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Nurs 6541: Primary Care of Adolescents and Children Week 2 Developmental Red Flags

Nurs 6541: Primary Care of Adolescents and Children

Week 2 Developmental Red Flags

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Case Study 3

Jose is a 36-month-old who presents for a preschool evaluation. His father reports the following development:

Physical: Walks, runs, and jumps independently, walks upstairs alternating feet, pedals a three-wheeler, scribbles, copies circles and squares, and is able to balance on one foot for 2 to 3 seconds.

Social: Recognizes three colors; speech is 75% understandable; uses three- to four-word sentences; talks about friends, favorite activities, and family; frequently engages in imitative play; has an imaginary friend; does stutter on occasion when excited or when intent on getting something said. Will typically repeat the first word in a sentence three to four times, but does not repeat syllables or consonants. This happens three to four times a week. Nurs 6541: Primary Care of Adolescents and Children Week 2 Developmental Red Flags

 

During the collection of information for the history, the provider will require the father to complete a previsit questionnaire supplied by Bright Futures Tools and Resources Kit for the three year visit to assist with provider with assessing if the child is meeting developmental milestones (Hagan, Shaw, & Duncan, 2017).  Another option is to have the father complete a Parents’ Evaluation of Developmental Status that has ten items that will take the father 2 to 5 minutes to complete and is available a variety of languages (Mackrides & Pyherd, 2011).

History

Based in the information provided by the father, the child in the case study, meets the gross and fine motor developmental milestones by being able to balance on one foot for 2 to 3 seconds, pedal a tricycle, copies circles and squares, and walk stairs using alternating feet (Burns, Dunn, Brady, Starr, Blosser, & Garzon, 2017). The child is meeting the language milestones by being able to speak in 75% understandable to strangers and uses three word sentences (Hagan et al., 2017). Social milestones that are meet include engaging in imaginary play and discusses items such as activities and friends (Hagan et al, 2017). The word repetition of words such as those at the beginning of a sentence described by the father is normal for this age group when the child is excited or expressing an important message (Burns et al., 2017). Nurs 6541: Primary Care of Adolescents and Children Week 2 Developmental Red Flags

 

The father did not state if the child is able to use the restroom independently, dress themselves, feed themselves, or place in cooperation with other and share (Hagan et al, 2017).  Language skills that were not addressed are if the child is able to tell a story from a book or television, compare things such as boy or girl, big or short, or repeat numbers (Hagan et al, 2017). Some of the fine motor skills that were not expressed include drawing a person with head and one body part and cut with child proof scissors (Hagan et al., 2017).

Assessment/Intervention

During the assessment, the child’s hearing and vision is assessed to ensure that there are no physical issues that may cause a delay in development. Mouth and neurological systems are assessed to address any health or comorbidities early to apply interventions such as a referral to neurologist, speech pathologist, or ophthalmologist if required. Some red flags would include if the child is unable to understand prepositions, action words, or follow two step directions would indicate receptive language delay (McLaughlin, 2011).  An expressive delay is indicated if the child is unable to use at least 200 words, ask for things by name, or repeats phrases in response to questions (McLaughlin, 2011). None of the above items were expressed by the father regarding the child. Education is provided to the father regarding the developmental milestones the child should meet by 3 and 4 years of age. Initiating the conversation and educational process regarding developmental milestones early will assist the parents with identifying a potential problem (Burns et al., 2017). Educational material search as Hawaii Early Learning Program at Home (HELP) information to assist with activities at home the parents can do to assist with child with meeting the milestones and arranging additional office visit to assess the child progression and assess if additional intervention is required (Burns et al., 2017). Nurs 6541: Primary Care of Adolescents and Children Week 2 Developmental Red Flags

References

Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., Blosser, C. G., & Garzon, D. L.  (Eds.).

(2017). 
Pediatric primary care
(6th ed.). St. Louis, Missouri: Elsevier.

Hagan, J. F., Jr., Shaw, J. S., Duncan, P. M. (Eds.). (2017). 
Bright futures: Guidelines for health

supervision of infants, children, and adolescents
 (4th ed.). Elk Grove Village, IL: American Academy of Pediatrics.

Mackrides, P.S.,& Ryherd, S.J.(2011). Screening for Development Delay.
American Family

Physician
. 2011 Sep 1;84(5):544-549.

McLaughlin, M.R. (2011). Speech and Language Delay in Children.
American Family

Physician.
2011 May 15;83(10):1183-1188. Nurs 6541: Primary Care of Adolescents and Children Week 2 Developmental Red Flags

NURS-6531 Adv. Practice Care of Adults Midterm Exam

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Course

NURS-6531N-8,Adv. Practice Care of Adults.2018 Summer Qtr 05/29-08/19-PT27

Test

Midterm Exam

Status

Needs Grading

Attempt Score

0 out of 100 points

Time Elapsed

1 hour, 53 minutes out of 1 hour and 50 minutes
OVER TIME

Results Displayed

All Answers, Submitted Answers, Correct Answers

Question 1

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0 out of 0 points

When completing this quiz, did you comply with Walden University’s Code of Conduct including the expectations for academic integrity? NURS-6531 Adv. Practice Care of Adults Midterm Exam

Selected Answer:

 

Yes

Answers:

 

Yes

No

Question 2

1 out of 1 points

The most common cancer found on the auricle is:

Selected Answer:

 

Basal cell carcinoma

Answers:

Actinic keratosis

 

Basal cell carcinoma

Squamous cell carcinoma

Acral-lentiginous melanoma

Question 3

0 out of 1 points

Which of the following medication classes should be avoided in patients with acute or chronic bronchitis because it will contribute to ventilation-perfusion mismatch in the patient?

Selected Answer:

 

Anticholinergics

Answers:

Xanthines

 

Antihistimines

Steroids

Anticholinergics

Question 4

0 out of 1 points

A 47 year old male patient presents to the clinic with a single episode of a moderate amount of bright red rectal bleeding. On examination, external hemorrhoids are noted. How should the nurse practitioner proceed?

Selected Answer:

 

Instruct the patient on measures to prevent hemorrhoids such as bowel habits and diet.

Answers:

Instruct the patient on measures to prevent hemorrhoids such as bowel habits and diet.

Order a topical hemorrhoid cream along with a stool softener.

 

Refer the patient for a barium enema and sigmoidoscopy.

Refer the patient for a surgical hemorrhoidectomy.

Question 5

0 out of 1 points

Which of the following patient characteristics are associated with chronic bronchitis?

Selected Answer:

 

Underweight, pink skin, and increased respiratory rate

Answers:

 

Overweight, cyanosis, and normal or slightly increased respiratory rate

Underweight, pink skin, and increased respiratory rate

Overweight, pink skin, and normal or slightly increased respiratory rate

Normal weight, cyanosis, and greatly increased respiratory rate

Question 6

1 out of 1 points

 A 65-year-old female with a past medical history of hypertension, hyperlipidemia, and polymyalgia rheumatica presents to urgent care with new onset left lower quadrant pain. Her current medications include omeprazole 20 milligrams po daily, lisinopril 20 milligrams po daily, simvastatin 20 milligrams po daily, and prednisone 12 milligrams po daily. The nurse practitioner suspects acute diverticulitis and possibly an abscess. The most appropriate diagnostic test for this patient at this time is:

Selected Answer:

 

CT scan

Answers:

CBC/diff

Erythrocyte sedimentation rate

Abdominal ultrasound

 

CT scan

Question 7

1 out of 1 points

A patient reports “something flew in my eye” about an hour ago while he was splitting logs. If there were a foreign body in his eye, the nurse practitioner would expect to find all except:

Selected Answer:

 

Purulent drainage

Answers:

 

Purulent drainage

Tearing

Photophobia

A positive fluorescein stain

Question 8

1 out of 1 points

A 21 year old college student presents to the student health center with copious, markedly purulent discharge from her left eye. The nurse practitioner student should suspect:

Selected Answer:

 

Gonococcal conjunctivitis

Answers:

Viral conjunctivitis

Common pink eye

 

Gonococcal conjunctivitis

Allergic conjunctivitis

Question 9

0 out of 1 points

 A 35 year old man presents with radicular pain followed by the appearance of grouped vesicles consisting of about 15 lesions across 3 different thoracic dermatomes. He complains of pain, burning, and itching. The nurse practitioner should suspect:

Selected Answer:

 

A complicated case of shingles and prescribe acyclovir, an analgesic, and a topical cortisone cream

Answers:

A common case of shingles and prescribe an analgesic and an antiviral agent

A complicated case of shingles and prescribe acyclovir, an analgesic, and a topical cortisone cream

 

Herpes zoster and consider that this patient may be immunocompromised

A recurrence of chickenpox and treat the patient’s symptoms

Question 10

0 out of 1 points

Which type of lung cancer has the poorest prognosis?

Selected Answer:

 

Adenocarcinoma

Answers:

Adenocarcinoma

Epidermoid carcinoma

 

Small cell carcinoma

Large cell carcinoma

Question 11

1 out of 1 points

 An 83-year-old female presents to the office complaining of diarrhea for several days. She explains she has even had fecal incontinence one time. She describes loose stools 3–4 times a day for several weeks and denies fever, chills, pain, recent antibiotic use. The history suggests that the patient has:

Selected Answer:

 

Chronic diarrhea

Answers:

Acute diarrhea

 

Chronic diarrhea

Irritable bowel

Functional bowel disease

Question 12

1 out of 1 points

Margaret, age 32, comes into the office with painful joints and a distinctive rash in a butterfly distribution on her face. The rash has red papules and plaques with a fine scale. What do you suspect?

Selected Answer:

 

Systemic lupus erythematosus

Answers:

An allergic reaction

Relapsing polychondritis

Lymphocytoma cutis

 

Systemic lupus erythematosus

Question 13

1 out of 1 points

Antibiotic administration has been demonstrated to be of little benefit to the treatment of which of the following disease processes?

