved health and in turn reduce healthcare costs.  According to several studies research has demonstrated sugar-sweetened beverages are price elastic, meaning that as prices raise consumption will decline in similar proportion (American Health Association, 2016; Escobar, Veerman, Tollman, Bertram, Huffman, 2013; & Wang, n.d.)

    In their research, The Centers for Disease Control and Prevention (2010) found that in order to modify obesity rates and improve the overall health of a population, more action must be taken.  Not only should a form of discouragement be placed to deter individuals from purchasing sugary beverages, access to safe and flavorful drinking water must be ensured, access to and consumption of alternatives must be promoted and encouraged, there must be a decrease in cost of healthier alternative beverages, marketing for sweetened beverages must be minimized particularly for children, screen and counseling about the dangers of sweetened beverages must be provided, and medical providers must have increased training regarding how to educate their patients on the dangers of sweetened beverages. Health Issues and Advocacy Assignment Sample Essay – Sweetened Beverages.

    Several sources identify the excise tax is only one step necessary to address the current health care crisis from conditions such as obesity, diabetes, and heart disease (Centers for Disease Control and Prevention, 2010 & American Public Health Association, 2016).  While the legislation has not yet gone into effect in Philadelphia, there has been little discussion regarding increasing prevention efforts and making healthier options more available and affordable for low-income consumers.  It is also concerning that Philadelphia has not included prevention efforts in its use for the revenue.

    Conclusion

    While most healthcare professionals, including nurses, will agree that excessive consumption of sweetened beverages contributes to health problems, it is questionable if imposing an increase in tax on those items alone will produce the intended effect of improved health. Health Issues and Advocacy Assignment Sample Essay – Sweetened Beverages While some research has linked an increase in taxes to a reduction in the consumption of those items, similarly to taxes imposed on tobacco and alcohol products, research has not yet established that this reduction in consumption of sweetened beverages leads to improved health outcomes.  It seems that without meaningful intervention to both motivate the American Consumer to engage in healthier behaviors and without increasing access to healthier products across all socioeconomic backgrounds, the effect of a sweetened beverage tax will not produce the marked improvement in health it promises.

     

     

     

    References

    American Public Health Association. (2016). Taxes on Sugar-Sweetened Beverages.  Retrieved from
    https://www.apha.org/policies-and-advocacy/public-health-policy

    Cabera Escobar, M.A., Veerman, L.J., Tollman, S.M., Bertram, M.Y., & Hofman, K. (2013).  Evidence that a tax on sugar sweetened beverages reduces the obesity rate: a meta-analysis. 
    BMC public health, 13
    :1072.  doi: 10.1186/1471-2458-13-1072

    Centers for Disease Control and Prevention. (2010) The CDC Guide to Strategies for Reducing the Consumption of Sugar-Sweetened Beverages.  Retrieved from
    http://www.cdph.ca.gov/SiteCollectionDocuments/StratstoReduce_Sugar_Sweetened_Bevs.pdf

    Centers for Disease Control and Prevention: National Center for Chronic Disease Prevention and Health Promotion. (2009). The power of prevention: chronic disease…the public health challenge of the 21
    st
    century.  Retrieved from
    http://www.cdc.gov/chronicdisease/pdf/2009-power-of-prevention.pdf

    City of Philadelphia. (2016). Sugar-Sweetened Beverage Tax.  Retrieved from
    https://phila.legistar.com/LegislationDetail.aspx?ID=2595907&GUID=36060B21-D7EE-4D50-93E7-8D2109D47ED1&Options=ID%3C/p%3E%3Cp%3EText%3C/p%3E%3Cp%3E&Search=160176

    Colchero, M.A., Popkin, B.M., Rivera, J.A, Wen Ng, S. (2016). Beverage purchases from stores in Mexico under the excise tax on sugar sweetened beverages: observational study BMJ 2016; 352 :h6704 Retrieved from
    http://www.bmj.com/content/352/bmj.h6704

    Fletcher, J.M., Frisvold, D., & Tefft, N. (2010).  Can soft drink taxes reduce population weight. 
    Contemp Econ Policy
    ; 28(1): 23–35. doi:10.1111/j.1465-7287.2009.00182.x.

    Kennedy, M. (2016, June 16).  Philadelphia Becomes the 1
    st
    Major U.S. City to Pass a Tax on Soda. 
    The two-way: Breaking news from NPR. 
    Retrieved from http://www.npr.org/sections/thetwo-way/2016/06/16/482359140/philadelphia-becomes-1st-major-u-s-city-to-pass-a-tax-on-soda

    Novak, N.N. & Brownell, K.D.  (2012). Role of Policy and Government in the Obesity Epidemic.

    Circulation
    ;126:2345-2352. http://dx.doi.org/10.1161/CIRCULATIONAHA.111.037929

    Shekhtman, L. (2016, June 17). How Philadelphia Passed a Soda Tax. 
    The Christian Science Monitor. 
    Retrieved from
    http://m.csmonitor.com/Business/2016/0617/How-Philadelphia-passed-a-soda-tax

    Wang, Y.C. (n.d.). 
    The Potential Impact of Sugar-Sweetened Beverage Taxes in New York State: A Report to the NYC Department of Health & Mental Hygiene
    .  Columbia University. New York, NY: Author. Health Issues and Advocacy Assignment Sample Essay – Sweetened Beverages

  • Aquifer High Value Care 03: 65-year-old woman – Adult preventive care and value Case Study

    High Value Care 03: 65-year-old woman – Adult preventive care and value

    Author(s):
     Heather Harrell, MD University of Florida College of Medicine

    PREVENTIVE CARE REVIEW

    TEACHING

    You are rotating in the outpatient clinic with Dr. Pritti, who asks you to see Lynda Jacobsen, a 65-year-old homemaker here for her “Welcome to Medicare” wellness visit. She reports no acute concerns but wants to get “every test Medicare will cover” as she plans to live to be 100. You recall there is more to prevention than just ordering tests.

    Question

    Which of the following are major categories of preventive care? Select all that apply.

    Stages of change

    Screening examinations

    Diagnostic testing

    Behavioral counseling

    Immunizations

    Prescription medications

    Integrative care plans

    SUBMIT

    CONTINUE

    ORDER A PLAGIARISM-FREE PAPER HERE

     

    Answer Comment

    The correct answers are B, D, E.

    The four major categories of preventive care are:

    Screening (B),

    Behavioral counseling (D)
    ,

    Immunizations (E)
    , and

    Chemoprevention
    .

    “Stages of change” (A) is a model used to help assess an individual’s readiness to make a behavioral change and can be helpful when performing behavioral counseling.

    Tests used for screening are often the same as those used for diagnosis. However, the 
    purpose
     of screening tests is not just to identify potential disease but to identify diseases in time to prevent consequences and complications. Diagnostic testing (C) is performed to determine the cause of a symptom and prescription medications (F) are used to manage health problems.

    An “integrative care plan” (G) could mean applying integrative medicine (a blend of allopathic medicine and complementary medicine) into a preventive medicine plan, but this term is also used in many other contexts and is not a major category of preventive care.

    HISTORY

    HISTORY

    You interview Ms. Jacobsen and learn that she enjoys good health. She is transferring her care from her gynecologist, Dr. Archy, because her friends said that at her age she needs an internist. She had seen Dr. Archy for the past 15 years, ever since she underwent a hysterectomy for uterine fibroids (leiomyomas, or benign tumors of the uterine muscle).

    You review Dr. Archy’s records:

    Test Results

    Pap smears annually: All normal

    Breast examinations annually: All normal

    Mammograms annually: All normal

    Colonoscopy 5 years ago: Normal

    Bone densitometry every 2 years: Normal

    Fasting lipid profile annually: Most recent LDL 98 mg/dL; HDL 50 mg/dL; triglycerides 78 mg/dL

    Immunizations

    Annual flu vaccine

    Herpes zoster vaccine (Zostavax) 1 year ago

    Ms. Jacobsen follows a low-fat diet and takes a daily multivitamin. She attends Zumba classes three times a week and sees a personal trainer weekly for weight training. She does not use tobacco products and drinks 2 to 3 alcoholic beverages a night with her dinner.

    The physical examination is normal, including a BP of 120/70 mmHg and BMI of 24.9.

    As you leave the room to speak with Dr. Pritti, Ms. Jacobsen hands you a flier she picked up at her church advertising “Vital Life,” a mobile screening bus that offers the following tests:

    Comprehensive metabolic testing

    Fasting lipid panel

    Advanced cardiac screen (C reactive protein, lipoprotein a, homocysteine)

    ECG

    Vascular disease screen (ankle-brachial index, ultrasound of abdominal aorta and carotid arteries)

    EBCT scan of the chest for coronary artery disease

    Bone densitometry

    She asks you to give the flier to Dr. Pritti and let her know she wants every test that Medicare will cover. You would like to see if the tests she is interested in are recommended for someone of her age and with her medical conditions.

    Question

    Which of the following are reliable sources for high quality, evidence-based preventive care recommendations? Select all that apply.

    U.S. Preventive Services Task Force (USPSTF)

    Centers for Disease Control and Prevention (CDC)

    Agency for Healthcare Research and Quality (AHRQ)

    Choosing Wisely® Campaign

    “Prevention” website

    Answer Comment

    The correct answers are A, B, C, D.

