Category: Nursing

Delirium Patients in the ICU Research Paper Assignment

Please follow the grading rubric. The paper should be 900 words APA format, based on the attached outline, and about the subject mentioned in the PICO question. The outline and annotated bibliography documents from down below will help you write this paper with ease.

You have to be very specific to the PICO question!

P:
 Adult critical care patients.

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I:
 Implement policies and interventions to reduce and eliminate ICU delirium.

C:
 Patients who are not on sedation drugs in the ICU.

O:
 Decrease the incidence or even eliminate delirium in ICU patients and decrease the length of stay of patients in the ICU.

PICO Question

Does limited use of sedation drugs with limited length of stay in critical care reduce delirium in critically ill patients compared to patient who are not on sedation drugs in the ICU?

NURS 6990-D02 Middle Tennessee State University

OUTLINE – Research Paper on Delirium Patients in the ICU Assignment

Effect of Limited Sedation on Delirium

Introduction

Delirium is a primary adverse event in ventilated patients who receive long-term treatment.

Too much sedation is associated with a longer duration of mechanical ventilation and a longer intensive care unit (ICU) stay. Delirium Patients in the ICU Research Paper Assignment.

Limited sedation may reduce these adverse effects.

Previous studies demonstrated that patients under mechanical ventilation exhibit a higher risk of experiencing delirium than non-mechanically ventilated patients.

This study will evaluate risk factors for delirium in limited sedation patients

Methods

Patients

In this planned study patients will be selected from a previous study

Patients who underwent sequential sedation will be enrolled.

Clinical Data
. Patient demographic characteristics included age, gender, body mass index (BMI), allergic history, drinking and smoking status, and medical history, including the presence or absence of hypertension. Delirium Patients in the ICU Research Paper Assignment.

Delirium Assessment.
 The primary endpoint of this study will be the occurrence of delirium.

Statistical Analysis.
 Statistical analyses were performed using SPSS

Results

Table will be used to presents demographic data and baseline characteristics of patients with or without delirium.

Data will be used to evaluate risk factors for delirium in sequential sedation patients

Univariate and multivariate Cox proportional hazards regressions will be used to predict risk factors.

Clinical data will include the use of sedative and analgesic medications, mechanical ventilation status, and sequential sedation characteristics.

It will involve Delirium Assessment among the patients.

The results of this study should demonstrate that sequential sedation with dexmedetomidine was a protective method to prevent delirium. Delirium Patients in the ICU Research Paper Assignment.

Results should show that management strategies may sometimes require alteration to reduce the incidence and severity of delirium in sequential sedation patients.

Conclusion:

The results used demonstrated that limited sedation is a protective method to prevent delirium.

Results should suggest that management strategies may sometimes require alteration to reduce the incidence and severity of delirium in sequential sedation patients.

Research Paper on Delirium Patients in the ICU Assignment References

Djaiani, G., Silverton, N., Fedorko, L., Carroll, J., Styra, R., Rao, V., & Katznelson, R. (2016). Dexmedetomidine versus propofol sedation reduces delirium after cardiac surgery a randomized controlled trial. 
Anesthesiology: The Journal of the American Society of Anesthesiologists
, 
124
(2), 362-368.

Jackson, P., & Khan, A. (2015). Delirium in critically ill patients. 
Critical care clinics
, 
31
(3), 589-603.

Lee, J., Choi, S., Park, Y., Lee, C. H., Lee, S. M., Yim, J. J., … & Kim, Y. (2017). C53 CRITICAL CARE: DELIRIUM AND THE EXPECTED AND UNEXPECTED CONSEQUENCES OF SEDATION/ANALGESIA IN THE ICU: Effect of Recent Alcohol, Smoking and Psychotropic Drug Use on Delirium In ICU. 
American Journal of Respiratory and Critical Care Medicine
, 
195
.

Lee, J., Choi, S., Park, Y., Lee, C. H., Lee, S. M., Yim, J. J., … & Kim, Y. (2017). C53 CRITICAL CARE: DELIRIUM AND THE EXPECTED AND UNEXPECTED CONSEQUENCES OF SEDATION/ANALGESIA IN THE ICU: Effect of Recent Alcohol, Smoking and Psychotropic Drug Use on Delirium In ICU. 
American Journal of Respiratory and Critical Care Medicine
, 
195
.

Lyons, P. G., Snyder, A. M., Edelson, D. P., Mokhlesi, B., & Churpek, M. M. (2016). C50 CRITICAL CARE: DELIRIUM AND SEDATION IN THE ICU: The Association Between Opioid and Benzodiazepine Use on Clinical Deterioration in Hospitalized Patients on The Wards. 
American Journal of Respiratory and Critical Care Medicine
, 
193
, 1. Delirium Patients in the ICU Research Paper Assignment.

Lyons, P. G., Snyder, A. M., Edelson, D. P., Mokhlesi, B., & Churpek, M. M. (2016). C50 CRITICAL CARE: DELIRIUM AND SEDATION IN THE ICU: The Association Between Opioid and Benzodiazepine Use on Clinical Deterioration in Hospitalized Patients On The Wards. 
American Journal of Respiratory and Critical Care Medicine
, 
193
, 1.