Selected Answer:

 

Acute bronchitis

Answers:

Chronic sinusitis

 

Acute bronchitis

Bacterial pneumonia

Acute exacerbation of chronic bronchitis

Question 14

0 out of 1 points

Lisa, age 49, has daily symptoms of asthma. She uses her inhaled short-acting beta-2 agonist daily. Her exacerbations affect her activities and they occur at least twice weekly and may last for days. She is affected more than once weekly during the night with an exacerbation. Which category of asthma severity is Lisa in?

Selected Answer:

 

Mild persistent

Answers:

Mild intermittent

Mild persistent

 

Moderate persistent

Question 15

0 out of 1 points

Which of the following is the most appropriate therapeutic regimen for an adult patient with no known allergies diagnosed with group A B-hemolytic strep?

Selected Answer:

 

None of the above

Answers:

 

Penicillin V 500 milligrams PO every 8 hours for 10 days

Ampicillin 250 milligrams PO twice a day for 10 days

Clarithromycin 500 milligrams po daily for 7 days

None of the above

Question 16

0 out of 1 points

A cashier complains of dull ache and pressure sensation in her lower legs. It is relieved by leg elevation. She occasionally has edema in her lower legs at the end of the day. What is the most likely cause of these problems?

Selected Answer:

 

Arterial insufficiency

Answers:

Congestive heart failure

 

Varicose veins

Deep vein thrombosis

Arterial insufficiency

Question 17

1 out of 1 points

Which statement below is correct about pertussis?

Selected Answer:

 

It is also called whooping cough

Answers:

 

It is also called whooping cough

It begins with symptoms like strep throat

It lasts about 3 weeks

It occurs most commonly in toddlers and young children

Question 18

0 out of 1 points

Which of the following is the most important diagnosis to rule out in the adult patient with acute bronchitis?

Selected Answer:

 

Asthma

Answers:

 

Pneumonia

Asthma

Sinusitis

Pertussis

Question 19

1 out of 1 points

A 70 year old patient presents with left lower quadrant (LLQ) abdominal pain, a markedly tender palpable abdominal wall, fever, and leukocytosis. Of the following terms, which correctly describes the suspected condition?

Selected Answer:

 

Diverticulitis

Answers:

Diverticulosis

Diverticula

 

Diverticulitis

Diverticulum

Question 20

1 out of 1 points

Sylvia, age 83, presents with a 3 day history of pain and burning in the left forehead. This morning she noticed a rash with erythematous papules in that site. What do you suspect?

Selected Answer:

 

Herpes zoster

Answers:

Varicella

 

Herpes zoster

Syphilis

Rubella

Question 21

0 out of 1 points

A 33-year-old female is admitted with acute pancreatitis. The nurse practitioner knows that the most common cause of pancreatitis is:

Selected Answer:

 

Medications

Answers:

Alcohol

 

Gallstones

Medications

Pregnancy

Question 22

1 out of 1 points

When a patient presents with symptoms of acute gallbladder disease, what is the appropriate nurse practitioner action?

Selected Answer:

 

Order an abdominal ultrasound

Answers:

Order abdominal x-rays

 

Order an abdominal ultrasound

Refer the patient to a surgeon for evaluation

Prescribe pain medication

Question 23

0 out of 1 points

A false-positive result with the fecal occult blood test can result from:

Selected Answer:

 

stool that has been stored before testing

Answers:

ingestion of large amounts of vitamin C

 

a high dietary intake of rare cooked beef

a colonic neoplasm that is not bleeding

stool that has been stored before testing

Question 24

0 out of 1 points

 A 76-year-old male complains of weight loss, nausea, vomiting, abdominal cramping and pain. Physical findings include an abdominal mass and stool positive for occult blood. The nurse practitioner pain suspects a tumor in the small intestine. The best diagnostic test for this patient is:

Selected Answer:

 

Colonoscopy

Answers:

Colonoscopy

 

Small bowel follow-through

Barium enema

CT abdomen

Question 25

1 out of 1 points

A patient presents to urgent care complaining of dyspnea, fatigue, and lower extremity edema. The echocardiogram reveals and ejection fraction of 38%. The nurse practitioner knows that these findings are consistent with:

Selected Answer:

 

Systolic heart failure

Answers:

Mitral regurgitation

 

Systolic heart failure

Cardiac myxoma

Diastolic heart failure

Question 26

1 out of 1 points

Maxine, Age 76, has just been given a diagnosis of pneumonia. Which of the following is an indication that she should be hospitalized?

Selected Answer:

 

Multilobar involvement on chest x-ray with the inability to take oral medications

Answers:

 

Multilobar involvement on chest x-ray with the inability to take oral medications

Alert and oriented, slightly high but stable vital signs, and no one to take care of her at home

Sputum and gram positive organisms

A complete blood count showing leukocytosis

Question 27

0 out of 1 points

A 55 year old man is diagnosed with basal cell carcinoma. The nurse practitioner correctly tells him:

Selected Answer:

 

“It is the most common cause of death in patients with skin cancer.”

Answers:

“It is the most common cause of death in patients with skin cancer.”

 

“It can be cured with surgical excision or radiation therapy.”

“It is a slow growing skin cancer that rarely undergoes malignant changes.”

“It can be cured using 5-flurouracil cream twice daily for 2 to 4 weeks.”

Question 28

1 out of 1 points

Expected spirometry readings when the patient has chronic emphysema include:

Selected Answer:

 

Increased total lung capacity (TLC)

Answers:

Decreased residual volume (RV)

Increased vital capacity (VC)

Increased forced expiratory volume (FEV-1)

 

Increased total lung capacity (TLC)

Question 29

1 out of 1 points

 An 80-year-old male admits to difficulty swallowing during the review of systems. The nurse practitioner recognizes the differential diagnosis for this patient’s dysphagia is:

Selected Answer:

 

A and C

Answers:

Esophageal cancer

Chest pain

GERD

 

A and C

All of the above

Question 30

0 out of 1 points

A 40 year old female with history of frequent sun exposure presents with a multicolored lesion on her back. It has irregular borders and is about 11mm in diameter. What should the nurse practitioner suspect?

Selected Answer:

 

Basal cell carcinoma

Answers:

Squamous cell carcinoma

 

Malignant melanoma

A common nevus

Basal cell carcinoma

Question 31

1 out of 1 points

Which of the following is not a goal of treatment for the patient with cystic fibrosis?

Selected Answer:

 

Replace water-soluble vitamins

Answers:

Prevent intestinal obstruction

Provide adequate nutrition

Promote clearance of secretions

 

Replace water-soluble vitamins

Question 32

1 out of 1 points

The nurse practitioner is performing a physical exam on a middle-aged African-American man. Which of the following areas is a common site for melanomas in African-Americans and other dark-skinned individuals?

Selected Answer:

 

B and C

Answers:

Scalp

Nails

Feet

 

B and C

All of the above

Question 33

1 out of 1 points

An adult presents with tinea corporis. Which item below is a risk factor for its development?

Selected Answer:

 

Topical steroid use

Answers:

 

Topical steroid use

Topical antibiotic use

A recent laceration

Cold climates

Question 34

0 out of 1 points

A patient has experienced nausea and vomiting, headache, malaise, low grade fever, abdominal cramps, and watery diarrhea for 72 hours. His white count is elevated with a shift to the left. He is requesting medication for diarrhea. What is the most appropriate response?

Selected Answer:

 

Order stool cultures.

Answers:

Prescribe loperamide (Immodium) or atropine-diphenoxylate (Lomotil) and a clear liquid diet for 24 hours.

 

Prescribe a broad-spectrum antibiotic such as ciprofloxacin (Cipro), and symptom management.

Offer an anti-emetic medication such as ondansetron (Zofran) and provide oral fluid and electrolyte replacement instruction.

Order stool cultures.

Question 35

1 out of 1 points

Janine, age 29, has numerous transient lesions that come and go, and she is diagnosed with urticaria. What do you order?

Selected Answer:

 

Antihistamines

Answers:

Aspirin

NSAIDs

Opioids

 

Antihistamines

Question 36

0 out of 1 points

 Of the following signs and symptoms of congestive heart failure (CHF), the earliest clinical manifestation is:

Selected Answer:

 

Peripheral edema

Answers:

Peripheral edema

 

Weight gain

Shortness of breath

Nocturnal dyspnea

Question 37

1 out of 1 points

A 16 year old male presents with mild sore throat, fever, fatigue, posterior cervical adenopathy, and palatine petechiae. Without a definitive diagnosis for this patient, what drug would be least appropriate to prescribe?

Selected Answer:

 

Amoxicillin

Answers:

Ibuprofen

Erythromycin

 

Amoxicillin

Acetaminophen

Question 38

1 out of 1 points

A 70 year old man who walks 2 miles every day complains of pain in his left calf when he is walking. The problem has gotten gradually worse and now he is unable to complete his 2 mile walk. What question asked during the history, if answered affirmatively, would suggest a diagnosis of arteriosclerosis obliterans?

Selected Answer:

 

“Is your leg pain relieved by rest?”

Answers:

“Are you wearing your usual shoes?”

“Do you also have chest pain when you have leg pain?”

 

“Is your leg pain relieved by rest?”

“Do you ever have the same pain in the other leg?”

Question 39

0 out of 1 points

Which of the following statements about malignant melanomas is true?

Selected Answer:

 

They usually occur in older adult males

Answers:

They usually occur in older adult males

The patient has no family history of melanoma

They are common in blacks

 

The prognosis is directly related to the thickness of the lesion

Question 40

1 out of 1 points

Sheila, age 78, presents with a chief complaint of waking up during the night coughing. You examine her and find an S3 heart sound, pulmonary crackles that do not clear with coughing, and peripheral edema. What do you suspect?