    Preventive Care Guidelines

    There are numerous guidelines that pertain to preventive care, and it can be difficult to decide which are reliable. 
    Health and Medicine Division (formerly The Institute of Medicine (IOM)
     has proposed the following eight standards that should be part of guideline development:

    Standard 1: Establishing Transparency

    Standard 2: Management of Conflict of Interest

    Standard 3: Guideline development group composition

    Standard 4: Clinical practice guideline-systematic review intersection

    Standard 5: Establishing evidence foundations for and rating strength of recommendations

    Standard 6: Articulation of recommendations

    Standard 7: External review

    Standard 8: Updating

    The 
    USPSTF
     (A)
     is considered by many to be the gold standard in this country for evidence-based preventive care recommendations. It is the reference used by Medicare to determine which screening tests will be covered.

    The USPSTF used to make immunization recommendations but now defers to the 
    CDC
     (B)
     guidelines because the CDC has its own rigorous review process.

    AHRQ
     (C)
     relies primarily on the USPSTF recommendations.

    Choosing Wisely®
     (D)
     is an initiative of the American Board of Internal Medicine Foundation that has been joined by over 50 specialty societies. Unlike the USPSTF, which focuses more on what preventive care physicians should recommend, Choosing Wisely® is a compilation of evidence-based lists of tests (both preventive and diagnostic) and treatments that physicians and patients should question because they are of low value.

    While some commercial internet websites, such as 
    “Prevention”
     or other media (E) base their recommendations on guidelines that follow the standards described above, this is not always the case. These types of websites contain obvious conflicts of interest with advertisers and sponsors. Additionally, anecdotes and low quality studies are weighted similarly to high quality evidence, the process by which recommendations are made is unclear, and there is no clear peer review process.

     

     

     

     

    PREVENTIVE SERVICES GUIDELINES

    TEACHING

    You know Dr. Pritti will ask for your thoughts, so you decide to use the 
    electronic preventive services selector (ePSS)
     app that you downloaded from the AHRQ website. The app will show you all of the USPSTF preventive service recommendations for a sexually active, nonsmoking woman 65 years of age listed by grade.

    The USPSTF grades their recommendations based on the amount and quality of evidence supporting each intervention.

    USPSTF Grade Definitions after July 2012

    View full table provided by US Preventive Services Task Force

    Grade

    Definition

    A

    The USPSTF recommends the service. There is high certainty that the net benefit is substantial.

    B

    The USPSTF recommends the service. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.

    C

    The USPSTF recommends selectively offering or providing this service to individual patients based on professional judgement and patient preferences. There is at least moderate certainty that the net benefit is small.

    D

    The USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.

    I Statement

    The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.

    Question

    Match each test listed on the Vital Life brochure with its USPSTF grade. (For each item, select an option from the list box.)

    Bone densitometry  — select an option — Grade B Grade C Grade D Grade I

    Fasting lipid panel  — select an option — Grade B Grade C Grade D Grade I

    Abdominal aorta ultrasound  — select an option — Grade B Grade C Grade D Grade I

    Carotid artery ultrasound  — select an option — Grade B Grade C Grade D Grade I

    ECG  — select an option — Grade B Grade C Grade D Grade I

    Advanced cardiac screen (C reactive protein, lipoprotein-a, homocysteine)  — select an option — Grade B Grade C Grade D Grade I

    Ankle-brachial index  — select an option — Grade B Grade C Grade D Grade I

    EBCT (Electronic Beam Computed Tomography) scan of the chest for coronary artery disease  — select an option — Grade B Grade C Grade D Grade I

    SUBMIT

    CONTINUE

     

     

    Question

    Match each test listed on the Vital Life brochure with its USPSTF grade. (For each item, select an option from the list box.)

    PARTIALLY CORRECT

    Bone densitometry  — select an option — Grade B Grade C Grade D Grade I
    Grade B

    Fasting lipid panel  — select an option — Grade B Grade C Grade D Grade I
    Grade C

    Abdominal aorta ultrasound  — select an option — Grade B Grade C Grade D Grade I
    Grade D

    Carotid artery ultrasound  — select an option — Grade B Grade C Grade D Grade I
    Grade D

    ECG  — select an option — Grade B Grade C Grade D Grade I
    Grade D

    Advanced cardiac screen (C reactive protein, lipoprotein-a, homocysteine)  — select an option — Grade B Grade C Grade D Grade I
    Grade I

    Ankle-brachial index  — select an option — Grade B Grade C Grade D Grade I
    Grade I

    EBCT (Electronic Beam Computed Tomography) scan of the chest for coronary artery disease  — select an option — Grade B Grade C Grade D Grade I
    Grade I

    SUBMIT

    Answer Comment

    Correct answers:

    Grade A

    Blood Pressure screening

    Grade B

    Bone densitometry

    Grade C

    Fasting lipid panel

    Grade D

    Abdominal aorta ultrasound

    Carotid artery doppler

    ECG

    Grade I

    Advanced cardiac screen

    Ankle-brachial index

    EBCT

    The USPSTF recommends screening for high blood pressure in adults aged 18 years or older. The USPSTF recommends obtaining measurements outside of the clinical setting for diagnostic confirmation before starting treatment.

    Use the National Heart, Lung, and Blood Institute’s (NHBLI’s) 10-year cardiac 
    risk calculator
    to calculate Ms. Jacobsen’s cardiac risk. Even though her lipid levels fall just within normal limits (total cholesterol 199 mg/dL and HDL 41 mg/dL), Ms. Jacobsen’s cardiac risk is low, so screening her would fall into the USPSTF’s Grade C category.

    (Note that the latest 
    AHA/ACC guidelines
     recommended checking lipids to calculate 10 year ASCVD risk every four – six years in healthy adults aged 40 – 75.)

    Similarly, the USPSTF recommends (Grade B) 
    bone densitometry
     in women 65 or younger if they are at increased risk of fracture (i.e., have a 10-year fracture risk of ≥ 9.3%, or that of a 65-year-old white woman).

    If Ms. Jacobsen’s bone density was unknown, her risk of fracture calculated by 
    FRAX
    (a fracture risk assessment tool developed by the World Health Organization) would be 12% for any fracture and 2.3% for a hip fracture.

    Jacobsen, however, has previously been screened and was determined to have normal bone density. When her known normal femoral neck bone density is included in the FRAX calculation, her 10-year risk of fracture is reduced to 6.5% (any fracture) and 0.1% (hip fracture). So, the B recommendation does not apply to Ms. Jacobsen.

    Obtaining screening 
    ultrasounds
     (for 
    abdominal aorta
     aneurysm in women and 
    carotid artery
     stenosis) and performing 
    ECG
    s in low-risk adults both receive Grade D recommendations from the USPSTF. This means there is evidence that routine testing may result in greater harm than benefit to the patient. The recommendation is therefore against ordering these tests for screening purposes. Aquifer High Value Care 04: 80-year-old woman – Medications and value

    There is insufficient evidence (Grade I) about using nontraditional coronary artery disease risk factors, including electronic beam computed tomography (
    EBCT
    ) results, 
    C reactive protein, lipoprotein-a, homocysteine,
     and 
    ankle-brachial indices
     to make recommendations for or against these interventions.

     

     

    TESTING RISKS AND BENEFITS

    TEACHING

    Dr. Pritti asks you, 
    “What do you think of this brochure? Would you recommend we order any of these things?”

    You answer, “I looked at the USPSTF guidelines, and it seems like she isn’t due for any of the tests she is requesting, though it does look like she needs a pneumonia vaccine and the TdaP booster, as she hasn’t had those.

    “She is expecting to get her blood drawn, and I’m afraid she will be upset if we don’t do it. I don’t think it will really harm her to get a little blood work if it keeps her from getting upset. However, we can tell her we checked her blood pressure as recommended on the brochure and that it looks normal.”

    Dr. Pritti responds, 
    “I agree with your vaccine recommendations, and I also agree that it is important to incorporate a patient’s goals into our decision-making. However, I’m not sure I agree that there is 
    no
     potential harm to testing without a clear indication.”

    Question

    What are potential harms of minimally invasive tests like blood work or an EKG? Select all that apply.

    Falsely abnormal tests

    Incidental findings

    Financial cost to the patient

    Financial cost to society

    Anemia

    Time spent reviewing tests that could be spent in other ways of more direct benefit to patients

    Patient anxiety

    Answer Comment

    The correct answers are A, B, C, D, F, G.

    All tests have the possibility of yielding a 
    falsely abnormal result (A)
     or 
    incidental finding (B),
     either of which can lead to further testing and 
    patient anxiety (G).
     For example, a third to half of patients with angiographically normal coronary arteries have Q or ST wave abnormalities, or T wave inversions on a resting ECG.

    Likewise, most tests impose a 
    financial cost to the patient (C)
     (see High Value Care 06: 65-year-old man – Paying for value: Insurance Part 1 for more information).

    A screening test is performed in a patient who, by definition, has 
    no symptoms
    . Thus, if the result yields no clear benefit to the patient, then the testing is completely unnecessary. This is in contrast to a patient 
    with symptoms,
    who requires evaluation: even though there is a cost and the potential for false positive results, the testing is necessary, and there is potential for the patient to benefit from it. Aquifer High Value Care 04: 80-year-old woman – Medications and value

    While not all tests have a 
    financial cost to society (D)
     – indeed, it is financially beneficial to screen for some diseases – tests without a clear benefit to the patient are also costly for society (see the Expert button for more about population health).