Salluh, J. I., Wang, H., Schneider, E. B., Nagaraja, N., Yenokyan, G., Damluji, A., … & Stevens, R. D. (2015). Outcome of delirium in critically ill patients: systematic review and meta-analysis. 
bmj
, 
350
, h2538.

Traube, C., Silver, G., Reeder, R. W., Doyle, H., Hegel, E., Wolfe, H. A., … & Buttram, S. D. (2017). Pediatric delirium in critically-ill children: An international point prevalence study. 
Critical care medicine
, 
45
(4), 584.

Vallabhajosyula, S., Kanmanthareddy, A., Morrow, L. E., & Esterbrooks, D. J. (2016). C50 CRITICAL CARE: DELIRIUM AND SEDATION IN THE ICU: Role Of Statins in Delirium Prevention In Critically Ill And Cardiovascular Surgery Patients: A Meta-Analysis. 
American Journal of Respiratory and Critical Care Medicine
, 
193
, 1.

Search Methods Draft

Scholarly Synthesis

NURS 6990-D02

Spring 2019

NURS 6990 Scholarly Synthesis

Search activity

My research question:

 

In critically ill patients in the ICU (P), with limited use of sedation drugs (I), compared to not using sedation drugs (C), reduce delirium (P)?

Places to search for information:

 

School online library, and google scholar Delirium Patients in the ICU Research Paper Assignment

List of sources searched:

Date of search

Search strategy used, including any limits

Total number of results found

Comments

1.      Lee, J., Choi, S., Park, Y., Lee, C. H., Lee, S. M., Yim, J. J., … & Kim, Y. (2017). C53 CRITICAL CARE: DELIRIUM AND THE EXPECTED AND UNEXPECTED CONSEQUENCES OF SEDATION/ANALGESIA IN THE ICU: Effect of Recent Alcohol, Smoking and Psychotropic Drug Use on Delirium In ICU. 
American Journal of Respiratory and Critical Care Medicine
, 
195
.2.      Lyons, P. G., Snyder, A. M., Edelson, D. P., Mokhlesi, B., & Churpek, M. M. (2016). C50 CRITICAL CARE: DELIRIUM AND SEDATION IN THE ICU: The Association Between Opioid and Benzodiazepine Use on Clinical Deterioration in Hospitalized Patients On The Wards. 
American Journal of Respiratory and Critical Care Medicine
, 
193
, 1.

3.      Djaiani, G., Silverton, N., Fedorko, L., Carroll, J., Styra, R., Rao, V., & Katznelson, R. (2016). Dexmedetomidine versus propofol sedation reduces delirium after cardiac surgery, a randomized controlled trial. 
Anesthesiology: The Journal of the American Society of Anesthesiologists
, 
124
(2), 362-368.

 

13 February 2019

Boolean operators

Delirium Patients in the ICU Research Paper Assignment

15,700

 Using the AND operator was very useful in narrowing the research to only include sedation use and delirium.

1.      Salluh, J. I., Wang, H., Schneider, E. B., Nagaraja, N., Yenokyan, G., Damluji, A., … & Stevens, R. D. (2015). Outcome of delirium in critically ill patients: systematic review and meta-analysis. 
bmj
, 
350
, h2538.2.      Vallabhajosyula, S., Kanmanthareddy, A., Morrow, L. E., & Esterbrooks, D. J. (2016). C50 CRITICAL CARE: DELIRIUM AND SEDATION IN THE ICU: Role of Statins in Delirium Prevention in Critically Ill and Cardiovascular Surgery Patients: A Meta-Analysis. 
American Journal of Respiratory and Critical Care Medicine
, 
193
, 1.

13 Feb 2019

Truncation

15, 000

 This strategy was useful in restricting the search to a word stem.

 

Delirium Patients in the ICU Research Paper Assignment

1.      Lyons, P. G., Snyder, A. M., Edelson, D. P., Mokhlesi, B., & Churpek, M. M. (2016). C50 CRITICAL CARE: DELIRIUM AND SEDATION IN THE ICU: The Association Between Opioid And2.       Benzodiazepine Use on Clinical Deterioration in Hospitalized Patients on The Wards. 
American Journal of Respiratory and Critical Care Medicine
, 
193
, 1.

3.      Lee, J., Choi, S., Park, Y., Lee, C. H., Lee, S. M., Yim, J. J., … & Kim, Y. (2017). C53 CRITICAL CARE: DELIRIUM AND THE EXPECTED AND UNEXPECTED CONSEQUENCES OF SEDATION/ANALGESIA IN THE ICU: Effect of Recent Alcohol, Smoking and Psychotropic Drug Use on Delirium In ICU. 
American Journal of Respiratory and Critical Care Medicine
, 
195
.

14 Feb. 2019

Parentheses

15,600 

 This strategical was helpful in making the search logical by pacing sedation use and delirium appear on the same search.

1.      Jackson, P., & Khan, A. (2015). Delirium in critically ill patients. 
Critical care clinics
, 
31
(3), 589-603.2.      Traube, C., Silver, G., Reeder, R. W., Doyle, H., Hegel, E., Wolfe, H. A., … & Buttram, S. D. (2017). Pediatric delirium in critically-ill children: An international point prevalence study. 
Critical care medicine
, 
45
(4), 584.

14 Feb 2019

 

Delirium Patients in the ICU Research Paper Assignment

NURS 4315 Senior Practicum Poster Board Presentation

Practicum Project Presentation

Topic:
 Patient Safety: FALLS

Topics to focus on:

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Define fall.