Selected Answer:

 

Heart failure

Answers:

Asthma

Nocturnal allergies

Valvular disease

 

Heart failure

Question 41

0 out of 1 points

Which antibiotic would be the most effective in treating community acquired pneumonia (CAP) in a young adult without any comorbid conditions?

Selected Answer:

 

Doxycycline (Vibramycin)

Answers:

Erythromycin

 

Clarithromycin (Biaxin)

Doxycycline (Vibramycin)

Penicillin

Question 42

1 out of 1 points

Which of the following dermatologic vehicles are the most effective in absorbing moisture and decreasing friction?

Selected Answer:

 

Powders

Answers:

 

Powders

Gels

Creams

Lotion

Question 43

1 out of 1 points

A 70 year old patient presents with a slightly raised, scaly, erythematous patch on her forehead. She admits to having been a “sun worshiper.” The nurse practitioner suspects actinic keratosis. This lesion is a precursor to:

Selected Answer:

 

Squamous cell carcinoma

Answers:

 

Squamous cell carcinoma

Basal cell carcinoma

Malignant melanoma

Acne vulgaris

Question 44

1 out of 1 points

An elderly patient is being seen in the clinic for complaint of “weak spells” relieved by sitting or lying down. How should the nurse practitioner proceed with the physical examination?

Selected Answer:

 

Compare the patient’s blood pressure lying first, then sitting, and then standing.

Answers:

Assist the patient to a standing position and take her blood pressure.

Assess the patient’s cranial nerves.

 

Compare the patient’s blood pressure lying first, then sitting, and then standing.

Compare the amplitude of the patient’s radial and pedal pulses.

Question 45

1 out of 1 points

What oral medication might be used to treat chronic cholethiasis in a patient who is a poor candidate for surgery?

Selected Answer:

 

Ursodiol

Answers:

 

Ursodiol

  Ibuprofen

Prednisone

  Surgery is the only answer

Question 46

0 out of 1 points

A 46-year-old female with a past medical history of diabetes presents with a swollen, erythematous right auricle and is diagnosed with malignant otitis externa. The nurse practitioner knows that the most likely causative organism for this patient’s problem is:

Selected Answer:

 

Staphylococcus aureus

Answers:

Staphylococcus aureus

Group A beta hemolytic streptococcus

Haemophilus influenza

 

Pseudomonas aeruginosa

Question 47

0 out of 1 points

Which of the following is not a symptom of irritable bowel syndrome?

Selected Answer:

 

Painful diarrhea

Answers:

Painful diarrhea

Painful constipation

Cramping and abdominal pain

 

Weight loss

Question 48

1 out of 1 points

A patient comes in complaining of 1 week of pain in the posterior neck with difficulty turning the head to the right. What additional history is needed?

Selected Answer:

 

Any recent trauma

Answers:

 

Any recent trauma

Difficulty swallowing

  Stiffness in the right shoulder

Change in sleeping habits

Question 49

0 out of 1 points

Marvin, age 56, is a smoker with diabetes. He has just been diagnosed as hypertensive. Which of the following drugs has the potential to cause the development of bronchial asthma and inhibit gluconeogenesis?

Selected Answer:

 

ACE Inhibitor

Answers:

ACE Inhibitor

 

Beta Blocker

Calcium channel blocker

Diuretic

Question 50

1 out of 1 points

The differential diagnosis for a patient complaining of a sore throat includes which of the following?

Selected Answer:

 

A, B, and C

Answers:

Gonococcal infection

Thrush

Leukoplakia

B only

 

A, B, and C

Question 51

0 out of 1 points

A patient presents to the primary care provider complaining of a rash on his right forehead that started yesterday and is burning and painful. The physical exam reveals an erythematous, maculopapular rash that extends over the patient’s right eye to his upper right forehead. Based on the history and examination, the most likely cause of this patient’s symptoms is:

Selected Answer:

 

Rhus dermatitis

Answers:

Rhus dermatitis

 

Ophthalmic zoster

Chemosis

Optic neuritis

NURS-6531 Adv. Practice Care of Adults Midterm Exam

Question 52

0 out of 1 points

Before initiating an HMG CoA-reductase inhibitor for hyperlipidemia, the nurse practitioner orders liver function studies. The patient’s aminotransferase (ALT) is elevated. What laboratory test(s) should be ordered?

Selected Answer:

 

Serum cholesterol with HDL and LDL

Answers:

 

Serologic markers for hepatitis

Serum bilirubin

Serum cholesterol with HDL and LDL

A liver biopsy

Question 53

1 out of 1 points

A patient with elevated lipids has been started on lovastatin. After 3 weeks of therapy, he calls to report generalized muscle aches. The nurse practitioner should suspect: NURS-6531 Adv. Practice Care of Adults Midterm Exam

Selected Answer:

 

Rhabdomyolysis

Answers:

A drug interaction

Hepatic dysfunction

Hypersensitivity to lovastatin

 

Rhabdomyolysis

Question 54

1 out of 1 points

Treatment of acute vertigo includes:

Selected Answer:

 

Bedrest and an antihistamine

Answers:

 

Bedrest and an antihistamine

Fluids and a decongestant

A sedative and decongestant

Rest and a low sodium diet

Question 55

1 out of 1 points

Treatment of H.pylori includes which of the following?

Selected Answer:

 

A, B, and C

Answers:

Proton pump inhibitor

Antibiotic therapy

Bismuth subsalicylate

A and B

 

A, B, and C

Question 56

1 out of 1 points

Carl, age 78, is brought to the office by his son, who states that his father has been unable to see clearly since last night. Carl reports that his vision is “like looking through a veil.” He also sees floaters and flashing lights but is not having any pain. What do you suspect? NURS-6531 Adv. Practice Care of Adults Midterm Exam

Selected Answer:

 

Retinal detachment

Answers:

Cataracts

Glaucoma

 

Retinal detachment

Iritis

Question 57

1 out of 1 points

In order to decrease deaths from lung cancer:

Selected Answer:

 

Patients should be counseled to quit smoking

Answers:

All smokers should be screened annually

All patients should be screened annually

Only high risk patients should be screened routinely

 

Patients should be counseled to quit smoking

Question 58

1 out of 1 points

John, age 33, has a total cholesterol level of 188 mg/dL. How often should he be screened for hypercholesterolemia?

Selected Answer:

 

Every 5 years

Answers:

 

Every 5 years

Every 2 years

 Every year

Whenever blood work is done

Question 59

1 out of 1 points

Mort is hypertensive. Which of the following factors influenced your choice of using an alpha blocker as the antihypertensive medication?

Selected Answer:

 

Mort has benign prostatic hyperplasia

Answers:

Mort is black

Mort also has congestive heart failure

 

Mort has benign prostatic hyperplasia

  Mort has frequent migraine headaches

Question 60

1 out of 1 points

John, age 59, presents with recurrent, sharply circumscribed red papules and plaques with a powdery white scale on the extensor aspect of his elbows and knees. What do you suspect?

Selected Answer:

 

Psoriasis

Answers:

Actinic keratosis

Eczema

 

Psoriasis

Seborrheic dermatitis

Question 61

1 out of 1 points

Harriet, a 79-year-old woman, comes to your office every 3 months for follow up on her hypertension. Her medications include one baby aspirin daily, Lisinopril 5mg daily, and Calcium 1500 mg daily. At today’s visit. Her blood pressure is 170/89. According to JNC VIII guidelines, what should you do next to control Harriet’s blood pressure? NURS-6531 Adv. Practice Care of Adults Midterm Exam

Selected Answer:

 

Add a thiazide diuretic to the Lisinopril 5mg daily

Answers:

Increase her Lisinopril to 20mg daily

 

Add a thiazide diuretic to the Lisinopril 5mg daily

Discontinue the Lisinopril and start a combination of ACE Inhibitor and calcium channel blocker

Discontinue the Lisinopril and start a diuretic

Question 62

0 out of 1 points

An active 65-year-old man under your care has known acquired valvular aortic stenosis and mitral regurgitation. He also has a history of infectious endocarditis. He has recently been told he needs elective replacement of his aortic valve. When he comes into the office you discover that he has 10 remaining teeth in poor repair. Your recommendation would be to:

Selected Answer:

coordinate with his cardiac and oral surgeons to have the tooth extractions and valve replacement done at the same time to reduce the risk of anesthetic complications.

Answers:

defer any further dental work until his valve replacement is completed

instruct him to have dental extraction done cautiously, having no more than 2 teeth per visit removed.

 

suggest he consult with his oral surgeon about having all the teeth removed at once and receiving appropriate antibiotic prophylaxis

coordinate with his cardiac and oral surgeons to have the tooth extractions and valve replacement done at the same time to reduce the risk of anesthetic complications.

Question 63

0 out of 1 points

Appropriate therapy for peptic ulcer disease (PUD) is:

Selected Answer:

 

Dependent on cessation of NSAID use

Answers:

Primarily by eradication of infection

 

Based on etiology

Aimed at diminishing prostaglandin synthesis

Dependent on cessation of NSAID use

Question 64

1 out of 1 points

Shirley, age 58, has been a diabetic for 7 years. Her blood pressure is normal. Other than her diabetes medications, what would you prescribe today during her routine office visit?

Selected Answer:

 

An ACE Inhibitor

Answers:

A calcium channel blocker

A beta blocker

 

An ACE Inhibitor

No hypertension medication

Question 65

1 out of 1 points

Medicare is a federal program administered by the Centers for Medicare and Medicaid Services (CMS). The CMS has developed guidelines for Evaluation and Management coding, which all providers are expected to follow when coding patient visits for reimbursement. Which of the following is an important consideration regarding billing practices?