    Reviewing the results of tests requires time (F)
     and, given current time constraints in ambulatory medicine, time spent reviewing results of unnecessary testing is wasted time that is of no value to patients or the healthcare system.

    Anemia (E) is a potential consequence of repeated blood draws, such as can occur during a hospitalization, but a single blood draw for outpatient tests will not cause anemia.

     

     

     

    TESTING COSTS

    THERAPEUTICS

    You tell Dr. Pritti, “That went better than I thought it would. I noticed you didn’t repeat my physical examination. Should I not have done all of that?”

    Dr. Pritti answers, “Technically, the only parts of the physical examination that her ‘Welcome to Medicare’ visit requires blood pressure, BMI, and vision screen, which I reviewed and did not need to repeat. The rationale is that it is unlikely we will pick up any significant abnormal findings in a healthy, asymptomatic patient. Thus, our time would be better spent assessing risk and counseling. There are many good reasons to perform a physical examination, but based on your insights about her expectations and concerns about her alcohol use, I wanted to make sure we had time to address those issues. As it turned out we did need that time today.”

    More of Ms. Jacobsen’s records arrive on the fax and you discover that her yearly “routine blood work” consisted of a CBC with differential, lipid panel, comprehensive metabolic panel, and thyroid stimulating hormone. You confirm that her bone densities, pap smears, and mammograms were all normal. Aquifer High Value Care 04: 80-year-old woman – Medications and value.

    Now that you have reviewed a few of the preventive care guidelines, you identify many potential areas of waste in Ms. Jacobsen’s past care. You wonder what was the financial cost of past testing that was not of clear benefit to her and decide to make a comparison:

    Cost of Testing Over 15 Years

    Cost of Testing

    You ask Dr. Pritti, “I guess I knew that all tests have a potential downside, but I was also concerned about her alcohol consumption, and I wondered whether you ever would compromise on something a patient wants in order to put them in a better mood when you need to discuss something they need to change like alcohol or diet?”

    Dr. Pritti responds, “That’s a good question, and I don’t want to give you the impression that shared decision making can’t accommodate reasonable compromises. Why don’t we go into the room together and I will try to role-model the process for you.”

     

    Question

    Which of the five major steps to behavior change were applied?

    Assess

    Advise

    Agree

    Assist

    Arrange

    Assurance

    SUBMIT

    This is the final page of the case. We value your perspective on the learning experience. After completing three required feedback ratings you can finish the case and access the case summary.

     

     

    TEACHING

    CARE DISCUSSION WITH PATIENT

    CARE DISCUSSION

    You reflect on the interaction you just observed.

    Question

    Which of the five major steps to behavior change were applied?

    The best options are indicated below. Your selections are indicated by the shaded boxes.

    Assess

    Advise

    Agree

    Assist

    Arrange

    Assurance

    SUBMIT

    Answer Comment

    The correct answers are A, B, C, D, E.

    The “5 As”

    The five major steps to intervention-also known as the “5 As”-are:

    Assess

    Advise

    Agree

    Assist

    Arrange

    You 
    assessed (A)
    Ms. Jacobsen’s alcohol use, which allowed you to identify a problem Aquifer High Value Care 04: 80-year-old woman – Medications and value.

    Dr. Pritti 
    advised (B)
     her to cut down her alcohol using clear, personalized language.

    Ms. Jacobsen 
    agreed (C)
     and, with you and Dr. Pritti, collaboratively set specific goals.

    Dr. Pritti 
    arranged (E)
     follow up by telephone in a week.

    Although 
    assist (D)
     is one of the 5 As, it was not clear that Ms. Jacobsen required further assistance.

    Assurance (F) is not one of the five major steps to intervention.

    Alcohol Misuse: Screening and Behavioral Counseling Interventions in Primary Care

    Aquifer High Value Care 04: 80-year-old woman – Medications and value

  • Aquifer High Value Care 04: 80-year-old woman – Medications and value

    Aquifer High Value Care 04: 80-year-old woman – Medications and value

    High Value Care 04: 80-year-old woman – Medications and value

    Author(s):
     Susan Merel, MD University of Washington Medicine; Anne Eacker, MD University of Washington Medicine

    REASON FOR ADMISSION

    HISTORY

    You are rounding on Mrs. Miller, a newly admitted 80-year-old patient with a heart failure (HF) exacerbation. She had been discharged from the hospital just 10 days ago after presenting with the same problem after a 5 day hospitalization. Aquifer High Value Care 04: 80-year-old woman – Medications and value.

    You review her list of chronic problems:

    Problem list

    Systolic heart failure due to ischemic cardiomyopathy with EF of 35% on last echocardiogram

    Well-controlled diabetes: A1c of 6.5

    Chronic kidney disease Stage 3

    Recurrent urinary tract infections

    Mild cognitive impairment

    Osteoarthritis

    ORDER A PLAGIARISM-FREE PAPER HERE

    You have found no evidence of infection, Mrs. Miller has not changed her diet, and her EKG is unchanged from previous. On rounds today your attending asks you why you think this patient had a second HF exacerbation so soon after discharge. Aquifer High Value Care 04: 80-year-old woman – Medications and value.

    Question

    Which of the following are likely to contribute to a HF exacerbation requiring readmission? Select all that apply.

    Medication nonadherence

    Residence in a skilled nursing facility

    Chronic kidney disease

    Diabetes

    Hyponatremia

    Medication side effects

    References

    Flacker J, Park W, Sims A. Hospital discharge information and older patients: do they get what they need? 
    J Hosp Med.
     2007;2(5):291-296
    .

    Amabile CM SA. Keeping your patient with heart failure safe: a review of potentially dangerous medications. 
    Arch Intern Med.
     2004;164(7):709-720
    .

    Krumholz HM, Chen YT, Wang Y, Vaccarino V, Radford MJ, Horwitz RI. Predictors of readmission among elderly survivors of admission with heart failure. 
    Am Heart J.
     2000;139(1 Pt 1):72-7
    .

    DEEP DIVE Aquifer High Value Care 04: 80-year-old woman – Medications and value

    References

    Journal of Managed Care & Specialty Pharmacy, Volume 22 Issue (5) 2016 May 22 (5): 516-523
    .

     

    Answer Comment

    The correct answers are A, C, D, F.

    Medication nonadherence (A)
     and 
    medication side effects (F)
     are important risk factors for readmission in patients discharged after a hospitalization for HF.

    Medication nonadherence is a pervasive problem; up to 25% of prescriptions ordered are never filled. In one study of elderly patients discharged from a county hospital with medication changes, only about 50% reported getting their prescriptions filled. (See the Expert to learn about the types and prevalence of medication nonadherence.)

    Older patients are likely to take multiple medications and are more susceptible to side effects and adverse drug events than younger patients because of comorbidities, frailty, and age-related physiologic changes in drug metabolism and excretion. Drug-induced HF exacerbations are also common. Medications to consider include non-steroidal anti-inflammatories (NSAIDS), corticosteroids, alpha-blockers, calcium-channel blockers, and tricyclic antidepressants.

    Elderly patients with 
    renal failure (C)
     and 
    diabetes (D)
     are at increased risk for readmission after an exacerbation of HF. Both conditions make it more difficult to control heart failure.

    Hyponatremia (E) is a common condition in the elderly and may make it more difficult to 
    treat
     heart failure, but has not been shown to be associated with HF readmission.

    Advanced age and residence in a skilled nursing facility (B) have not been shown to be risk factors for HF readmission.

     

     

    REASON FOR ADMISSION

    HISTORY

    READMISSION QUESTION

    HISTORY

    Question

    Why is readmission to the hospital within 30 days of discharge a concern? Select all that apply.

    Association with increased mortality

    Increased occurrence in patients with depression

    Cost to health care facility

    Cost to the patient

    SUBMIT

    TEACHING POINT

    Early readmission, within 30 days of discharge, is associated with an increased rate of all-cause mortality for community-dwelling elderly patients. Patients over age 80, with five or more comorbidities, or depression are at greater risk of early readmission

    References

    Lum HD, Studenski SA, Degenholtz HB, Hardy SE. Early hospital readmission is a predictor of one-year mortality in community-dwelling older Medicare beneficiaries. 
    J Gen Intern Med.
    2012;27(11):1467-74
    .

    Marcantonio ER, McKean S, Goldfinger M, Kleefield S, Yurkofsky M, Brennan TA. Factors associated with unplanned hospital readmission among patients 65 years of age and older in a Medicare managed care plan. 
    Am J Med.
     1999;107(1):13-17
    .

    Centers for Medicare and Medicaid Services. Readmissions Reduction Program
    .

     

     

    Question

    Why is readmission to the hospital within 30 days of discharge a concern? Select all that apply.

    The best options are indicated below. Your selections are indicated by the shaded boxes.

    Association with increased mortality

    Increased occurrence in patients with depression

    Cost to health care facility

    Cost to the patient

    SUBMIT

    Answer Comment

    The correct answers are A, B, C, D.

    All of the above are correct.

    Early readmission, within 30 days of discharge, is associated with an 
    increased rate of all-cause mortality (A)
     for community-dwelling elderly patients initially admitted for any diagnosis. It is more common in patients who:

    Are over age 80

    Have five or more comorbidities

    Have 
    depression (B)
    .