Types of falls (fall are categorized as)

Injury levels are categorized as

Risk factors.

Hester Davis Fall Prevention Program

What can staff members do to prevent falls?

What can patients do to prevent falls?

Cost of falls according to CMS

Info about standard room with a fall mat

1 fact about Posey belt (such as used when a patient is up; quick release belt)

ORDER NOW FOR A COMPLETE, ORIGINAL ORDER on NURS 4315 Senior Practicum Poster Board Presentation

Hey! I have the rubric, topic and specific information to focus on, and some sources I found with some good information . I would like for the I highlighted areas to be included, most it is important. If you can please make me a poster presentation example along with an outline of the information like you did the last project that would be great. Thank you!

Attachment preview
Poster Board Presentation

Grading Rubric

NURS 4315 Senior Practicum

Grading Criteria

Points

Poster Board Presentation:

APA format (6th edition). Presentations should follow guidelines for research presentation in APA format. A minimum of three (3) to five (5) scholarly references should be cited internally within the presentation as needed as well as on the reference page. Plagiarism will result in an automatic deduction of all points in this area. NURS 4315 Senior Practicum Poster Board Presentation. Presentations should be presented on a tri-fold poster board.

/10

Topic to be decided by student and nurse manager or nurse educator. Submit topics via the assignment folder in D2L by March 11, 2019.

/15

Healthcare topic researched thoroughly.

/15

Presentation:

Briefly discuss the areas of the topic as if you were presenting in front of

an audience.

/10

Creativity

/30

Presentation should scholarly and meet the criteria of the manager or educator. Content should be organized according to the flow. Be sure show your presentation to faculty before turning it in to the unit. Due to clinical faculty no later than April 8, 2019. NURS 4315 Senior Practicum Poster Board Presentation

/20

Total Possible Points

/100

Spring 2019

Poster Board Presentation

Grading Rubric

NURS 4315 Senior Practicum

Grading Criteria

Points

Poster Board Presentation:

APA format (6th edition). Presentations should follow guidelines for research presentation in APA format. A minimum of three (3) to five (5) scholarly references should be cited internally within the presentation as needed as well as on the reference page. Plagiarism will result in an automatic deduction of all points in this area. Presentations should be presented on a tri-fold poster board.

          /10

Topic to be decided by student and nurse manager or nurse educator. Submit topics via the assignment folder in D2L by March 11, 2019.

          /15

Healthcare topic researched thoroughly.

           /15

Presentation:

Briefly discuss the areas of the topic as if you were presenting in front ofan audience.

NURS 4315 Senior Practicum Poster Board Presentation

/10

Creativity

/30

Presentation should scholarly and meet the criteria of the manager or educator. Content should be organized according to the flow. Be sure show your presentation to faculty before turning it in to the unit. Due to clinical faculty no later than April 8, 2019.

/20

 

Total Possible Points
 

/100

Spring NURS 4315 Senior Practicum Poster Board Presentation

Academic Success Professional Development Plan Part 1 Network Success

Academic Success and Professional Development Plan

Part 1: Developing an Academic and Professional Network

When was the last time you read 
Devotions Upon Emergent Occasions and Several Steps in my Sickness—Meditation XVII
?

Unless you are a student of 17th-century poetry, you may not be all that familiar with this piece by author John Donne. However, you may be much more familiar with one of its well-known phrases: “No man is an island.”

As you begin your journey toward achieving your academic and professional goals, you have a great opportunity to network with academics and professionals who can help ensure you do not travel alone. This network can help to clarify your own vision for success and can help guide you now and in the future. To paraphrase Donne, no one is an island. Academic Success Professional Development Plan.

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Begin creating an academic and professional network by identifying which academic and professional connections and resources you need to collaborate with to be successful in your MSN program and as a practicing nurse.

To Prepare:

Consider individuals, departments, teams, and/or resources within Walden University and within your profession that you believe can support your academic and professional success.

Identify at least two academic and at least two professional individuals, colleagues, or teams to collaborate with to help you be successful in your MSN program and as a practicing nurse.

Download the 
Academic Success and Professional Development Plan Template
.

The Assignment:

(I AM AN RN CURRENTLY ENROLLED IN THE PSYCH NURSE PRACTITIONER PROGRAM I HAVE BEEN A NURSE SINCE 2011 MARRIED WITH 4 KIDS IN KANSAS) PLEASE ASK ME MORE QUESTIONS AS NEEDED.

Academic and Professional Network

Complete Part 1 of your 
Academic Success and Professional Development Plan Template
. Be sure to address the following:

Identify 
at least two
 academic and 
at least two
 professional individuals or teams to collaborate with to be successful in your MSN program and as a practicing nurse.

Explain why you selected these individuals and/or teams and how they will support your success in the MSN program and as a practicing nurse Academic Success Professional Development Plan.

Academic and Professional Success Plan Template

 
Prepared by:

 

This document is to be used for 
NURS 6002 Foundations of Graduate Study
 to complete Assessments 1-6. Just as importantly the document serves to organize your thoughts about planning for your academic and professional success.

For specific instructions see the weekly assessment details in the course, or ask your instructor for further guidance.