Selected Answer:

 

Failing to bill for billable services will lead to unnecessarily low revenues

Answers:

It is important to “undercode” so that one does not get charged with Medicare fraud

The practice of “overcoding” is essential in this age of decreasing reimbursements

 

Failing to bill for billable services will lead to unnecessarily low revenues

Time spent with the patient is a very important determinant of billing

Question 66

1 out of 1 points

A 2 year old presents with a white pupillary reflex. What is the most likely cause of this finding?

Selected Answer:

 

Retinoblastoma

Answers:

Viral conjunctivitis

Glaucoma

Corneal abrasion

 

Retinoblastoma

NURS-6531 Adv. Practice Care of Adults Midterm ExamQuestion 67

0 out of 1 points

Harvey has had Meniere’s disease for several years. He has some hearing loss but now has persistent vertigo. What treatment might be instituted to relieve the vertigo?

Selected Answer:

 

A labyrinthectomy

Answers:

Pharmacological therapy

A labyrinthectomy

 

A vestibular neurectomy

Wearing an earplug in the ear with the most hearing loss

Question 68

0 out of 1 points

Which of the following is not a risk factor for coronary arterial insufficiency?

Selected Answer:

 

Hyperhomocysteinemia

Answers:

Hyperhomocysteinemia

Smoking

Genetic factors

 

Alcohol ingestion

Question 69

1 out of 1 points

An 18-year-old female presents to the urgent care center complaining of severe pruritus in both eyes that started 2 days ago. Associated symptoms include a headache and fatigue. On examination, the nurse practitioner notes some clear discharge from both eyes and some erythema of the eyelids and surrounding skin. Which of the following is the most likely cause of this patient’s symptoms?

Selected Answer:

 

Allergic conjunctivitis

Answers:

 

Allergic conjunctivitis

Bacterial conjunctivitis

Gonococcal conjunctivitis

Viral conjunctivitis

Question 70

0 out of 1 points

A 20 year old is diagnosed with mild persistent asthma. What drug combination would be most effective in keeping him symptom-free?

Selected Answer:

 

A long-acting bronchodilator

Answers:

A long-acting bronchodilator

An inhaled corticosteroid and cromolyn

Theophylline and a short acting bronchodilator

 

A bronchodilator PRN and an inhaled corticosteroid

Question 71

0 out of 1 points

Acute rheumatic fever is an inflammatory disease which can follow infection with:

Selected Answer:

 

Β-hemolytic Streptococcus

Answers:

 

Group A Streptococcus

Staphlococcus areus

Β-hemolytic Streptococcus

Streptococcus pyogenes

NURS-6531 Adv. Practice Care of Adults Midterm ExamQuestion 72

0 out of 1 points

A 60 year old male diabetic patient presents with redness, tenderness, and edema of the left lateral aspect of his face. His left eyelid is grossly edematous. He reports history of a toothache in the past week which “is better.” His temperature is 100°F and pulse is 102 bpm. The most appropriate initial action is to:

Selected Answer:

 

Start an oral antibiotic, mouth swishes with an oral anti-infective, and an analgesic

Answers:

Start an oral antibiotic, refer the patient to a dentist immediately, and follow up within 3 days

Order mandibular x-rays and question the patient about physical abuse

Start an oral antibiotic, mouth swishes with an oral anti-infective, and an analgesic

 

Initiate a parenteral antibiotic and consider hospital admission

Question 73

1 out of 1 points

If a patient presents with a deep aching, red eye and there is no discharge, you should suspect:

Selected Answer:

 

Iritis

Answers:

 

Iritis

Allergic conjunctivitis

Viral conjunctivitis

Bacterial conjunctivitis

Question 74

1 out of 1 points

The National Cholesterol Education Program’s Adult Treatment Panel III recommends that the goal for low density lipoproteins in high risk patients be less than:

Selected Answer:

 

100 mg/dL

Answers:

160 mg/dL

130 mg/dL

 

100 mg/dL

70 mg/dL

Question 75

1 out of 1 points

 A patient presents with classic symptoms of gastroesophageal reflux disease (GERD). He is instructed on life style modifications and drug therapy for 8 weeks. Three months later he returns, reporting that he was “fine” as long as he took the medication. The most appropriate next step is:

Selected Answer:

 

Investigation with endoscopy, manometry, and/or pH testing

Answers:

Referral for surgical intervention such as a partial or complete fundoplication

Dependent upon how sever the practitioner believes the condition

To repeat the 8 week course of drug therapy while continuing lifestyle modifications

 

Investigation with endoscopy, manometry, and/or pH testing

NURS-6531 Adv. Practice Care of Adults Midterm ExamQuestion 76

0 out of 1 points

Group A β-hemolytic streptococcal (GABHS) pharyngitis is most common in which age group?

Selected Answer:

 

Under 3 years of age

Answers:

Under 3 years of age

Preschool children

 

6 to 12 years of age

Adolescents

Question 77

0 out of 1 points

The most appropriate treatment for a child with mild croup is:

Selected Answer:

 

A decongestant

Answers:

A bronchodilator

An antibiotic

A decongestant

 

A cool mist vaporizer

Question 78

0 out of 1 points

A child complains that his “throat hurts” with swallowing. His voice is very “throaty” and he is hyperextending his neck to talk. Examination reveals asymmetrical swelling of his tonsils. His uvula is deviated to the left. What is the most likely diagnosis?

Selected Answer:

 

Epiglottitis

Answers:

 

Peritonsillar abscess

Thyroiditis

Mononucleosis

Epiglottitis

Question 79

1 out of 1 points

Salmeterol (Servent) is prescribed for a patient with asthma. What is the most important teaching point about this medication?

Selected Answer:

 

It is not effective during an acute asthma attack.

Answers:

 

It is not effective during an acute asthma attack.

It may take 2 to 3 days to begin working.

This drug works within 10 minutes.

This drug may be used by patients 6 years and older.

Question 80

0 out of 1 points

Which intervention listed below is safe for long term use by an adult with constipation?

Selected Answer:

 

Stool softeners

Answers:

 

Bulk-forming agents

Stool softeners

Laxatives

Osmotic agents

Question 81

1 out of 1 points

A 40 year old presents with a hordeolum. The nurse practitioner teaches the patient to:

Selected Answer:

 

Apply a topical antibiotic and warm compresses.

Answers:

 

Apply a topical antibiotic and warm compresses.

Apply cool compresses and avoid touching the hordeolum.

Use an oral antibiotic and eye flushes.

Apply light palpation to facilitate drainage.

Question 82

1 out of 1 points

Sarah has allergic rhinitis and is currently being bothered by nasal congestion. Which of the following meds ordered for allergic rhinitis would be most appropriate?

Selected Answer:

 

A decongestant nasal spray

Answers:

An antihistamine intranasal spray

 

A decongestant nasal spray

Ipratropium

Omalizumab

Question 83

1 out of 1 points

What is the Gold standard for the diagnosis of asthma?

Selected Answer:

 

Spirometry

Answers:

Patient’s perception of clogged airways

Validated quality-of-life questionnaires

  Bronchoscopy

 

Spirometry

Question 84

0 out of 1 points

A patient complains of “an aggravating cough for the past 6 weeks.” There is no physiological cause for the cough. Which medication is most likely causing the cough?

Selected Answer:

 

Methyldopa

Answers:

Methyldopa

 

Enalapril

Amlodipine

Hydrochlorothiazide

Question 85

1 out of 1 points

Stacy, age 27, states that she has painless, white, slightly raised patches in her mouth. They are probably caused by:

Selected Answer:

 

Candidiasis

Answers:

Herpes simplex

Aphthous ulcers

 

Candidiasis

Oral cancer

Question 86

1 out of 1 points

Risk factors for acute otitis media (AOM) include all of the following except:

Selected Answer:

 

African-American ethnicity

Answers:

Household cigarette smoke

Group daycare attendance

Sibling history of acute otitis media

 

African-American ethnicity

NURS-6531 Adv. Practice Care of Adults Midterm Exam Question 87

1 out of 1 points

Which of the following can result from chronic inflammation of a meibomian gland?

Selected Answer:

 

A chalazion

Answers:

 

A chalazion

Uveitis

Keratitis

A pterygium

Question 88

0 out of 1 points

What conditions must be met for you to bill “incident to” the physician, receiving 100% reimbursement from Medicare?

Selected Answer:

 

You must initiate the plan of care for the patient

Answers:

You must initiate the plan of care for the patient

 

The physician must be on-site and engaged in patient care

You must be employed as an independent contractor

You must be the main health care provider who sees the patient

Question 89

1 out of 1 points

Of the following choices, the least likely cause of cough is:

Selected Answer:

 

Acute pharyngitis

Answers:

Asthma

Gastroesophageal reflux

 

Acute pharyngitis

Allergic rhinitis

Question 90

1 out of 1 points

The most common correlate(s) with chronic bronchitis and emphysema is(are):

Selected Answer:

 

Cigarette smoking

Answers:

Familial and genetic factors

 

Cigarette smoking

Air pollution

Occupational environment

Question 91

0 out of 1 points

Which choice below is least effective for alleviating symptoms of the common cold?

Selected Answer:

 

Topical decongestants

Answers:

 

Antihistamines

Oral decongestants

Topical decongestants

Antipyretics

Question 92

0 out of 1 points

When teaching a patient with hypertension about restricting sodium, you would include which of the following instructions?

Selected Answer:

 

Diets with markedly reduced intakes of sodium may be associated with other beneficial effects beyond blood pressure control

Answers:

Diets with markedly reduced intakes of sodium may be associated with other beneficial effects beyond blood pressure control

Sodium restriction can cause serious adverse effects

A goal of 3 g of sodium chloride or 1.2 g of sodium per day is easily achievable

 

Seventy-five of sodium intake is derived from processed foods

NURS-6531 Adv. Practice Care of Adults Midterm Exam Question 93

1 out of 1 points

Which of the following heart murmurs warrants the greatest concern?