    The Affordable Care Act currently requires the Center for Medicare and Medicaid Services (CMS) to reduce payments to hospitals in the setting of “excess readmissions” of patients hospitalized for acute myocardial infarction, heart failure, and pneumonia within 30 days of the first hospitalization. If readmission rates exceed the expected rate, a 
    penalty is charged to the hospital (C).
     The amount of these penalties will increase in the future, and additional medical conditions will be added.

    Even with insurance, Medicare or otherwise, 
    most patients still have to pay (D)
     some portion of their health care costs. For example, Medicare Part A covers 80% of inpatient costs. The average cost of inpatient care per day in the U.S. is about $2270. 
    Hospital Adjusted Expenses per Inpatient Day 2015
    .

     

     

     

    MEDICATION REVIEW

    HISTORY

    While you are rounding, Mrs. Miller’s daughter arrives with her mother’s home medications in a grocery bag. You express your appreciation that she was able to bring these in for review. They are as follows:

    Scheduled medications

    Aspirin 81 mg po daily

    Calcium carbonate 500 mg po bid

    Furosemide 20 mg po daily

    Glipizide 5 mg po daily

    Lisinopril 10 mg po daily

    Metformin 500 mg po bid

    Metoprolol XL 50 mg po daily

    Multivitamin one tab po daily

    Nitrofurantoin 50 mg po daily

    Pravastatin 40 mg po daily

    Cholecalciferol 800 IU po daily

    Naproxen over-the-counter, patient has been taking 500 mg twice a day for a week.

    As needed medications

    Diphenhydramine 25 mg po q 6 hours prn pruritus

    Zolpidem 5 mg po qhs prn insomnia

    Hydrocodone/acetaminophen 5/500 mg po q 6 hours prn pain

    Question

    After a discussion with the patient and her primary care doctor, which of the following medications would be appropriate to consider discontinuing during this hospitalization? Select all that apply.

    Aspirin

    Nitrofurantoin

    Metoprolol

    Diphenhydramine

    Naproxen

    Vicodin

    Zolpidem

    SUBMIT

    TEACHING POINT

    Older patients are at increased risk of adverse drug events.

    The Beers Criteria is an evidence-based list developed by experts documenting medications which are potentially inappropriate in the elderly and should be referenced when caring for older patients.

    References

    Budnitz DS, Lovegrove MC, Shehab N, Richards CL. Emergency hospitalizations for adverse drug events in older Americans. 
    N Engl J Med.
     2011;365(21):2002-12
    .

    Steinman MA, Landefeld CS, Rosenthal GE, Berthenthal D, Sen S, Kaboli PJ. Polypharmacy and prescribing quality in older people. 
    J Am Geriatr Soc.
     2006;54(10):1516-23
    .

    Steinman MA, Story PS. Managing medications in clinically complex elders: “There’s got to be a happy medium.” 
    JAMA.
     2010;304(14):1592-1601
    .

    Kolla BP, Lovely JK, Mansukhani MP, Morgenthaler TI. Zolpidem is independently associated with increased risk of inpatient falls. 
    J Hosp Med.
     2013;8(1):1-6
    .

    DEEP DIVE

    References

    Brater DC. Effects of nonsteroidal anti-inflammatory drugs on renal function: Focus on cyclooxygenase-2-selective inhibition. 
    Am J Med.
     1999;107(6A):65S-71S
    .

     

     

    Question

    After a discussion with the patient and her primary care doctor, which of the following medications would be appropriate to consider discontinuing during this hospitalization? Select all that apply.

    The best options are indicated below. Your selections are indicated by the shaded boxes.

    Aspirin

    Nitrofurantoin

    Metoprolol

    Diphenhydramine

    Naproxen

    Vicodin

    Zolpidem

    SUBMIT

    Answer Comment

    The correct answers are B, D, E, F, G.

    Adverse Drug Events in the Elderly

    Older patients are at high risk for adverse drug events due to age-related changes in physiology, including changes in drug metabolism.

    Older patients generally have more comorbid conditions and are prescribed more medications: 40% of adults over age 65 take 5 to 9 medications and 18% take 10 or more.

    Frail elderly patients who take multiple medications are at increased risk for falls, fractures and delirium; these conditions can have serious consequences for an elderly patient’s health and independence.

    As many as 10% of hospital admissions in older adults may be related to adverse drug events.

    The 
    Beers Criteria
     is an evidence-based list developed by experts documenting medications which are potentially inappropriate in the elderly.

    Medication

    Category

    Risks

    Nitrofurantoin

    Antibiotic

    Pulmonary toxicity

    Diphenhydramine

    Anticholinergic

    Side effects include somnolence, confusion, constipation and dry mouth

    Naproxen

    NSAID

    Increased risk of gastrointestinal bleeding, acute kidney injury

    Hydrocodone/acetaminophen (Vicodin)

    Opioid

    Associated with delirium and falls in the elderly

    Zolpidem

    Sedative-hypnotic (nonbenzodiazepine)

    Associated with increased risk of falls, fractures, and delirium in older adults

    Nitrofurantoin (B), diphenhydramine (D), naproxen (E), Vicodin (F), and zolpidem (G)
     are all medications which may be appropriate to discontinue:

    Nitrofurantoin
    is generally an inappropriate medication in the elderly because of its pulmonary toxicity; it is also less effective in patients with a creatinine clearance less than 60 ml/min due to inadequate concentration in the urine. It should not be used for long-term suppression of urinary tract infections in elderly patients. The reason for the nitrofurantoin should be determined and this medication should be stopped or replaced with a safer appropriate antibiotic. If she is taking nitrofurantoin as suppressive therapy to reduce the risk of recurrent UTI’s, the role of suppressive therapy should be reconsidered as the evidence supporting this is not strong.

    Diphenhydramine
    (Benadryl) should be avoided in all elderly patients because of its strong anticholinergic properties, unless it is necessary for acute treatment of a severe allergic reaction. Side effects include somnolence, constipation, and dry mouth. Anticholinergic drugs (
    view list
    ) increase the risk of both delirium and falls in elderly patients.

    Naproxen
    is an NSAID. The American Society of Nephrology recommends that patients of all ages with hypertension, heart failure or chronic kidney disease avoid NSAIDs when possible (read the 
    ASN’s recommendation
    ). NSAIDs should also be avoided in many elderly patients, especially those over age 75 or those taking antiplatelet agents, anticoagulants, or corticosteroids because of the increased risk of gastrointestinal bleeding. See the Deep Dive to learn about the physiologic effects of NSAIDs on the kidney. NSAIDs can also contribute to both hypertension and congestive heart failure exacerbations, and should be avoided in patients with these conditions.

    Diphenhydramine and NSAIDs are both examples of over-the-counter medications that are inexpensive, but of low value in many patients because of their associated toxicities. It is important to ask about over-the-counter and herbal medications when taking a medication history.

    Zolpidem
    , which binds the benzodiazepine receptor subunit of the GABA-A receptor complex, is associated with an increased risk of falls, fractures, and delirium in older adults, and is not proven to be very effective in the elderly. Always teach patients about sleep hygiene before considering a sedative-hypnotic.

    Vicodin
    is an opioid combined with acetaminophen. Opioids can be associated with delirium and falls in the elderly population and should be used with caution. They also carry the risk of addiction.

    If the patient has osteoarthritis pain that is refractory to conservative measures, such as exercise, acetaminophen, and physical therapy, judicious use of hydrocodone/acetaminophen is reasonable if it improves her function. Although opioids can be associated with delirium and falls in the elderly population, untreated pain can also contribute to delirium, decreased mobility and decreased quality of life. Opioids should be used with caution in the elderly patient for pain that has been refractory to acetaminophen and non-pharmacologic measures at the lowest effective dose with the goal of improved function. While opioids should be used with caution, they are often appropriate in older adults with refractory pain and would not need to be stopped in this patient if they are used sparingly and improve her function.

    Aspirin (A), metoprolol,(C)
     and lisinopril are indicated in this patient because of her systolic heart failure and ischemic cardiomyopathy.

     

     

     

    Question

    Which of the following contribute to increased drug costs, particularly for elderly patients? Select all that apply.

    The best options are indicated below. Your selections are indicated by the shaded boxes.

    Medication price inflation has far exceeded general inflation.

    The number of medications prescribed to patients is rising over time.

    The elderly pay a larger percentage of their prescription medication costs out of pocket.

    Medicare Part D pays 80% of the cost of each prescription medication for those over 65.

    SUBMIT

    Answer Comment

    The correct answers are A, B, C.

    Nonadherence with medications can increase the use of medical resources. Always ask your patients if they are able to afford their prescriptions. Patients on minimal fixed incomes (most elderly patients) may be unable to afford necessary medications. Aquifer High Value Care 04: 80-year-old woman – Medications and value

    Since 1980, prescription 
    medication prices have increased (A)
     two to three times faster than all consumer prices.

    Prescription drug use in the U.S. has been steadily increasing over time. Between 1999 and 2008, the 
    percentage of Americans taking at least one prescription drug increased (B)
     by 10% and use of five or more drugs increased by 70%; spending for prescription drugs doubled during that time period.

    Medicare Part D subsidizes the cost of prescription medications; 
    however, there is a monthly premium, a yearly deductible, and a per prescription co-pay (C)
    , which varies by plan. In addition there is a coverage gap for patients who have more than about $3000 in annual drug costs in 2013. While a patient is in the coverage gap (a.k.a. “donut hole”), he or she pays 79% of the costs of all generic medications and 47.5% of the costs of all brand-name medications. This coverage gap ends at $4750 of drug coverage annually. Because of these costs, not all patients sign up for Medicare Part D.