Week 1
|
Part 1
:
My Academic and Professional Network

I have identified and secured the participation of the following
academic (at least two) and professional
(at least two) individuals and/or teams to form the basis of my network.
This network
will help me to clarify my vision for success and will help guide me now and in the future.

Directions: Complete the information below for each member of your network. For more than four entries repeat the items below with details of your additional network member(s) in the ‘ADDITIONAL NETWORK MEMBERS’ section. Academic Success Professional Development Plan.

NETWORK MEMBER 1

 
Name:

Title:

Organization:

Academic or Professional:

Why I selected this individual and/or team and how they will support my success in the MSN program and as a practicing nurse:

Notes:

NETWORK MEMBER 2

 
Name:

Title:

Organization:

Academic or Professional:

Why I selected this individual and/or team and how they will support my success in the MSN program and as a practicing nurse:

Notes:

NETWORK MEMBER 3

 

Name:

 

 

Title:

 

 

Organization:

 

 

Academic or Professional:

 

 

Why I selected this individual and/or team and how they will support my success in the MSN program and as a practicing nurse:

 

Notes:

 

 

NETWORK MEMBER 4

 

Name:

 

 

Title:

 

 

Organization:

 

 

Academic or Professional:

 

 

Why I selected this individual and/or team and how they will support my success in the MSN program and as a practicing nurse:

 

Notes:

 

 

 

ADDITIONAL NETWORK MEMBERS

 

 

Week 2 | Part 2:
Academic Resources and Strategies

 

I have identified the following
academic resources
and/or
strategies
that can be applied to success in the nursing practice in general or my specialty in particular.

 

Directions: In the space below Identify and describe 
at least three academic resources
 or strategies that can be applied to the MSN program, and 
at least three
 
professional resources
 that can be applied to success in the nursing practice in general or your specialty in particular. For each, explain how you intend to use these resources, and how they might benefit you academically and professionally.

 

 

Academic Resource/Strategy
 1

 

 

 

 

Academic Resource/Strategy
 2

 

 

 

 

Academic Resource/Strategy
 3

 

 

 

 

Professional Resource/Strategy
 1

 

 

 

Professional Resource/Strategy
 2

 

 

 

Professional Resource/Strategy
 3

 

 

 

 

ADDITIONAL RESOURCES/STRATEGIES

 

 

 

 

 

Week 3 | Part 3: 
Strategies to Promote Academic Integrity and Professional Ethics

 

I have analyzed the
relationship between academic integrity and writing
, as well as the relationship between professional practices and scholarly ethics. I have also identified strategies I intend to pursue to maintain integrity and ethics of my academic work while a student of the MSN program, as well as my professional work as a nurse throughout my career. The results of these efforts are shared below.

 

Directions: In the space below craft your analysis/writing sample, including Part 1 (The Connection Between 
Academic and Professional Integrity) and Part 2 (Strategies for Maintaining Integrity of Work).

 

 

Part 1: Writing Sample:
The Connection Between Academic and Professional Integrity

 

In the space below write a 2- 3-paragraph analysis that includes the following:

 

Explanation for the relationship between academic integrity and writing

Explanation for the relationship between professional practices and scholarly ethics

Cite at least 2 resources that support your arguments, being sure to use proper APA formatting.

Use Grammarly and SafeAssign to improve the product.

Explain how Grammarly, Safe Assign, and paraphrasing contributes to academic integrity Academic Success Professional Development Plan.

 

PART 2: Strategies for Maintaining Integrity of Work

Expand on your thoughts from Part 1 by:

Identifying and describing strategies you intend to pursue to maintain integrity and ethics of your 1) academic work while a student of the MSN program, and 2) professional work as a nurse throughout your career. Include a review of resources and approaches you propose to use as a student and a professional.

 

Week 4 | Part 4: 
Research Analysis

I have identified one topic of interest for further study. I have researched and identified one peer-reviewed research article focused on this topic and have analyzed this article.  The results of these efforts are shared below.

Directions: Complete Step 1 by using the table and subsequent space below identify and analyze the research article you have selected. Complete Step 2 by summarizing in 2-3 paragraphs the results of your analysis using the space identified.

Step 1:
Research Analysis

Complete the table below

Topic of Interest:

 

Research Article:
Include full citation in APA format, as well as link or search details (such as DOI)

Academic Success Professional Development Plan

Professional Practice Use:
One or more professional practice uses of the theories/concepts presented in the article

Research Analysis Matrix
Add more rows if necessary

Strengths of the Research

Limitations of the Research

Relevancy to Topic of Interest

Notes

 

Step 2: Summary of Analysis

Craft a summary (2-3 paragraph) below that includes the following:

Describe your approach to identifying and analyzing peer-reviewed research

Identify at least two strategies that you would use that you found to be effective in finding peer-reviewed research

Identify at least one resource you intend to use in the future to find peer-reviewed research

 

Week 5 | Part 5: 
Professional Development

 

I have developed a curriculum vitae to capture my academic and professional accomplishments to date. I have also developed a statement identifying one or more professional development goals, and a statement proposing how I might align one or more of these professional development goals with the University’s emphasis on social change.

 

The results of my efforts are below.

 

Directions: Complete Step 1 by developing (or copying and pasting) a curriculum vitae (CV) in the space provided. Complete Step 2 by completing a statement identifying your professional development goals space identified. Complete Step 3 by writing a statement proposing how you might align one or more of your professional development goals with the University’s emphasis on social change.