Selected Answer:

 

Diastolic murmur

Answers:

Systolic murmur

Venous hum murmur

 

Diastolic murmur

Flow murmur

Question 94

1 out of 1 points

A patient presents with an inflamed upper eyelid margin. The conjunctiva is red and there is particulate matter along the upper eyelid. The patient complains of a sensation that “there is something in my eye.” What is the diagnosis and how should it be treated?

Selected Answer:

 

Blepharitis; treat with warm compresses and gentle debridement with a cotton swab

Answers:

Hordeolum; treat with a topical antibiotic and warm compress

Conjunctivitis; treat with topical antibiotic and warm compresses

 

Blepharitis; treat with warm compresses and gentle debridement with a cotton swab

Chalazion; refer to an ophthalmologist for incision and drainage

Question 95

1 out of 1 points

A 57-year-old male presents to urgent care complaining of substernal chest discomfort for the past hour. The EKG reveals ST elevations in Leads II, III, and AVF. The nurse practitioner is aware that these changes are consistent with which myocardial infarction territory?

Selected Answer:

 

Inferior wall

Answers:

 

Inferior wall

Anterior wall

Apical wall

Lateral wall

Question 96

0 out of 1 points

The nurse practitioner observes a tympanic membrane that is opaque, has decreased mobility, and is without bulging or inflammation. The least likely diagnosis for this patient is:

Selected Answer:

 

Otitis media with effusion

Answers:

 

Acute otitis media (AOM)

Otitis media with effusion

Mucoid otitis media

Serous otitis media

Question 97

0 out of 1 points

Alan, age 54, notices a bulge in his midline every time he rises from bed in the morning. You tell him it is a ventral hernia, also known as:

Selected Answer:

 

incisional hernia

Answers:

inguinal hernia

 

epigastric hernia

umbilical hernia

incisional hernia

Question 98

1 out of 1 points

A 58-year-old man is diagnosed with Barrett’s esophagus after an endoscopy. He has no known allergies. Which of the following medications is MOST appropriate to treat this patient’s disorder?

Selected Answer:

 

Omeprazole

Answers:

 

Omeprazole

Ranitidine

An antacid

None of the above

NURS-6531 Adv. Practice Care of Adults Midterm Exam Question 99

1 out of 1 points

Larry, age 66, is a smoker with hyperlipidemia and hypertension. He is 6 months post-MI. To prevent reinfarction, the most important behavior change that he can make is to:

Selected Answer:

 

Quit smoking

Answers:

 

Quit smoking

Maintain aggressive hypertension therapy

Stick to a low-fat, low-sodium diet

Continue with his exercise program

Question 100

1 out of 1 points

Risk factors for acute arterial insufficiency include which of the following?

Selected Answer:

 

All of the above

Answers:

Recent myocardial infarction

Atrial fibrillation

Atherosclerosis

 

All of the above

Question 101

1 out of 1 points

Impetigo and folliculitis are usually successfully treated with:

Selected Answer:

 

Topical antibiotics

Answers:

Systemic antibiotics

 

Topical antibiotics

Topical steroid creams

Cleansing and debridement

NURS-6531 Adv. Practice Care of Adults Midterm Exam

NURS 6541 Week 1 Discussion – Family Essay

Family

Every family is unique.  Families may differ in their structure, life cycle stages, functioning, social networks, beliefs, and other areas (Burns, Dunn, Brady, Starr, Blosser, & Garzon, 2017).  Children depend on their families to nurture and support them throughout their lifetime (Burns, Dunn, Brady, Starr, Blosser, & Garzon, 2017).  It is essential that healthcare providers include the family unit when providing care for pediatric patients.  Family-centered care, where the health care provider partners with the family when providing care for the child, is important to promote the development of the child and the family unit (Hagan, Shaw, & Duncan, 2017). To provide care that is family centered and foster an open mind, healthcare providers should periodically examine their own beliefs about families (Burns, Dunn, Brady, Starr, Blosser, & Garzon, 2017). NURS 6541 Week 1 Discussion – Family Essay  Biased family views from the provider can negatively impact the assessment, treatment, and outcomes of the patient (Burns, Dunn, Brady, Starr, Blosser, & Garzon, 2017).

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Culture

Culture is a dynamic learned pattern of behavior which influences how people view the world (Burns, Dunn, Brady, Starr, Blosser, & Garzon, 2017).  Culture is shaped by ethnicity, gender, age, sexual orientation, spiritual beliefs, social status, educational attainment, economic status, and geographic location (Burns, Dunn, Brady, Starr, Blosser, & Garzon, 2017). An individual’s culture constantly changes over time as they are exposed to other cultures (Burns, Dunn, Brady, Starr, Blosser, & Garzon, 2017).  Healthcare providers can facilitate communication when they are aware of a patient’s cultural beliefs and integrate those beliefs into the assessment and treatment plans (Hagan, Shaw, & Duncan, 2017). The cultural beliefs of healthcare providers may strongly influence their medical recommendations (AAP, 2013). Health care providers should engage in self-reflection, self-knowledge and self-critique to understand their own cultural beliefs (AAP, 2013).   Understanding their own beliefs will enable them to consciously realign the power underlying patient-provider communication and allow them to practice with cultural humility (AAP, 2013). Cultural variations in communication, both verbal and nonverbal, can be a barrier to effective patient care (American Academy of Pediatrics, 2013).   Miscommunication in the patient -provider relationship can lead to problems such as an inaccurate history, misunderstanding of treatment recommendations, deferred follow-up visits, and poor patient outcomes (AAP, 2013).

Strategies to Assist Families with Making Health-Related Decisions

Establish an effective family-provider relationship: An effective family-provider relationship should be built on mutual respect, open and honest communication, trust, cultural competence, and collaboration (Hagan, Shaw, & Duncan, 2017). When providers and patients have an effective relationship, where they can successfully communicate and share in the decision-making process, treatment adherence will be increased, and better patient outcomes can be achieved (Smirnoff, 2013) NURS 6541 Week 1 Discussion – Family Essay.

Provide the family with appropriate information: Healthcare providers are an important source of information for the patient. Often, patients obtain information from outside sources (media, theorists, other family members, etc.) who may not have the best available evidence when they are providing recommendations to the family.  Healthcare providers should ensure that family members are provided with evidence-based information on all proposed treatment regimens, and this information should include the risks and benefits of each proposed treatment option (Hagan, Shaw, & Duncan, 2017).  Providing the patient with evidence-based information can help to facilitate the decision-making process NURS 6541 Week 1 Discussion – Family Essay.

Remove barriers to care: Providers can help patients to discover ways of obtaining needed resources, such as insurance, food, respite care, transportation, or monetary assistance, that may be needed to implement their health-related decisions (Burns, Dunn, Brady, Starr, Blosser, & Garzon, 2017).

References

American Academy of Pediatrics. (2013). Policy Statement: Enhancing Pediatric Workforce Diversity and Providing Culturally Effective Pediatric Care: Implications for Practice, Education, and Policy Making.
Pediatrics
,
132
(4), e1105-e1116. doi:10.1542/peds.2013-2268.

Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., Blosser, C. G., & Garzon, D. L. (Eds.). (2017).
Pediatric Primary Care
(6
th
ed.). St. Louis, MO: Elsevier. NURS 6541 Week 1 Discussion – Family Essay

Hagan, J. F., Jr., Shaw, J. S., Duncan, P. M. (Eds.). (2017).
Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents
(4
th
ed.). Elk Grove Village, IL: American Academy of Pediatrics.

Smirnoff, L. A. (2013). Incorporating patient and family preferences into evidence-based medicine.
BMC Medical Informatics and Decision Making
,
13
(3), 1-7. Retrieved from http://www.biomedcentral.com/1472-6947/13/S3/S6. NURS 6541 Week 1 Discussion – Family Essay

Pakistani Woman with Delusional Thought Processes Decision Tree Case Study

sychosis and schizophrenia greatly impact the brain’s normal processes, which interferes with the ability to think clearly. When symptoms of these disorders are uncontrolled, clients may struggle to function in daily life. However, clients often thrive when properly diagnosed and treated under the close supervision of a psychiatric mental health practitioner. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with psychosis and schizophrenia. Pakistani Woman with Delusional Thought Processes Decision Tree Case Study.

Learning Objectives

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Students will:

Assess client factors and history to develop personalized plans of antipsychotic therapy for clients

Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring antipsychotic therapy

Evaluate efficacy of treatment plans

Analyze ethical and legal implications related to prescribing antipsychotic therapy to clients across the lifespan

 

To prepare for this Assignment:

Review this week’s Learning Resources. Consider how to assess and treat clients requiring anxiolytic therapy.

The Assignment

Examine Case Study: Pakistani Woman with Delusional Thought Processes.
You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes. Pakistani Woman with Delusional Thought Processes Decision Tree Case Study

At each decision point stop to complete the following:

Decision #1

Which decision did you select?

Why did you select this decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different? Pakistani Woman with Delusional Thought Processes Decision Tree Case Study

Decision #2

Why did you select this decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?

Decision #3

Why did you select this decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

SAMPLE  ONLY

 

NURS 6630

WEEK SEVEN

Case 2:
 
Volume 2, Case #11: The figment of a man who looked upon the lady

Introduction

Briefly, this is a scenario of a 42 year- old woman with a complex psychiatric history extending from depression, posttraumatic stress disorder, insomnia, visual hallucinations (little man)and impaired behavior with aggression. In the course of more than 36 months, the client was treated with Paroxetine (SSRI), Bupropion ( NDRI), Tiagabine, Ramelteon and , but finally a combination of Lexapro, Bupropion and quetiapine was able to decrease her symptoms . The client’s medical history includes diabetes, hypertension, CAD, hyperlipidemia, COPD, OSA, GERD, Glaucoma, overweight and a remote history of substance abuse. Pakistani Woman with Delusional Thought Processes Decision Tree Case Study

Related Professional Questions

Certain medications or supplements can cause symptoms of mental illness and also due to her extensive medical history and usage of multiple medications I would ask the following questions:

1. Do you take any over -the – counter, herbal supplements or remedies and I would check for interactions with current medication regimen?