    Medicare Part D does not provide 80% coverage of each prescription (D).

    References

    Gu Q, Dillon CF, Burt VL. Prescription drug use continues to increase: U.S. prescription drug data for 2007-2008. Centers for Disease Control. 
    NCHS Data Brief.
     No. 42, September 2010:1-8
    .

     

     

    REASON FOR ADMISSION

    HISTORY

    READMISSION QUESTION

    HISTORY

    MEDICATION REVIEW

    HISTORY

    MEDICATION NON-ADHERENCE

    MANAGEMENT

    MEDICATION COST

    THERAPEUTICS

    During her hospitalization, some of Mrs. Miller’s medications have been stopped or changed, and some have been added. Her current medication list in the hospital is as follows:

    Hospital Medications

    Medications at Home

    Scheduled Aquifer High Value Care 04: 80-year-old woman – Medications and value

    Aspirin
     81 mg po daily

    Aspirin
     81 mg po daily

    Calcium carbonate
     500 mg po bid

    Calcium carbonate
     500 mg po bid

    Cholecalciferol
     800 IU po daily

    Cholecalciferol
     800 IU po daily

    Furosemide (Lasix)
     40 mg po daily

    Furosemide
     20 mg po daily

    Glipizide
     5 mg po daily

    Glipizide
     5 mg po daily

    Lisinopril (Prinivil)
     10 mg po daily

    Lisinopril
     10 mg po daily

    Metformin
     500 mg po bid

    Metformin
     500 mg po bid

    Multivitamin
     1 tab po daily

    Multivitamin 
    1 tab po daily

    Carvedilol (Coreg)
     25 mg po bid

    Metoprolol XL
     50 mg po daily

    Rosuvastatin (Crestor)
     10 mg po daily

    Pravastatin
     40 mg po daily

    Omeprazole
     20 mg po daily

    Nitrofurantoin
     50 mg po daily

    Naproxen
     (over-the-counter) patient has been taking 500 mg twice a day for a week

    As Needed

    Hydrocodone/acetaminophen
     5/500 mg po q 6 hours prn pain

    Hydrocodone/acetaminophen
     5/500 mg po q 6 hours prn pain

    Benadryl
     25 mg po q 6 hours prn pruritus

    Zolpidem
     5 mg po qhs prn insomnia

    Question

    How could you make this medication list more cost-effective? Document an appropriate discharge medication list here. Aquifer High Value Care 04: 80-year-old woman – Medications and value

    Letter Count: 805/1000

    SUBMIT

    TEACHING POINT

    Six Simple Rules for High-Value Medication Prescribing

    Have a compelling reason for every medication you prescribe. Consider non-pharmacologic alternatives when appropriate.

    Keep your patient’s medication list as short as possible. Discontinue all non-essential medications and review the list for duplicates.

    Evaluate affordability before prescribing new medications to patients. This may mean reviewing the patient’s actual copay, generic versus brand name, and the medication tier in their insurance plan. (See High Value Care 06: 65-year-old man – Paying for value: Insurance Part 1.)

    Make every effort to prescribe generic equivalent medications. Also be aware of lists of less expensive generic prescriptions available at large chain pharmacies, often for as little as $4 per month.

    Collaborate with pharmacists to avoid drug-drug interactions and help provide lower-cost alternatives.

    Ask the patient to “teach-back” to show they understand the reason for each medication on the list and how/when to take it.

    References

    Bulger J, Nickel W, Messler J, et al. Choosing wisely in adult hospital medicine: five opportunities for improved healthcare value. 
    J Hosp Med.
     2013;8(9):486-92
    .

     

     

    The medication list can be made more cost effective by ensuring the list is as short as possible and ensuring that there is a compelling reason for each prescribed medication. When appropriate, non-pharmacologic alternatives and generic equivalent medications should be considered. It will also be important to find out if there are other lower-cost alternative medications used to treat same health condition and have them replace the medications on the list. Lastly, I will collaborate with pharmacists to help suggest lower-cost alternatives.

     

    Furosemide (Lasix) 40 mg po daily

    Multivitamin 1-tab po daily

    Aspirin 81 mg po daily

    Lisinopril 10 mg po daily

    Pravastatin 40 mg po daily

    Metformin 500 mg po bid

    Rosuvastatin (Crestor) 10 mg po daily

    Hydrocodone/acetaminophen 5/500 mg po q 6 hours prn pain

     

    Answer Comment

    The table below outlines a suggested higher-value medication list for this patient, with a comparison of actual monthly costs of the 
    initial
     and the 
    higher-value
     medication list, without consideration of her prescription drug plan coverage:

    Initial hospital medication list

    Cost for 30-day

    supply ($)

    Higher-value medication list

    Cost* for 30-day

    supply ($)

    Aspirin
     81 mg po daily

    0.30

    Aspirin
     81 mg po daily

    0.30

    Calcium supplement with Vitamin D

    1.20

    Calcium supplement with Vitamin D

    1.20

    Coreg (carvedilol)
     25 mg po bid

    164.24

    Metoprolol XL
     50 mg po daily

    17.65

    Crestor (rosuvastatin)
     10 mg po daily

    188.29

    Atorvastatin
     40 mg po daily

    17.00

    Furosemide
     40 mg po daily

    3.37

    Furosemide
     40 mg po daily

    3.37

    Glipizide
     5 mg po daily

    4.00

    Glipizide
     5 mg po daily

    4.00

    Metformin
     500 mg po bid

    4.00

    Metformin
     500 mg po bid

    4.00

    Multivitamin

    0.90

    (discontinued)

    –

    Prinivil (lisinopril)
     10 mg po daily

    44.44

    Lisinopril
     10 mg po daily

    4.00

    Omeprazole
     20 mg po daily

    10.25

    (discontinued)

    –

    Hydrocodone/acetaminophen
     5/500 mg po q 6 hours prn severe pain, thirty tabs

    17.00

    Hydrocodone/acetaminophen
     5/500 mg po q 6 hours prn severe pain

    17.00

    Total cost for a one-month supply

    $437.99

    Total cost for a one-month supply

    $68.52

    *Costs are based on GoodRx.com using the zip code 98115 and cheapest Costco prices for over-the-counter medications.

    Using a 
    Medicare Part D plan,
     the per-month cost for these medications using the higher value medication list could be reduced to about $20/month out of pocket, including the monthly premium, copay, and annual deductible. However, many patients do not sign up for Medicare Part D due to the cost.

    Discontinue nonessential medications started during a hospital stay.

    In the hospital, this patient was started on a proton pump inhibitor, omeprazole. Proton pump inhibitors are sometimes started as prophylaxis against stress ulcers, but there is 
    no evidence to support this
    outside of the intensive care unit, and proton-pump inhibitors are associated with an increased risk of pneumonia and 
    difficile
     colitis.

    Always switch back to generics from brand-name hospital formulary medications.

    Hospital formularies often contain expensive brand-name medications obtained through special pricing arrangements between the hospital and pharmaceutical companies.

    In this case, generic lisinopril was substituted for the brand name Prinivil and carvedilol was substituted for brand name Coreg. Although brand name Crestor is available as generic rosuvastatin, another high intensity statin, atorvastatin, was less expensive in Mrs. Miller’s town. Aquifer High Value Care 04: 80-year-old woman – Medications and value

    If there is no generic for the brand-name drug chosen, consider whether it is appropriate to switch to a drug in the same class that does have a generic option available.

     

     

     

    CARE DISCUSSION

    CARE DISCUSSION

    It is hospital day four. Mrs. Miller’s dyspnea has resolved, and she is near her goal weight. You plan to discharge her later this morning.

    Question

    What is the 
    best
     way to educate your patient about her medications before discharge? Choose the single best answer.

    Use the teach-back method to review the medication list with the patient and her daughter.

    Have the nurse review the medication list with the patient and her daughter.

    Ask the clinical pharmacist to do discharge medication education.

    Order home health nursing and have the nurse check to make sure she is taking her medications correctly.

    SUBMIT

    TEACHING POINT

    The teach-back method assesses the patient’s recall and comprehension of any new concept. It is an effective method for both assessing a patient’s understanding of a situation and providing education. It should be used to educate patients about their medications before hospital discharge.

    References

    Coleman EA, Smith JD, Raha D, Min SJ. Posthospital medication discrepancies: prevalence and contributing factors. 
    Arch Intern Med.
     2005;165(16):1842-1847
    .

    Wong JD, Bajcar JM, Wong GG, et al. Medication reconciliation at hospital discharge: evaluating discrepancies. 
    Ann Pharmacother.
     2008;42(10):1373-1379
    .

    White M, Garbez R, Carroll M, Brinker E, Howie-Esquivel J. Is “teach-back” associated with knowledge retention and hospital readmission in hospitalized heart failure patients? 
    J Cardiovasc Nurs.
    2013;28(2):137-46
    .

    Schillinger D, Piette J, Grumbach K, et al. Closing the loop: physician communication wtih diabetic patients who have low health literacy. 
    Arch Intern Med.
     2003;163(1):83-90
    .

     

    Question

    What is the 
    best
     way to educate your patient about her medications before discharge? Choose the single best answer.

    The best option is indicated below. Your selections are indicated by the shaded boxes.