Step 1: Curriculum Vitae (CV)

Use the space below to write your CV based on your current education and professional background. Alternatively, you may write this in a separate document and copy/paste the results below.

NOTE: If needed there are a variety of online resources available with tips and samples of graduate nurse CVs. Academic Success Professional Development Plan.

Step 2: Professional Development Goals

Use the space below to write a statement identifying your professional development goals.

Step 3: Alignment with Social Change

Use the space below to write a statement proposing how you might align one or more of your professional development goals with the University’s emphasis on social change.

Week 6 | Part 6: 
Finalizing the Plan

I have considered various options for my nursing specialty, including a close look at my selected (or currently preferred) specialty and second-preferred specialty.  I have also developed a justification of my selected (or preferred) specialty. Lastly, I have examined one professional organization related to my selected or preferred specialty and considered how I can become a member of this organization.

The results of my efforts are below.

Directions: Complete Step 1 by writing 2-3 paragraphs in the space below comparing the nursing specialty you have selected – or the one you prefer if your choice is still under consideration –  to your second preference. Identify each specialty and describe the focus and the role that graduates are prepared for. Identify any other differentiators you feel are significant, especially those that helped or may help you reach a decision.

Complete Step 2 by writing a paragraph identifying and justifying your reasons for choosing your MSN specialization. Be sure to incorporate any feedback you received from colleagues in this week’s Discussion Forum.

Complete Step 3 by examining and identifying one professional organization related to your selected or preferred specialty. Explain how you can become a member of this organization.

Step 1: Comparison of Nursing Specialties

Use the space below to write 2-3 paragraphs comparing the nursing specialty you have selected – or the one you prefer if your choice is still under consideration –  to your second preference. Identify each specialty and describe the focus and the role that graduates are prepared for. Identify any other differentiators you feel are significant, especially those that helped or may help you reach a decision. Academic Success Professional Development Plan.

Step 2: Justification of Nursing Specialty

Use the space below to write a paragraph identifying and justifying your reasons for choosing your MSN specialization. Be sure to incorporate any feedback you received from colleagues in this week’s Discussion Forum.

Step 3: Professional Organizations

Use the space below to identify and examine one professional organization related to your selected or preferred specialty. Explain how you can become a member of this organization. Academic Success Professional Development Plan.

– END –

National Patient Safety Goals Sample Essay Assignment

Please write the paper on the topic : Prevent pressure ulcers in long term care

Use the attached Nursing Journals articles for references

Provide in text citation

Assignment instructions are on the attached document. you can also follow the youtube link for more explanation

National patient safety goal Written assignment instructions.pptx

Here’s the link to the recorded instructions (about 7 minutes)

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National Patient Safety Goals Assignment