2. When and how often do you use your albuterol inhaler ? Some of the side effects of albuterol include anxiety, nervousness, and insomnia ( Cunha, 2016)

Sleep Hygiene: Do you keep regular sleep schedule ? Do you drink caffeine beverages close to bedtime?

Patient History

The patient may not be a reliable source of information, particularly that she has a significant mental illness that affects her functioning, hence verifying her responses with her direct family members, and mental social workers to get clues to the underlying or precipitating causes of mental crisis. Also checking facility records from previous encounters, or any psychiatric hospitalizations would be useful. Pakistani Woman with Delusional Thought Processes Decision Tree Case Study

Diagnostics Testing

1. Thyroid Stimulating Hormone (TSH). Based on recent evidence, the prevalence of depressive symptoms in hypothyroidism was nearly 50%, and clinical depression occurs in more than 40% of people suffering from hypothyroidism ( Bhagwat, 2017) Pakistani Woman with Delusional Thought Processes Decision Tree Case Study

2.
 Electrocardiogram (ECG) The client has cardiovascular diseases ( HTN, CAD), with risks of cardio complications. In the setting of taking antidepressants and antipsychotics, baseline ECG and possibly every three to six months would be appropriate.  Several atypical antipsychotics including quetiapine (Seroquel) are known to cause prolongation of the QT interval, hypothesized to occur via direct inhibition of the cardiac delayed potassium rectifier channel, which extends the ventricular repolarization process (Zhai et al., 2017)

Differential Diagnoses

1.
 
Posttraumatic Stress Disorder ( PTSD)_

2.
 
Major Depressive Disorder 
 
(MDD)

3.
 
Insomnia Disorder.

Pharmacotherapy Options for Sleep/ Wake cycle

1. Zolpidem (Ambien) 5mg oral at bedtime for Seven days.

Zolpidem is nonbenzodiazepine hypnotic, it works by enhancing GABA inhibitory actions that provide sedative hypnotic effects more selectively than other actions of GABA (Stahl, 2017). With its side effects of sedation,  low dose prescribed as the client has respiratory problems (sleep apnea OSA)).  Studies have shown that Zolpidem did not significantly worsen OSA as measured by the numbers and duration of pauses in breathing during sleep, but in one trial, it significantly lowered minimum oxygen levels during the night when compared with placebo ( Mason & Smith, 2015). Pakistani Woman with Delusional Thought Processes Decision Tree Case Study

2. Trazadone 25 mg oral at bedtime for Thirty days.

Trazadone is a serotonin 2 antagonist/reuptake inhibitor, used in management of depression and insomnia. It is absorbed well, metabolized by CYP 450 3A4 with average half life of 6hrs. It has less side sedative effects compared to zolpidem (Stahl, 2017)

The best choice for the client would be Trazadone as there is no reliable evidence of dependence or withdraws and it can also work for the client’s depression. Pakistani Woman with Delusional Thought Processes Decision Tree Case Study

Conclusion

The case was a perfect example how it is sometimes difficult to find effective pharmacological treatments of psychiatric illnesses. In the course of four years, the client was prescribed 5-6 medications targeting different neurotransmitters to improve the symptoms. Client’s polypharmacy increased risks of drug-drug interactions, and her medical comorbidities increased risks of adverse reactions. Lesson learned from this study was  that treatment  should be optimally initiated after diagnosis, and augment or switching to a new agent must be carefully  done in consideration of possible  side effects and better outcomes. Pakistani Woman with Delusional Thought Processes Decision Tree Case Study

References

Bhagwat, N., Tayde, P., Sharma, P., Sharma, B., Dalwadi, P., Sonawane, A., … Varthakavi, P. (2017). Hypothyroidism and depression: Are cytokines the link? 
Indian Journal of Endocrinology and Metabolism
, 
21
(6), 886. Retrieved from https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/pdfviewer/pdfviewer?vid=7&sid=aeb79c1d-68dc-40a4-bd10-f956796bc9e8%40sessionmgr101

Cunha, J. (2016). Common Side Effects of Ventolin HFA (Albuterol Sulfate Inhalation Aerosol) Drug Center – RxList. Retrieved from https://www.rxlist.com/ventolin-hfa-side-effects-drug-center.htm Pakistani Woman with Delusional Thought Processes Decision Tree Case Study

Mason, M., & Smith, I. (2015). Effects of opioid, hypnotic and sedating medications on obstructive sleep apnoea (OSA) in adults with known OSA | Cochrane. Retrieved from http://www.cochrane.org/CD011090/AIRWAYS_effects-opioid-hypnotic-and-sedating-medications-obstructive-sleep-apnoea-osa-adults-known-osa

Zhai, D., Lang, Y., Dong, G., Liu, Y., Wang, X., Zhou, D., … Zhang, R. (2017). QTc interval lengthening in first-episode schizophrenia (FES) patients in the earliest stages of antipsychotic treatment. 
Schizophrenia Research
, 
179
, 70-74. Retrieved from https://resolver-ebscohost-com.ezp.waldenulibrary.org/openurl?ID=pmid%3a27727006&genre=article&atitle=QTc+interval+lengthening+in+first-episode+schizophrenia+(FES)+patien Pakistani Woman with Delusional Thought Processes Decision Tree Case Study

Social Determinate Of Health Contributing To A Family Health Status

Refer back to the interview and evaluation you conducted in the Topic 2 Family Health Assessment assignment. Values/Health Perception

Nutrition

Sleep/Rest

Elimination

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Activity/Exercise

Cognitive

Sensory-Perception

Self-Perception

Role Relationship

Sexuality

Coping

Identify the social determinates of health (SDOH) contributing to the family’s health status. In a 750-1,000-word paper, create a plan of action to incorporate health promotion strategies for this family. Include the following:

Describe the SDOH that affect the family health status. What is the impact of these SDOH on the family? Discuss why these factors are prevalent for this family. Social Determinate Of Health Contributing To A Family Health Status

Based on the information gathered through the family health assessment, recommend age-appropriate screenings for each family member. Provide support and rationale for your suggestions.

Choose a health model to assist in creating a plan of action. Describe the model selected. Discuss the reasons why this health model is the best choice for this family. Provide rationale for your reasoning.

Using the model, outline the steps for a family-centered health promotion. Include strategies for communication. Cite at least three peer-reviewed or scholarly sources to complete this assignment. Sources should be published within the last 5 years and appropriate for the assignment criteria. Prepare this assignment according to the guidelines found in the APA Style Guide. An abstract is not required. Social Determinate Of Health Contributing To A Family Health Status

RUBRICS:
The SDOH directly affecting family health status are relevant, accurately identified and thoroughly described. The direct impact to the family, and why the factors are prevalent to the family, are discussed in detail. The discussion is well supported and illustrates insight into SDOH and their effect on family health status.

Screenings presented for each family member are age appropriate and highly relevant. Screenings correlate to the information gathered through family health assessment. Strong rationale and support is presented.

A health model is selected and thoroughly described. A detailed discussion of how the model will assist in creating a plan of action is presented. Reasons for why it is best for this family are clearly outlined. Strong rationale and support are provided to support reasoning Social Determinate Of Health Contributing To A Family Health Status

The health model is used to create a relevant and viable family-centered health promotion. The steps to achieve the desired outcome are described in detail. Appropriate strategies for communication with the family are clearly presented. The health promotion is well-designed and demonstrates an ability to assimilate findings and appropriately apply theoretical knowledge to achieve desired outcomes.

Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear. Social Determinate Of Health Contributing To A Family Health Status

Clear and convincing argument that presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.

Writer is clearly in command of standard, written, academic English. All format elements are correct. Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error. Social Determinate Of Health Contributing To A Family Health Status

Strengths Finder self assessment

From self assessment below ,please give 
a brief description of your results from the Strengths Finder assessment Below. Then, briefly describe two core values, two strengths, and two characteristics that you would like to strengthen based on the results of your Strengths Finder assessment. Be specific.  In addition,

Do you believe you have the traits to be an effective leader? Perhaps you are already in a supervisory role, but as has been discussed previously, appointment does not guarantee leadership skills.

How can you evaluate your own leadership skills and behaviors from the assessment that you completed? And please identify your personal strengths, which have been shown to improve motivation, engagement, and academic self-conference. Strengths Finder self assessment. Through this assessment, you will discover your top five themes—which you can reflect upon and use to leverage your talents for optimal success and examine how the results relate to your leadership traits. In addition,
RANK
 
STRENGTH

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1Individualization

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RELATIONSHIP BUILDING

People who are especially talented in the Individualization theme are intrigued with the unique qualities of each person. They have a gift for figuring out how people who are different can work together productively.

2Ideation

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STRATEGIC THINKING

People who are especially talented in the Ideation theme are fascinated by ideas. They are able to find connections between seemingly disparate phenomena. Strengths Finder self assessment

3Achiever

People who are especially talented in the Achiever theme have a great deal of stamina and work hard. They take great satisfaction from being busy and productive.

4

Competition

People who are especially talented in the Competition theme measure their progress against the performance of others. They strive to win first place and revel in contests.

5Learner

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STRATEGIC THINKING

People who are especially talented in the Learner theme have a great desire to learn and want to continuously improve. In particular, the process of learning, rather than the outcome, excites them. Strengths Finder self assessment

Therapeutic assessment interview

Identify an older adult age 65 +, use a 1st and last initial. Execute a therapeutic assessment interview with them for at least two interview sessions assessing their self-identified:

·  Demographics, life time education and career/employment

·  Two most significant (positive) times in their lives

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·  What past hardship or loss has the client successfully negotiated in the past?