    Use the teach-back method to review the medication list with the patient and her daughter.

    Have the nurse review the medication list with the patient and her daughter.

    Ask the clinical pharmacist to do discharge medication education.

    Order home health nursing and have the nurse check to make sure she is taking her medications correctly.

    SUBMIT

    Answer Comment

    The correct answer is A.

    Discrepancies between what a patient is prescribed upon discharge from the hospital and what they actually take at home are common and are associated with a higher rate of hospital readmission, as happened in this case. Thoughtful patient education may improve adherence and reduce the chance of readmission. The 
    teach-back method (A)
    , in which a clinician assesses the patient’s recall and comprehension of any new concept, is an effective method for both assessing a patient’s understanding of a situation and providing education if the patient cannot demonstrate understanding. Using teach-back simply involves asking patients to restate information that has been presented to them. It allows the provider to check the patient’s understanding, reinforce important concepts, and engage in open dialogue.

    Answers B and C are not the best answers as it is not clear that the nurse and pharmacist will use the teach back method. Ordering home health nursing and having the nurse check to make sure she is taking her medications correctly (D) is a strategy to identify medication nonadherence after it occurs. The best strategy should prevent nonadherence.

    View guidelines for using teach-back in patient education.

    Mrs. Miller receives her discharge instructions:

    Mrs. Miller discharge instructions

    Click here for a transcript of the video above.

     

    DISCHARGE FOLLOW-UP

    CARE DISCUSSION

    You see Mrs. Miller in clinic with your preceptor three months later. Mrs. Miller has not been rehospitalized, and her heart failure has been stable. She has had one fall without serious injuries and continues to have trouble with her memory.

    Your preceptor asks you to review the patient’s diabetes control during this visit. She has been on metformin and glipizide, and a recent HbA1C was 6.5%. She has stage II chronic kidney disease with a recent creatinine of 1.2 mg/dL and eGFR of 45. She watches her diet carefully, and in fact has lost ten pounds in the past year. Her BMI is 25. Aquifer High Value Care 04: 80-year-old woman – Medications and value

    Question

    What should you do today regarding Mrs. Miller’s diabetes management? Choose the single best answer.

    The best option is indicated below. Your selections are indicated by the shaded boxes.

    Continue her metformin and glipizide; recheck a HbA1C in three months

    Continue her metformin but stop the glipizide

    Reduce the metformin to 500 mg po daily and stop the glipizide

    Stop her metformin but continue the glipizide

    Stop both her metformin and her glipizide

    SUBMIT

    Answer Comment

    The correct answer is B.

    Reducing medications in the elderly reduces harm. Elderly patients on more than 4 medications are at higher risk of adverse events such as falls.

    Mrs. Miller is a frail, community-dwelling elderly person, with a life expectancy that is likely less than 10 years. See the Expert for more information regarding prognosis in the elderly. Her goal HbA1C should be about 8% based on 
    current guidelines
     (see guideline #3).

    Comorbidities

    Goal HbA1C

    Healthy older adults with long life expectancy

    7-7.5%

    Older adults with comorbidities and life expectancy <10 years 7.5-8% Multiple comorbidities and shorter life expectancy, including most patients in long-term care facilities 8-9% Because Mrs. Miller’s HbA1C was 6.5%, and because she had fallen and is at increased risk of falling with hypoglycemia, her glipizide should be stopped, thus answers (A) and (D) are incorrect. In the future, the metformin could be decreased (C) or stopped (E) depending on her A1c and renal function. Her weight should be monitored closely because weight loss in the elderly is a marker of frailty and may reflect difficulties with self-care in a patient with cognitive impairment. Glipizide should be stopped before metformin because of the risk of hypoglycemia with sulfonylureas and better evidence for efficacy and safety in the older population with metformin. TEACHING POINT Reducing medications in the elderly reduces harm. Considering an elderly patient’s life expectancy before offering interventions is an important part of high-value care in this population. References Sue Kirkman M, Briscoe VJ, Clark N, et al. Diabetes in older adults: a consensus report.  J Am Geriatr Soc.  2012;60(12):2342-56 . DEEP DIVE References Yourman L, Lee S. Prognostic Indices for Older Adults: A Systematic Review.  JAMA.  2012;307(2);182-192 . This is the final page of the case. We value your perspective on the learning experience. After completing three required feedback ratings you can finish the case and access the case summary. Aquifer High Value Care 04: 80-year-old woman – Medications and value

  • levine’s conservation model in nursing practice powerpoint presentation

    levine’s conservation model in nursing practice powerpoint presentation

    žConservation Model

    Myra estrin Levine

     

    žMyra E. Levine

    žWhy nurses use theory to guide their practice:

    oA nursing theory provides the theoretical foundation of the profession.

    oTheory defines what nursing is, what it does, and the goals or outcomes of nursing care.

    oNursing is the synthesis of many theories.

    oOur group identified with Levine’s Conservation Model because it focuses on conserving an individual’s wholeness. It addresses an individual from birth to death and aims to maintain an equilibrium conducive to health.

    o

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    žPurpose:

    The purpose of this project is to describe the use of a conceptual nursing model, Levine’s Conservation Model.

    žTheory Overview

    Myra Estrin Levine proposed four principles of conservation. The process by which conservation is achieved is adaptation and the desired outcome is integrity or wholeness. Adaptation includes responses based on past experiences (historicity), specific to the need (specificity), and with a variety of levels of possible response (redundancy). The principles of conservation relate to the conservation of energy, structural integrity, personal integrity, and social integrity of the individual.

    žLevine’s Nursing model:

    Objectives

    oDescribe the historical background of the development of Levine’s model for health

    oDefine Levine’s three major concepts and four principles of conservation

    oPresent the relationship between Levine’s model and concepts in nursing’s metaparadigm

    oProvide an example of Levine’s model in a clinical practice

    oEvaluation of the Conservation Model

    o

    o

    o

    žHistorical background and motivation for development of conservation model

    žEducational Background

    and accomplishments

    žPhilosophic Values and knowledge development levine’s conservation model in nursing practice powerpoint presentation

    ž

    žMany Teachers influenced the conservation model

    ž

    ž

    žThe Three Major Concepts of the Conservation Model

    Wholeness (Holism)

    ž

    Adaptation

    Conservation

    žWholeness

    oTo understand the whole person, one must first understand the parts of the whole.

    o

    oLevine used Erickson’s description of wholeness as an open system (Levine, 1969).

    o

    oLevine believed that humans respond in “ an integrated, singular fashion to environmental changes” (Levine 1966).

    žAdaptation

    “Adaptation is the process of change whereby the individual retains his integrity within the realities of his internal and external environment” (Levine, 1973).

    oAll adaptations vary in degree, and not all are successful.

    oConservation is the outcome.

    oAdaptation has three characteristics

    oHistoricity

    oSpecificity

    oRedundancy

    žConservation

    “Conservation describes the way complex systems are able to continue to function even when severely challenged (Levine, 1973).

    oThe primary goal of conservation is maintaining wholeness and uniqueness.

    oNursing actions reflecting this model are directed at helping the client conserve:

    o* Energy  * Personal Integrity

    o* Structural Integrity  * Social Integrity

    žGlobal Concepts in the Nursing Profession

    oHuman Being: Each person has freedom of choice, identity, and self-worth.  Each person expresses themselves as a summary of all contributing parts.

    oHealth: Defined in social contexts; the ability to function within reasonable limits.  Health is more than the absence of disease, and changes with time. levine’s conservation model in nursing practice powerpoint presentation

    oEnvironment:  Not just the place a person lives, but also the situation.  There is an internal and an external environment, and both contribute to accommodation.

    žGlobal Concepts in the Nursing Profession

    “The goal of nursing is to promote adaptation and maintain wholeness” (Levine 1971). 

    oNursing is not a series of specific tasks but is a human interaction.

    oIt is based on knowledge and scientific reasoning, but is an art that each person practices in a unique manner based on each client’s needs.

    ž

    Each one of the global concepts of nursing has the ability to add to wholeness or to detract from it.

    žInterpretation & Inference

    Implications & Consequences

    žEvaluation of nursing model

    oMyra Levine’s conservation model focuses on promoting adaptation and maintaining wholeness using the principles of conservation.

    oAccording to Levine (1973) “human beings conserve their bodies’ incredible ability to adapt to environmental stimuli” (Schaefer & Pond, 1994, p.53). levine’s conservation model in nursing practice powerpoint presentation

    žOrigins

    Levine’s Conservation Model is clearly influenced by other disciplines.  It is not unique to nursing.  It has elements of the physical sciences as evidenced by the principle of energy conservation.  The social sciences are represented in the concept of the perseveration of personal integrity.  The influence of humanities is reflected by the concept of how a person’s social system is part of their environment and all forms of environment have an influence on the person.

    žorigins

    Levine’s Conservation model was developed as an organizational framework for teaching medical surgical nursing.  It was not intended to be a nursing theory (Schaefer, 2006, p.228).

    žLevine’s theory and its uniqueness to nursing

    oThe conservation principles are used by the nurse to identify interventions and to maintain wholeness for the patient (Schaefer & Pond, 1994, p.53).

    oThis theory is influenced by a person’s wholeness and their ability to adapt and respond to different environmental challenges.

    o

    žFour Global concepts

    This model adequately describes the four global concepts:

    o     Human being

    o     Environment

    o     Health

    o     Nursing

    All of these concepts represent the factors that influence individuals and their ideas about their own health and how they view healthcare in general which can influence the individual’s treatment goals and outcome.