N U TR ITIO N Nutrition and pressure ulcers: putting evidence into practice Carolyn Taylor Nutritional intake can have an effect on many areas of a patient’s health, while malnutrition specifically has a recognised role in pressure ulcer development. In this article, the author looks at whether there is any high quality evidence to recommend specific nutritional measures when trying to prevent pressure ulcers, as well as looking at overall recommendations for malnourished patients. Nutritional screening remains essential to help identify those patients most at risk of malnutrition and allows community nurses to prepare nutritional care plans and begin to correct any nutritional deficiencies. National Patient Safety Goals Sample Essay Assignment. The author recommends that community nurses perform nutritional screening at any patient contact, be that in hospital, nursing home or in the patient’s own home. Recording the outcome of screening at regular intervals also helps to identify trends in a patient’s nutritional state and means that any reduction will be picked up quickly. KEYWORDS: Nutrition ■ Wounds ■ Dietitian ■ Malnutrition ■ Screening ressure ulcer treatment — and crucially prevention — has become a key focus for improving the quality of health care. Most pressure ulcers are now considered avoidable and consequently prevention has been included in domain 5 of the NHS Outcome Framework (Department of Health [DH], 2014), which has a stated aim of: ‘Treating and caring for people in a safe environment and protecting them from avoidable harm.’ P There is also a financial burden to consider, with pressure ulcers costing the NHS £1.4-2.lbn per year (Bennett et al, 2004), with category four pressure ulcers costing approximately £14,108 per patient (Dealey et al, 2012). The cost to Carolyn Taylor, research coordinator for combined community and acute care group; specialist dietitian, Dietetic Department, Northern General Hospital, Sheffield Teaching Hospital NHS Foundation Trust 38 JCN 2016, Vol 30, No 4 patients in terms of quality of life is also significant, with pressure ulcers affecting people’s ability to work and maintain independence. Any treatment that reduces the costly, painful and debilitating effect of pressure ulcers must be considered and the National Institute for Health and Care Excellence (NICE, 2014) recently released updated guidance on the prevention and management of pressure ulcers; in conjunction with this guidance, the NICE Quality Standards for pressure ulcers also highlight where improvements in patient care can be made and in particular what factors will prevent the development of pressure ulcers (NICE, 2015). A good nutritional status and fluid intake have always been considered important to both the prevention and management of pressure ulcers (Posthauer et al, 2015), and reference is made to the importance of nutritional status and nutritional intake throughout the recent NICE (2014) guidance. This is also highlighted in the quality standards (NICE, 2015), which repeatedly mention malnutrition as one of the risk factors for pressure ulcer development. Further evidence for the role of nutrition is provided by a recently updated Cochrane review into the specific role of nutrition in the prevention and management of pressure ulcers (Langer and Fink, 2014). While the Cochrane review showed much of the evidence to be of poor quality, it did demonstrate that nutritional supplements could reduce the development of pressure ulcers, although not to a significant level. The evidence that nutritional supplements could contribute to the healing of pressure ulcers was also of poor quality and difficult to draw conclusions from, although Langer and Fink (2014) specifically mentioned that there was emerging evidence that supplementing diet with the amino acid arginine (thought to become essential following trauma) may improve healing rates, although further research is required. While the evidence was found to be generally poor, Langer and Fink (2014) stated that it is still important to correct any nutritional deficiencies. This article reviews the current guidance relating to nutrition and how it affects the development of pressure ulcers, before considering how community nurses can put the recommendations into practice. N U TR ITIO N A N D PRESSURE ULCER PREVENTION Both of the NICE documents mentioned above (NICE, 2014; 2015), highlighted that malnutrition is one of the risk factors for pressure ulcer development. NUTRITION However, identifying malnutrition is difficult (Posthauer et al, 2015). While body weight is a factor in pressure ulcers, assessment is not straightforward, as being both underweight and overweight are known to increase the risk of pressure ulcer development. A low body weight (body mass index [BMI] of less than 18 Kg/m2) is associated with reduction in subcutaneous fat deposits, particularly over the bony prominences. National Patient Safety Goals Sample Essay Assignment. Underweight patients are also more likely to be eating insufficiently and not meeting the recommended daily amounts of macro and micronutrients, meaning that they may not be eating sufficient energy, protein, vitamins and minerals. Conversely, being overweight (BMI over 25 Kg/m2) can also increase the risk of pressure ulcers due to higher body weight and poor mobility. There is also no guarantee that an overweight person’s dietary intake is balanced — just because they are eating does not mean they are taking in the required micronutrients. Loss of body weight, irrespective of the person’s initial weight, and especially if it is sudden and unplanned, is also a contributing risk factor for pressure ulcer development. This weight loss could be associated with illness or changes in social situation such as recent bereavement. As well as causing a loss of appetite, illness can also result in increased levels of inflammatory markers, such as C-reactive protein, which is also a known risk factor for pressure ulcers (Posthauer et al, 2015); the associated production of cytokines also results in a rising demand for energy and protein. At a time when illness may cause patients to lose their appetite, this increased metabolic load increases the risk of skin breakdown or reduced healing as energy and protein reserves are targeted for use elsewhere. The loss of muscle mass associated with age (sarcopenia) can also be a risk factor for pressure ulcers, however, while sarcopenia may not be avoidable, illness, lack of 40 JCN 2016, Vol 30, No 4 appetite, and the malabsorption of nutrients from the gastrointestinal tract can exacerbate it. IDENTIFYING THOSE AT RISK OF MALNUTRITION Identifying a patient’s risk of malnutrition is vital and was supported by the NICE guidelines and quality standard (NICE, 2014; 2015).There is additional NICE guidance that recommends the use of validated screening tools for identifying risk of malnutrition (NICE, 2012), which is also recommended by the National Pressure Ulcer Advisory Panel (NPUAP, 2014). The tool most frequently used is the Malnutrition Universal Screening Tool (MUST) (Todorvic et al, 2003), where patients are’scored’based on BMI, unintentional weight loss and any acute illness. MUST, therefore, relies on