·  Two personal strengths Therapeutic assessment interview

·  Engage them in identifying what is healthy versus non-healthy coping skills

·  Inquire of 2 healthy coping skills they have used in the past and/or now

·  Three (3) pieces of advice they would give to their younger self if they could?

·  Support the client in taking the 
Geriatric Depression Scale.pdf

·  Support the client in taking the 
Fulmer SPICES Assessment.pdf

·  Perform a 
Mini Mental State Exam.pdf
 and 
Patient_Stress_Questionnaire.pdf
 (attach here)

·  Perform a 
Hall, Hall, and Chapman Article.pdf

·  Report the findings from the Geriatric Depression Scale, Fulmer Spices, Patient stress questionnaire and the mini mental status exam

·  Discuss your older adult’s level of ego integrity vs. despair as described by psychoanalyst Erik Erikson. If you had to rate them on a scale of 1-10, with 1 representing a full state of despair and 10 representing full ego integrity, what rating would you give your older adult?

·  Describe at least two nursing diagnoses for this client. Therapeutic assessment interview

·  Create a plan of care for the client to include at least three nursing goals with two nursing interventions each.

The assignment should be written in an APA-formatted essay. The essay should be at least 1500 words in length and include at least two scholarly sources other than provided materials. Therapeutic assessment interview

Health Delivery System Competencies Reflection Sample essays

Week 8: ReflectionReflect back over the past eight weeks and describe how the achievement of the course outcomes in this course have prepared you to meet the MSN program outcome #4, the MSN Essential IV, and the Nurse Practitioner Core Competencies # 7.

Program Outcome #4
:  Integrate professional values through scholarship and service in health care. (Professional identity)

MSN Essential IV:
Translating and Integrating Scholarship into Practice Recognize that the master’s-prepared nurse applies research outcomes within the practice setting, resolves practice problems, works as a change agent, and disseminates results.

Nurse Practitioner Core Competencies # 7

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Health Delivery System Competencies

Applies knowledge of organizational practices and complex systems to improve health care delivery.

Effects health care change using broad based skills including negotiating, consensus-building, and

partnering.

Minimizes risk to patients and providers at the individual and systems level.

Facilitates the development of health care systems that address the needs of culturally diverse

Health Delivery System Competencies Reflection Sample essays

populations, providers, and other stakeholders.

Evaluates the impact of health care delivery on patients, providers, other stakeholders, and the

environment.

Analyzes organizational structure, functions and resources to improve the delivery of care.

Collaborates in planning for transitions across the continuum of care.

In the past seven weeks, this course has taught me important concepts that enhance my understanding in the health promotion of numerous conditions affecting the primary care setting. We learned to optimize one’s health through disease prevention and treatment implementation for neurological issues, pulmonary conditions, cardiovascular and hematological problems, mental health, and inflammatory disorders. This course has helped me achieve the master’s program outcome number four, the Master’s Essential IV, and the Nurse Practitioner Core Competency number seven competency. Health Delivery System Competencies Reflection Sample essays

 

Master’s Program Outcome #4:
Integrating professional values via scholarship and the provision of service in healthcare

 

In this course, we achieved the program’s outcome of professional identity by analyzing how primary care practice is organized and influenced by ethical, legal, economic, and political factors (Chamberlain University, 2019). Through evaluation of clinical cases and research, I was able to integrate professional values and thus, develop professional identity as a family nurse practitioner (FNP). The professional core values of a nurse practitioner was not only learned in theory, but implemented in practice as well. Integrating the professional core values of compassion, trustworthiness, and  accountability in clinical practice helped further my development of professionalism and my identity as a FNP. One instance in which I had exposure to this outcome was during my clinical rotation when I addressed a young female with bulimia nervosa disorder. It was evident that she was extremely anxious and expressed concern about her body image and eating habits. It was important to allow her to openly communicate about her emotions. While it was difficult to address all of her concerns in a time-constraint environment, I did the best I could to provide compassion and give her ample time to talk and ask questions about her treatment plan. Developing the trust and respect between myself and the patient was critical in optimizing her health outcome. Another instance that helped achieve this particular outcome was in the implementation of treatment plans for patients who struggled to obtain proper services in healthcare. During my clinical rotations, I had a patient who had multiple comorbidities and came in with a chief complaint of constipation. Through imaging, she was found to have bile duct cancer and had issues getting an initial evaluation appointment with an oncologist. Instead of placing another referral that would take a significant amount of time to address the patient’s issue, we placed a call to an oncologist colleague to expedite the care and accommodate for the patient. Furthermore, she was also counseled and supported with financial resources.

 

Master’s Essential IV:
Transforming and incorporating scholarship into practice

 

The Master’s Essential IV of transforming and incorporating scholarship into practice was also met during this course through interdisciplinary team participation, application of research outcomes within the primary care setting, dissemination of research results, and utilization of practice guidelines to improve health outcomes (American Association of Colleges of Nursing [AACN], 2011). This particular master’s essential was heavily emphasized throughout this course by using reliable sources of information, applying national guidelines, and integrating clinical judgment and perspectives of other professionals for treatment plans of various illnesses (AACN, 2011). For example, we applied different evidence-based clinical guidelines to help formulate treatment plans for patients in the weekly discussion posts. Case studies of different illnesses, such as pulmonary, cardiovascular, and mental health disorders, during week 2 and 3 were heavily discussed and supported with the latest recommendations of scholarly research, as well as national treatment guidelines from healthcare associations and governmental agencies, including the American Heart Association, the Centers for Disease Control and Prevention, and the American Psychological Association. Applying these practice guidelines to improve practice fulfilled incorporating scholarship into the primary care practice. This master’s essential was also fulfilled in a second example during week 6 where we were assigned mental health disorder case studies to present. Various mental health disorders were discussed and supported by reliable sources and each peer took on a leadership position to facilitate the discussion throughout the week. As leader of an assigned topic, I responded to peers and demonstrated my knowledge of the mental health disorder through discussion of hallmark symptoms, diagnostic tools, and treatment plans while acknowledging results and conclusions of others. This example fulfilled knowledge and research dissemination to enhance health outcomes for each case study patient and incorporate scholarship into clinical practice.

 

Nurse Practitioner Core Competency #7:
Health Delivery System Competencies

 

Lastly, the nurse practitioner core competency #7, which was established by the National Organization of Nurse Practitioner Faculties (NONPF), focuses on the competencies related to health delivery systems. This competency involves the application of knowledge generated from organizational practices, the support of healthcare needs of culturally diverse populations, the impact of healthcare change, the organizational structure of the healthcare system, and the collaboration in the continuity of care (NONPF, 2017). This competency was achieved in the clinical rotation by supporting continuity of care and incorporating cultural competence in the primary care office. For example, I saw an elderly male patient in the clinical rotation with complaints of hematuria intermittently for the past three weeks. The patient had not established care with a primary care provider in many years. We obtained a urine sample, which showed frank blood. The patient required a higher level of care and was subsequently referred to the nearest ER. We were able to call the facility and give report to the receiving physician. The patient was then evaluated emergently. This example demonstrated the process of collaborating and planning for transitions across the healthcare continuum. Health Delivery System Competencies Reflection Sample essays. The second example of achieving this competency deals with cultural competence in healthcare. In the clinical rotation, I saw a young Hispanic female patient who had depression and an eating disorder. Her mother had brought her into the office, but they both primarily spoke Spanish. The office generally does not have a high Hispanic population, but we had interpreter services to help facilitate the visitation. We were able to utilize the interpreter services to help formulate a treatment plan for the patient, as well as discuss her emotions with her mother. The goal of culturally competent healthcare care services is to provide the highest quality of care to every patient, regardless of race, ethnicity, cultural background, and English proficiency. Both the patient and her mother were very appreciative for taking the time to address their concerns. This example demonstrated support of healthcare needs of culturally diverse populations. Therefore, the accomplishment of outcomes in this course helped me prepare to meet the program’s outcome number four, the master’s Essential IV, and the NONPF competency number seven. Health Delivery System Competencies Reflection Sample essays.

References

American Association of Colleges of Nursing. (2011). The essentials of master’s education in nursing
.
Retrieved from http://www.aacnnursing.org/Portals/42/Publications/MastersEssentials11.pdf

Chamberlain University. (2019). Academic catalog 2019-2020
.
Retrieved from https://www.chamberlain.edu/docs/default-source/academics-admissions/catalog.pdf

National Organization of Nurse Practitioner Faculties. (2017). Nurse practitioner core competencies content
.
Retrieved from Health Delivery System Competencies Reflection Sample essayshttps://cdn.ymaws.com/www.nonpf.org/resource/resmgr/competencies/2017_NPCoreComps_with_Curric.pdf

 
After reflecting over the course of Advanced Clinical Diagnosis and Practice Across the Lifespan, the student identified achievements of the course outcomes.  This course had a few specific areas that the student reflected on that assisted her in preparing for the Master of Science program outcome #4, the Master of Science in Nursing (MSN) Essential IV, and the Nurse Practitioner Core Competency #7.

The professional outcome #4 is to “Integrate professional values through scholarship and service in health care.”  This outcome was achieved by taking the week 4 APEA predictor exam.  As the student studied for the exam, she identified several areas of improvement. Health Delivery System Competencies Reflection Sample essays  By reviewing a wide knowledge base of concepts seen in the primary care setting the student was to identify her areas of strengths and weaknesses.  The test was broken down into categories and assisted the student to find her professional identity.  Another way the student found her professional identity was through clinicals.  The preceptor pushed autonomy and let the student formulate the treatment plan while she would offer suggestions and advice.  The student realized that in a few short months that she would be in practice with varying levels of guidance depending on job location. The student identified her professional identity in the clinic which will aide her in her next rotation and future practice.