    žapplications

    oA theory deals with one or more specific concepts and is usually derived from a conceptual model (Kearney-Nunnery, 2005).

    oLevine’s Conservation model is a general guide of systems and statements and uses broad concepts in a logical, organized form that can be used in different settings.  “Conservation principles as a framework are not limited to nursing care in the hospital but can be generalized and used in every environment, hospital, or community (Levine, 1990, 1991)” (Schaefer, 2006, p.233).

    žApplications levine’s conservation model in nursing practice powerpoint presentation

    This model has been used in varied areas of nursing.  “Conservation principles have been used as frameworks for numerous practice settings in cardiology, obstetrics, gerontology, acute care (neurology), pediatrics, long-term care, emergency care, primary care, neonatology, critical care areas, and in the homeless community” (Savage & Culbert, 1989; Schaefer & Pond, 1991).

    žapplications

    “Use of an appropriate conceptual model facilitates the design and testing of theory-based interventions and the development of science to support nursing practice”(Mock et al, 2007, p. 512).

    žPutting the Conservation Model to Work

    ž

    You are a labor and delivery nurse working for a local hospital.  You are caring for a teenager who is about to deliver her first child.  In the room are her boyfriend, her mother, and her best friend.  She is quiet and is not making eye contact with care staff, and her family members are watching television.  You sit down next to the bed and ask the patient if there is anything she needs and she replies “no” but your gut instinct tells you there’s more to the picture.  Your assessment skills tell you there is a great potential here for problems.

    ž

    You ask the patient how she feels about becoming a mother.  She tells you she is scared.  In further conversation, she tells you she is not planning to go back to school because she is embarrassed and afraid of social rejection.  She did not take any birthing classes or childcare education.  She is afraid of pain during active labor, and has questions about pain control options.  She says her mother and her boyfriend have been supportive, but also voices concern about taking care of her mother, who has a physical disability.

    žAssessing the situation

    oIs this patient demonstrating wholeness?

    o

    oIs this patient demonstrating adaptation?

    o

    oIs this patient demonstrating conservation?

    žWholeness

    Wow.  This patient has issues, right?  Let’s look at the pieces here.  Levine states we have to look at all of the little pieces to see the whole person.  In order to understand our patient, we have to assess her lifestyle, social integration, spirituality, self-image, family dynamic, environment, cultural identity, and anything else she feels may contribute to her identity.  We get a few hints of that in our initial conversation. levine’s conservation model in nursing practice powerpoint presentation

    žAdaptation

    How well is your patient adapting?  Before you say “poorly” look at what you can build on.  Adaptation is not a “pass or fail” but can vary in degree.  Consider environment, organismic response, and trophicognosis in your response.  This is a new situation for your patient. How is she relating this to past experiences?  What does she perceive as a challenge?  What does she not perceive as a challenge or a goal?

    žConservation

    Levine describes conservation as “… the way complex systems are able to continue to function even when severely challenged” (1990).  Is your patient conserving energy? Is she conserving structural (physical) integrity?  Is she conserving her personal integrity?  Is she preserving social integrity?  How could you, as a nurse, promote these principles?

    žPutting the model to work

    žPromoting
    wholeness
    :  Talk with your patient about what roles for her are important, discuss what parts of her identity have been fragmented.  What is she proud of?  What is she missing?  What are her goals?

    žPromoting
    adaptation
    :  Although your patient has not been to prenatal education and has dropped out of school, she has spent time gathering baby supplies and has stopped hanging out with unsupportive friends.  Build on this.  Encourage her and tell her about other community resources available to her.  Help her explore all of her options and consider her preferences.

    ž

    žPromoting
    conservation
    :  Provide her with pain control options, encourage physical rest.  Encourage her to advocate for her needs and allow her to carry out her social roles during her hospital stay by involving friends and family there to support her, if that is what she desires.

    ž

    Using Levine’s Conservation Model to guide our nursing practice takes conscious effort, but has   the potential to help our patients reach a higher state of health, which is the ultimate goal of nursing practice.

    Conservation Model

    žReferences

    Alligood, M.R.,& Tomey, A.M.(2006). Myra Estrin

    Levine :The conservation model. Y. Alexopoulos, & K. Hebberd (Eds.),
    Nursing theorists
    (pp. 726 – 742).St. Louis, MO: Mosby

    Chitty, K. (2007).
    Professional Nursing Concepts &Challenges
    . St. Louis, Missouri: Saunders. George, J.

    Current Nursing. (n.d.). Nursing theories: Levine’s four conservation      principles. Retrieved from http://currentnursing.com on July 2009.

    Dalida D. N207 Blogger (2009). Myra Levine’s Conservation Theory.
    University of the Philippines Open University

    Retrieved from
    http://nursingtheories.blogspot.com

    George, J. B. (2001). Nursing theories: Base for professional nursing. (5th ed). Pearson Education.

    Levine, M. E. (1992). Nightingale redux. In B.S. Barnum (Ed.),
    Nightingale’s notes on nursing
    (pp. 39-43). Philadelphia: J.B. Lippincott.

    Schaefer, K.M. (2006). Nursing Theorists and Their Work. In Y.Alexopaoulos (Ed. “Et al”), Myra Estrin Levine: The Conservation Model (pp. 227-243). St. Louis, Missouri: Mosby Elsevier.

    Schaefer, K.M. & Pond, J.B. (1994). Levine’s Conservation Model as a Guide to Nursing Practice.
    Nursing Science Quarterly,
    7, 53-54. doi: 10.1177/089431849400700204 levine’s conservation model in nursing practice powerpoint presentation

    ž

  • NURS 6550 FINAL EXAM

    NURS 6550 FINAL EXAM QUESTION 1

    Mr. Jeffers was admitted 2 days ago for a carotid endarterectomy. A Foley catheter was inserted intraoperatively and remains in place. His urine output has declined markedly despite continued IV fluid infusion. Today his morning labs reveal a BUN of 19 mg/dL and a creatinine of 2 mg/dL. A leading differential includes:

     

    A.

    Foley lodged in the urethra causing post-renal failure

     

    B.

    Decreased renal perfusion causing prerenal failure

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    C.

    Age-related decreased eGFR causing prerenal failure

     

    D.

    Post-surgical rhabdomyolysis causing intrarenal failure

     

    NURS 6550 FINAL EXAM QUESTION 2

    Janet is admitted with symptomatic tachycardia. Her pulse is 160 b.p.m. and she is weak, diaphoretic, and anxious. Physical examination reveals a 5’4” 107 lb black female who is awake, alert, and oriented, anxious, with moist skin and racing pulse. Her blood pressure is 140/100 mm Hg. Temperature and respiratory rate are within normal limits. The patient admits to having a “thyroid condition” but she never followed up on it when she was advised to see an endocrinologist. The AGACNP anticipates a diagnosis of:

     

    A.

    Hashimoto’s thyroiditis

     

    B.

    Cushing’s syndrome

     

    C.

    Grave’s disease

     

    D.

    Addison’s disease

     

    QUESTION 3

    Systemic lupus erythematosis (SLE) is a multiorgansystem autoimmune disorder that can prevent with a wide variety of manifestations. Which clinical triad should prompt an evaluation for SLE?

     

    A.

    Fever, normal white count, elevated sedimentation rate

     

    B.

    Hyperkalemia, hyponatremia, low blood pressure

     

    C.

    Leukocytosis, hyperglycemia, hypokalemia

     

    D.

    Joint pain, rash, fever

     

    QUESTION 4

    A patient presents with profound vertigo of acute onset yesterday. She can barely turn her head without becoming very vertiginous; she is nauseous and just doesn’t want to move. This morning when she tried to get out of bed she felt like she was pushed back down. The vertigo is reproducible with cervical rotation. The patient denies any hearing loss or tinnitus, she has no fever or other symptoms. The AGACNP knows that the most helpful intervention will probably be:

     

    A.

    Meclizine

     

    B.

    Diazepam

     

    C.

    Bed rest

     

    D.

    Epley’s maneuvers

     

    QUESTION 5

    Mrs. Mireya is an 85-year-old female who is admitted for evaluation of acute mental status change from the long term care facility. She is normally ambulatory and participates in lots of facility activities. Today a nursing assistant found her in her room, appearing confused and disconnected from her environment. When she tried to get up she fell down. Her vital signs are stable excepting a blood pressure of 90/60 mm Hg. The AGACNP knows that the most likely cause of her symptoms is:

     

    A.

    Osteoarthritis

     

    B.

    Drug or alcohol toxicity

     

    C.

    Hypotension

     

    D.

    Urosepsis

     

    NURS 6550 FINAL EXAM QUESTION 6

    A patient with SIADH would be expected to demonstrate which pattern of laboratory abnormalities?

     

    A.

    Serum Na+ 119 mEq/L, serum osmolality 240 mEq/L, urine Na+ of 28 mEq/L, urine osmolality of 900 mOsm/kg

     

    B.

    Serum Na+ 152 mEq/L, serum osmolality 315 mEq/L, urine Na+ of 5 mEq/L, urine osmolality of 300 mOsm/kg

     

    C.

    Serum Na+ 121 mEq/L, serum osmolality 290 mEq/L, urine Na+ of 7 mEq/L, urine osmolality of 850 mOsm/kg

     

    D.