measuring the amount of weight the patient has lost, but this may be more difficult in those with limited mobility. In nursing and residential care, monitoring the weight of those patients with mobility issues can be made easier by creative use of equipment: ► Asking the patient to sit on scales ► Attaching scales to hoists when moving patients ► Using medical beds that incorporate a facility for weighing the patient. For patients at home, options for assessing weight change and risk of malnutrition include the following (Taylor, 2014): ► Measuring waist circumference, although this may be more difficult if a patient is unable to stand ► Measuring the patient’s arm circumference, although correlation may be affected by any pre-existing physical issues such as arm paralysis ► Hand-grip measurements can also be used as there is some correlation between declining strength and nutritional state (Flood et al, 2014) ► The physical Took’of the patient ► The fit of the patient’s clothes, i.e. are they loose? ► Fit of dentures —■the gum line will recede with weight loss National Patient Safety Goals Sample Essay Assignment► Patient-reported lethargy ► Deteriorating skin condition or a non-healing pressure ulcer. The NICE (2015) quality standards recommended identifying pressure ulcer risk factors for all patients referred to community services and on admission to any healthcare setting. The guidelines also highlight that, along with assessing all risk factors, nutritional screening using a validated screening tool should be included and become part of routine care. As Posthauer et al (2015) suggested, early identification of malnutrition or risk of malnutrition can ensure that treatment begins quickly and will help prevent pressure ulcers developing as well as contributing to healing. For those patients not identified as being at risk of malnutrition, both a Cochrane review (Langer and Fink, 2014) and the NICE (2014) guidance highlighted that there was no specific evidence to recommend additional nutritional treatment to prevent pressure ulcers. In other words, if people are well nourished then increasing their nutritional intake to prevent pressure ulcers occurring is not recommended — only if they are malnourished can nutritional measures reduce the risk. HYDRATION There is limited evidence on how hydration affects pressure ulcer development and the recommendation is to ensure that the patient’s hydration status is adequate (NICE, 2014). Despite the lack of evidence in this area, dehydration is commonly accepted to affect skin turgor (the degree of elasticity of skin); in the author’s opinion it follows that this would increase the risk of pressure ulcers. All fluid losses, including urine, diarrhoea, excessive sweating, losses from pressure ulcers or other wounds, and stoma or fistula outputs, need to be accounted for. Fluid requirements will increase in certain circumstances such as fever and increased respiratory effort, while there will be excessive losses with NUTRITION S u d d e n loss o f b o d y w e ig h t Community nurses should be aware that loss of body weight, irrespective of the person’s initial weight, and especially if it is sudden and unplanned, is a contributing risk factor for pressure ulcer development. diarrhoea, vomiting and in people with wounds who will lose fluid through exudate leakage. While fluid requirements may reduce in the older population, their reduced thirst and anxiety about maintaining continence may reduce their desire to drink, thus making dehydration a risk in this population; similarly, the use of diuretics for the management of other long-term conditions such as heart failure and high blood pressure may increase fluid loss. NUTRITION AND PRESSURE ULCER MANAGEMENT There have been some studies into the effect of nutritional supplements on the treatment of pressure ulcers, however, these were generally of low quality, making specific recommendations difficult (NICE, 2014). National Patient Safety Goals Sample Essay Assignment The majority of research was associated with the use of oral nutritional supplements; either generic oral nutritional supplements, which contain a mixture of macro and micronutrients, or those containing specific amino acids or vitamins. In the NICE (2014) guidance, consideration was given to the costbenefit of nutritional supplements. In view of the inconclusive evidence around their use, and the cost of many of the generic oral nutritional supplements when used in the community (as opposed to in hospital where they are often negotiated at a contract price), the recommendation was that they should not be routinely used in the treatment of pressure ulcers when the patient’s nutritional intake is otherwise adequate. 42 JCN 2016, Voi 30, No 4 However, the guidance also stated that nurses should seek to correct any nutritional deficiency a patient may have, which may involve using nutritional supplements. For those with inadequate nutritional intake or poor nutritional status, a’food-first’ approach should be used to increase intake (the use of high energy and high protein foods often considered the more palatable and cost-effective way of meeting requirements), however, if this is tried and the patient’s intake remains insufficient, nutritional supplements may be the next line of treatment. This means that, rather than routinely providing nutritional supplements to patients who have a pressure ulcer, nurses need to undertake a nutritional assessment to identify those at risk of malnutrition so that they can be given the specific advice required to improve their nutritional intake. If patients are considered to be at risk of malnutrition following an assessment, then nutritional action plans need to be implemented. A review of their dietary intake would help to begin a conversation about the types and variety of foods they are eating. Typical dietary aspects that would raise concern include: ► Meals being missed ► Repetitive meal choices with limited variation in ingredients ► Inability to recall a variety of different meals recently eaten ► Indications that patient may be using smaller plates. Specific nutrition a l e le m en ts Specific nutritional elements are considered to promote pressure ulcer repair, including protein (both whole proteins and specific amino acids), iron, zinc and vitamin C. As mentioned above, the Cochrane review (Langer and Fink, 2014) stated that good quality evidence for the routine supplementary use of these elements is lacking, although the authors did suggest that more recent research into the use of arginine in the treatment of pressure ulcers is worth further investigation, as indications are that it may be beneficial in improving healing rates (Desneves et al, 2005; Cereda et al, 2009; Van Anholt et al, 2010). THE SCIENCE — MALNUTRITION Malnutrition can be defined as a state of nutrition in which a deficiency or excess (or imbalance) of energy, protein and other nutrients causes measurable adverse effects both on tissue/ body form, body function, and clinical outcome (Elia, 2000). Malnutrition is a reversible risk factor for pressure ulcers in adults (NICE, 2014), therefore it is essential that all healthcare professionals are able to correctly identify those at risk