The MSN Essential IV is “Translating and integrating scholarship into practice recognize that the master’s prepared nurse applies research outcomes within the practice setting, resolves practice problems, works as a change agent, and disseminates results.” Health Delivery System Competencies Reflection Sample essays.  Over the course, the student achieved the MSN Essential IV by discussion in week 6 mental health presentation and in the clinical setting.  The student is accustomed to seeing a lot of mental health patients but sometimes has difficulty categorizing the present illness.  The week 6 presentation allowed each student to formulate a patient scenario with a diagnosis provided by the instructor.  The student saw how mental illness was related, but also how it differed form patient to patient.  This assignment assisted the student in identifying patient’s chief complaints, differentiate from different ailments, educate and act as a change agent, and evaluate results over time.  In the clinical setting, the student was able to educate teens about IUDs.  The NP she followed at the FQHC would insert IUDs that lasted for 5 years for $20.  Many teenage girls would come to the clinic and admit to being sexually active without the use of protection or teenagers that already had a few kids would come in asking for birth control options.  The student felt as if she was able to minimize teenage pregnancy or unwanted pregnancies by providing patients with the appropriate knowledge and offer an affordable pregnancy prevention method. Health Delivery System Competencies Reflection Sample essays.

The Nurse Practitioner Core Competency #7 is geared towards Health Delivery System Competencies.  In the course, the students were exposed to case studies, expected to formulate case studies, and created diagnoses based upon case studies other students provided.  The different levels and dynamics of the case studies opened up opportunities for the student to review articles, clinical practice guidelines, and the most up-to-date information for each disease process.  Real-life scenarios allowed the student to apply practice knowledge to complex systems and improve healthcare outcomes.  In the clinic setting, the student had many Hispanic patients who were Spanish speaking only.  This opened up a concept of culturally diverse patients and populations.  The student learned that diabetes is common amongst the Hispanic race related to their culturally diverse diet and heritage.  The student incorporated a sliding scale pay plan to make it affordable for the patients, utilized an on-site translator, and reviewed costs of medications to ensure the patient would pick up the prescription and adhere to the treatment plan.  The FQHC clinic allowed for the student to identify the organizational structure, function, and resources available for these types of low socioeconomic patient classes. Health Delivery System Competencies Reflection Sample essays

Thank you,

NURS 4005/4006 Week 5 Assignment: Dashboard Analysis and Nursing Plan Essay

Dashboard Analysis and Nursing Plan

 
In order for health care facilities to enhance and improve the care they deliver to their patients, they rely on data collected within their facility and from surveys sent out to patients. The information collected is formatted into a quarterly dashboard where goals are set for each quality indicator and then interpreted if the facility met those goals. Through the use of dashboards and quality indicators proactive decisions can be made based on actual events occurring, rather than changing the plan of care based on assumptions. The dashboard is effective in determining particular areas in which improvements would be beneficial to not only the care of the patient but the overall morale of the health care facility. The dashboard is also helpful in strategic planning, where the assessment of performance can be undertaken (Tomlinson, Hewitt, & Blackshaw, 2013). The overall objective of this paper is to analyze areas where the facility excels, and determining a plan of action to improve negative performance by utilizing evidenced based practice. NURS 4005/4006 Week 5 Assignment: Dashboard Analysis and Nursing Plan Essay.

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After carefully analyzing the data presented in this week’s dashboard, communication between the nurses and the patients excels. Nurses develop a good rapport with the majority of their patients and give thorough explanations of the care provided. However, their promptness and attention to detail needs to be an area addressed to improve patient outcomes. Thus, could also be the result of negative data reflected on the dashboard that represents patient safety measures such as falls, pressure ulcers, mislabeled specimens and uncontrolled pain. Patient safety is crucial in the plan of care and if not carefully addressed could lead to adverse events and outcomes.

Paying attention to details is important for avoiding errors, maintaining efficiency, preventing injuries, making a good impression and analyzing information. Attention to detail improves accuracy in performing tasks. Preventing errors is valuable when providing care to all patients. Careful management of details contributes to overall efficiency and success in the healthcare facility. Reducing errors also contributes to patient satisfaction. By developing a nurse-patient relationship you are able to address needs and concerns of the patient, as well as pick up on detail-oriented cues that will need implemented for each individual patient in order to maintain a balance of trust and communication during the patients stay.

Attention of detail leads to patient safety. Patient safety throughout the hospital should be developed by the leadership. Leadership assumes a role in establishing a culture of safety that minimizes hazards and patient harm by focusing on processes of care. The leaders of the organization are responsible for fostering an environment through their personal example; emphasizing patient safety as an organizational priority; providing education to medical and hospital staff regarding the commitment to reduction of medical errors; supporting proactive reduction in medical/health care errors; and integrating patient safety priorities into the new design and redesign of all relevant organization processes, functions and services (IHI, 2017).

There are many quality indicators that fall into the category of patient safety such as:  medication errors or adverse events, pressure ulcers, falls, restraint use, nosocomial infections, VTE, etc. Various tools can be set in place to ensure adequate monitoring of these areas to protect the patients and the facility. Conducting a thorough head-to-toe physical examination on admission is a high priority. Patients come into the hospital and we treat their presenting symptoms, however many times there may be an underlining problem that needs addressed to ensure an optimal outcome and patient experience. A full physical assessment gives you a thorough picture of the patient’s condition.

Best practice would be to conduct a fall risk assessment and a skin risk assessment on each patient every shift or as needed if there has been a change in the patient’s condition. With a fall risk assessment, it can determine what interventions need put in place to ensure patients are free from physical injury while in our care. The fall risk assessment we use at our facility is similar to the one presented by John Hopkins, called the JHFRAT (Hopkins Medicine, 2017). The fall risk assessment tool addresses various patient safety indicators such as: age, history of falls within 6 months, elimination of bowel and bladder (incontinence, urgency or frequency), medications (PCA/opiates, anticonvulsants, antihypertensive, diuretics, hypnotics, laxatives, sedatives, psychotropic, etc.), use of patient care equipment (IV infusion, chest tube, indwelling catheter, SCDs, etc.), mobility (unsteady gait or needs assistance), sensations (decrease in hearing, vision, etc.), and cognition (impulsive behavior, sedation, or altered mental status). If the patient scores greater than 6 then they are required to wear fall risk socks, fall risk bracelet, and bed/chair alarms are put in place. This is a great tool as we can reassess it multiple times throughout the day to ensure the safety of the patient and decrease the rate of falls on our dashboard to improve quality indicators. It also shows the patients that we are concerned for their safety and are putting all measures of safety in place to ensure a positive outcome.

Another best practice tool we can utilize would be the skin risk assessment to prevent and manage pressure ulcers. The Braden Scale for predicting pressure sore risk is a clinically validated tool that allows nurses and other health care providers to reliably score a patient/client’s level of risk for developing pressure ulcers. It measures functional capabilities of the patient that contribute to either higher intensity and duration of pressure or lower tissue tolerance for pressure. Lower levels of functioning indicate higher levels of risk for pressure ulcer development (NLM, 2013). The Braden Scale uses various categories to determine the patient’s skin risk such as: sensory perception (ability to respond meaningfully to pressure-related discomfort), moisture (degree to which skin is exposed to moisture), physical activity (degree of physical activity), mobility (ability to change and control body positions), nutrition (usual food intake pattern), and friction and shear risk. NURS 4005/4006 Week 5 Assignment: Dashboard Analysis and Nursing Plan Essay. A score of 18 or below alerts the nurse that the patient may be at risk for pressure areas, a score 9 or less determines that the patient is high risk. Interventions should be put in place to prevent pressure ulcers for at risk patients. The nurses should be required to inspect patients skin each shift, manage moisture on the skin, conduct a skin risk assessment each shift or as needed if there is a change in the patient’s condition, minimize pressure to bony prominence by reposition patient every 1-2 hours, increasing nutrition intake and hydration (if the patient is unable to consume these orally then intravenous methods need to be implemented). By completing each of these steps for all patients it will prevent secondary diagnosis and prolonging of patient stay. Maintaining skin integrity will increase the patient’s outcome and satisfaction. NURS 4005/4006 Week 5 Assignment: Dashboard Analysis and Nursing Plan Essay.

Through the use of quality indicators and data collection we have the ability to improve our patient satisfaction and the care we deliver on a daily basis. By utilizing best practices to maintain patient safety and recognizing the needs and concerns of our patients we can achieve high standards. We must realize though that perfect scores across the dashboard is unrealistic. Health care and evidenced-based practices are always changes and the care we are providing is becoming more acute. By continuing our education and having our patient’s safety as our number one priority we will continue to excel in the health care continuum. NURS 4005/4006 Week 5 Assignment: Dashboard Analysis and Nursing Plan Essay

 

References

Tomlinson, P., Hewitt, S., & Blackshaw, N. (2013). Joining up health and planning: How Joint Strategic Needs Assessment (JSNA) can inform health and wellbeing strategies and spatial planning. Perspectives In Public Health, 133(5), 254-262. Retrieved from:
http://dx.doi.org/10.1177/1757913913488331

Institute for Healthcare Improvement. (2017). Patient Safety Plan. St. Francis Health System: St. Joseph Medical Center. Bloomington, Illinois. Retrieved from:
http://www.ihi.org/resources/Pages/Tools/PatientSafetyPlan.aspx

Hopkins Medicine. (2017). Fall Risk Assessment: JHFRAT. The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System. Retrieved from:
http://www.hopkinsmedicine.org/institute_nursing/models_tools/fall_risk.html

National Library of Medication. (2013). Braden Scale. National Institutes of Health, Health & Human Services. Retrieved from:
https://www.nlm.nih.gov/research/umls/sourcereleasedocs/current/LNC_BRADEN/
  NURS 4005/4006 Week 5 Assignment: Dashboard Analysis and Nursing Plan Essay