    Serum Na+ 158 mEq/L, serum osmolality 251 mEq/L, urine Na+ of 20 mEq/L, urine osmolality of 420 mOsm/kg

     

    QUESTION 7

    Sean is a 29-year-old male who presents to the emergency department for evaluation and treatment of foreign body in the eye. Ophthalmic anesthesia is achieved and removal is attempted unsuccessfully with a moist cotton tipped swab. A wet fluorescein stain is applied to the lower eyelid, and a corneal abrasion ruled out but the AGACNP notes a positive Seidel sign. This indicates:

     

    A.

    Penetration of the cornea with resultant aqueous leak

     

    B.

    A rust ring remnant due to metal foreign body

     

    C.

    An elevated intraocular pressure

     

    D.

    Paradoxical pupil dilation in response to light

     

    QUESTION 8

    Mrs. Lowen is an 82-year-old female who comes to the emergency department for evaluation of a fever of 102.9° F. She complains of a headache in the right side of her temple and some right-sided jaw pain. A urinalysis, chest radiograph, complete blood count (CBC) and 12-lead ECG are all non-contributory. A comprehensive metabolic panel is significant only for a slightly elevated BUN and creatinine. The AGACNP appreciates distinct right temple tenderness to percussion. Which laboratory test is necessary to support the suspected diagnosis?

     

    A.

    An erythrocyte sedimentation rate

     

    B.

    A white blood cell differential

     

    C.

    Two sets of blood cultures

     

    D.

    Echocardiography

     

    NURS 6550 FINAL EXAM QUESTION 9

    Ms. Schiebel, a 31-year-old female who is brought to the emergency department by police after being arrested for disruptive behavior in a public establishment. The differential diagnosis includes drug and alcohol ingestion/toxicity, central nervous system disease, severe trauma, and psychotic illness; ultimately the alcohol and toxicology screen as well as head imaging are negative. When considering psychotic illness, the AGACP knows that this is a physiologic imbalance that typically involves an excess of:

     

    A.

    Serotonin

     

    B.

    Norepinephrine

     

    C.

    Acetylcholine

     

    D.

    Dopamine

     

    QUESTION 10

    Mr. Lincoln is a 55-year-old male who was admitted for management of sepsis secondary to pneumonia. He has declined rapidly, and today chest radiography demonstrates a diffuse, bilateral “white-out” appearance. His paO2 is 55 mm Hg. In order to increase his oxygenation the AGACNP knows that which of the following interventions is indicated?

     

    A.

    Increased FiO2

     

    B.

    Increased respiratory rate

     

    C.

    Increased tidal volume

     

    D.

    Increased PEEP

     

    QUESTION 11

    A 29-year-old female patient presents with a complaint of palpitations. Physical examination reveals an essentially healthy female with no significant medical history and no maintenance medications; the only thing she can report is that she had a head cold a week or so ago. The vital signs include a blood pressure of 139/90 mm Hg, pulse of 105 b.p.m, respiratory rate of 16 b.p.m. and a temperature of 98.6° F. The only abnormal finding on physical examination is diffuse anterior neck tenderness with thyroid palpation. The AGACNP considers which medication for symptom control?

     

    A.

    Ibuprofen

     

    B.

    Pseudoephedrine

     

    C.

    Propranolol

     

    D.

    Methimazole

     

    QUESTION 12

    Jennifer is an 18-year-old homeless female who was found unresponsive. She was admitted to the hospital for management of severe bleeding after a spontaneous abortion escalated to a uterine hemorrhage. An underlying infection and dehydration were corrected and nutritional supplements were started. Her volume status is stable, morning labs were all within normal limits and she is to be discharged today. When the AGACNP enters the room to prepare the patient for discharge, she finds her agitated, pale, and diaphoretic with vital signs to include a pulse of 105 bpm, respirations of 24 bpm, blood pressure of 110/76 mm Hg and a temperature is 97.9° F. The most appropriate action would be to:

     

    A.

    Order a CBC to assess for recurrent bleeding

     

    B.

    Request and abdominal CT to assess for bleeding

     

    C.

    Evaluate the patient for anxiety/panic attack

     

    D.

    Prescribe alprazolam 1 mg now

     

    QUESTION 13

    Physical examination findings in a patient with pneumothorax is likely to reveal:

     

    A.

    Increased tactile fremitus

     

    B.

    Low grade temperature

     

    C.

    Hyperresonance to percussion

     

    D.

    Egophany

     

    NURS 6550 FINAL EXAM QUESTION 14

    Mr. Parker brings his 73-year-old wife to a clinic appointment because he is worried about her. She has a long history of hypertension and dyslipidemia, but he says she has taken medication for years and everything has been OK. His concern today is that for a long time she has been very forgetful, and he has tried to help her by keeping a strict routine around the house. Over the past few months, she just seems more and more forgetful, does not seem interested in doing anything, and now seems to be forgetting how to do simple everyday tasks. Yesterday she could not figure out which dollar bills to use at the store to pay the cashier. The AGACNP knows Mrs. Parker should first be screened for:

     

    A.

    Depression

     

    B.

    A brain tumor

     

    C.

    Hypothyroidism

     

    D.

    Adrenal dysfunction

     

    QUESTION 15

    M.R. is a 40-year-old female who has a known history of peptic ulcer disease. She has been admitted through the emergency room with a diagnosis of GI bleeding—she is vomiting dark blood and had a nasogastric tube placed. When attached to low intermittent suction it initially drained 400 cc of dark brown/black drainage, but now it is starting to drain lighter red colored blood. The AGACNP knows that immediate priorities of care include:

     

    A.

    Ensuring hemodynamic stability

     

    B.

    Beginning a parenteral proton pump inhibitor

     

    C.

    Beginning gastric lavage

     

    D.

    Ordering a gastrointestinal consult

     

    QUESTION 16

    A patient with sharp, stabbing chest pain directly over the precordium has a 12-lead ECG that demonstrates concave ST-T wave elevations in leads II, III, avR, avL, avF, and all six precordial leads. The AGACNP expects which physical finding?

     

    A.

    A grade IV/VI systolic murmur with radiation to the axilla

     

    B.

    A split S2 that increases with inspiration

     

    C.

    A pericardial friction rub

     

    D.

    An S4 heart sound

     

    QUESTION 17

    J.Q. is a 45-year-old male who had gastric bypass surgery 18 months ago. A CBC reveals a macrocytic anemia with aHgb of 9.8 g/dL, HCT of 30%, MCV of 115 and RDW of 19%. The AGACNP suspects which type of anemia?

     

    A.

    Iron deficiency

     

    B.

    Sickle cell anemia

     

    C.

    Pernicious anemia

     

    D.

    Anemia of chronic disease

     

    QUESTION 18

    Megan K. is a 21-year-old female who presents complaining of irritated eyes. She says this happens a couple of times a year and this time it is really a problem. Both eyes are itchy and red and she has a lot of stringy discharge, especially at the end of the day. Her visual acuity is 20/25 OS, OD, and OU with her glasses on. Physical exam reveals injected conjunctiva bilaterally but there is no photophobia. Pupils are equal, round, briskly reactive, and accommodate. The AGACNP knows that immediate treatment should include ophthalmic application of:

     

    A.

    Steroids

     

    B.

    Antihistamine

     

    C.

    Antibiotic

     

    D.

    Cycloplegic

     

    NURS 6550 FINAL EXAM QUESTION 19

    Ellen is a 61-year-old female who presents with a chief complaint of neck pain. The history of present illness reveals that Ellen felt as though a bug bit her behind the neck a few days ago. A day or two later it started to hurt, and when she began to pick at it she felt drainage come out. She is here now for evaluation. Physical exam reveals an 8 cm x 8 cm draining abscess in the right post auricular region with posterior cervical lymphadenopathy. Ellen has a temperature today of 101.9° F. The AGACNP knows that in addition to incision and drainage of the abscess, effective management must include:

     

    A.

    Systemic antibiotics

     

    B.

    Tetanus immune globulin

     

    C.

    Tetanus toxoid

     

    D.

    Antipyretics

     

    QUESTION 20

    A 13-year-old male presents with a chief complaint of ear drainage. The patient and his mother both indicate that the patient has not had any pain or any systemic complaints, but the pus-like discharge from the ear is very persistent. According to Mom they went to a retail clinic two weeks ago and the patient was prescribed both oral antibiotics and ear drops, but it didn’t help. Physical exam of the ear reveals a painless pinna; otoscope exam reveals only a large amount of mucopurulent drainage—the tympanic membrane could not be visualized. The AGACNP knows the diagnosis is most likely:

     

    A.

    Acute otitis media

     

    B.

    Acute otitis externa

     

    C.

    Cholesteatoma

     

    D.

    Otitis media with effusion

     

    QUESTION 21

    A 71-year-old male patient with lung cancer is admitted for treatment of sepsis related to his chemotherapy-induced immunosuppression. He seems to be improving from an infectious perspective, but during today’s assessment the AGACNP appreciates coarse rales in the lung fields, a blood pressure of 140-100 mm Hg, a bounding pulse, and trace pretibial edema. The urine output via Foley catheter has only been 100 mL in the last 8 hours. Suspicious for syndrome of inappropriate antidiuretic hormone (SIADH), the AGACNP orders a basic metabolic panel anticipating which of the following abnormalities? NURS 6550 FINAL EXAM.