early on and provide appropriate management. Nutritional screening should be implemented in all healthcare settings, particularly in the community where undernourished patients are harder to spot. National Patient Safety Goals Sample Essay Assignment. Studies have shown that up to 93% of malnourished people are living in the community and this continues to be a major clinical and public health problem in the UK (Elia, 2000; Elia and Russell, 2009). Source: Rabess C (2015) Understanding the link between wound care and nutrition. J Comm Nurs 29(4): 60-5 Practical m easures Despite the lack of evidence for the positive effect of specific nutritional elements on healing pressure ulcers, there are some practical suggestions that can help community nurses improve patient’s overall nutritional intake: ► For those with a small appetite, eating little and often is frequently recommended. By eating small amounts frequently it is possible to improve nutritional intake. It is important that high calorie snacks (chocolates, sweets and crisps, etc) do not replace more nutritious meals or highly Credit: epsosLX&flickr. com Red Flag NUTRITION ► ► ► ► nutritious snacks such as cheese and biscuits, full-fat yoghurts, fruitcake, teacakes, scones, crumpets, nuts and cereal bars So-called ‘milky’ drinks can help to improve protein intake. Cheese and cream can also be added to meals, for example cheese can be grated over mashed potatoes. This will not increase the volume of food eaten, but will make every mouthful more nourishing In patients who may struggle to prepare full meals,’ready meals’ can provide a nourishing alternative and can be easier for patients to access, especially if they are being advised to rest. There are also companies that will deliver meals to the patient’s home Frozen vegetables can help to add variety to meals — handfuls of different vegetables can be cooked in one meal Sandwiches, toast and jacket potatoes can all be nourishing when prepared with a variety of fillings or toppings. Local community and hospital dietetic departments will usually have patient literature available that covers these strategies. CONCLUSION While there is a lack of high quality evidence to recommend specific nutritional measures when trying to prevent pressure ulcers or promote ulcer healing in well-nourished patients, there are some consistent overall recommendations for malnourished patients. Nutritional screening remains essential to help identify those patients most at risk of malnutrition, which will allow community nurses to prepare appropriate nutritional care plans and begin to correct any nutritional deficiencies. It is recommended that community nurses should perform nutritional screening at any patient contact, be that in hospital, nursing home or in the patient’s own home. The NICE guidelines for nutritional support in adults recommend the use of a validated 44 JCN 2016, Vol 30, No 4 screening tool such as MUST (NICE, 2012), and this is now widely used as a simple measure for identifying patients at nutritional risk. Recording the outcome of these screening tools at regular intervals can help to identify trends in a patient’s nutritional state and mean that any reduction will be picked up quickly. Available online: www.nice.org.uk/ guidance/qs24/chapter/quality-statement1-screening-for-the-risk-of-malnutrition (accessed 23, March, 2016) NICE (2014) Pressure ulcers: prevention and management. Available online: www.nice. org.uk/guidance/cgl79 (accessed 24 June, 2016) NICE (2015) Pressure ulcers: NICE Quality Further research into the role of nutrition in promoting pressure ulcer healing is required. This is echoed by the James Lind Pressure Ulcer Partnership (www.jla.nihr.ac.uk), which has highlighted diet and pressure ulcer research as one of its key areas for further investigation. JCN REFERENCES Bennett G, Dealey C, Posnett J (2004) The cost of pressure ulcers in the UK. Age Ageing 33(3): 230-235 Cereda E, Gini A, Pedroli C,Vanotti A (2009) Disease-specific, versus standard, nutritional support for the treatment of pressure ulcers in institutionalized older adults: a randomised controlled trial. Geriatrics Society 57(8): 1395-1402 Dealey C, Posnett J, Walker A (2012) The cost of pressure ulcers in the United K ingdom./ Wound Care 21(6): 261-6 Desneves KJ,Todorovic BE, Cassar A, Crowe TC (2005) Treatment with supplementary Standards. Available online: www.nice.org. uk/guidance/qs89 (accessed 24 June, 2016) NPUAP (2014) Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline. Available online: http://www.npuap.org (accessed 24 June, 2016) Posthauer ME, Banks M, Dom er B & Schols, J (2015) The Role of Nutrition for Pressure Ulcer Management: NPUAP EPUAP, and Fhn Fhcific Pressure Injury Alliance White Paper. Adv Skin Wound Care 28(4): 175-88 Taylor C (2014) Looking at malnutrition from the patient’s perceptive. / Comm Nurs 28(2): 38-44 TodorvicV, Russell C, Elia M (2003) The M U S T ‘ Explanatory Booklet. A guide to the Malnutrition Universal Screening Tool’for Adults. Available online: www.bapen.org. uk (accessed 24 June, 2016) Van Anholt RD, Sobotka L, Meijer ER et al (2010) Specific nutritional support accelerates pressure ulcer healing and reduces wound care intensity in nonmalnourished patients Nutrition 26(9): arginine, vitamin C and zinc in patients with pressure ulcers: a randomised controlled trial. Clinical Nutrition 24(6): 979-87 DH (2014) The NHS Outcomes Framework 2014/15. Available online: www.gov.uk (accessed on 29 June, 2016) Elia M (2000) Guidelines for Detection. National Patient Safety Goals Sample Essay Assignment.

Episodic/Focused SOAP Note Template Sample Essay.

Episodic/Focused SOAP Note Template
 Assignment 1

Book: Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). 
Seidel’s guide to physical examination
 (8th ed.). St. Louis, MO: Elsevier Mosby.

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Format: 
Episodic/Focused SOAP Note format (sample attached)

Nausea and Vomiting

A 20-year-old female complains of nausea and has vomited three times over the past 48 hours. The patient also experienced a low-grade fever this morning. She states that she recently ate shellfish at a new restaurant with two friends who are suffering from similar symptoms. Episodic/Focused SOAP Note Template Sample Essay.

Post
 a description of the health history you would need to collect from the patient in the case study. Explain which physical exams and diagnostic tests would be appropriate and how the results would be used to make a diagnosis. List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each.

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Assignment 2

Book:Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). 
Pharmacotherapeutics for advanced practice: A practical approach
 (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.

Video:
 Laureate Education, Inc. (Executive Producer). (2012). Pharmacology for the gastrointestinal system. Baltimore, MD: Author.

This media presentation outlines drug treatment options for disorders of the gastrointestinal system. Episodic/Focused SOAP Note Template Sample Essay.

Note: The approximate length of this media piece is 2 minutes.

Format: fully detail discussion paper

Patient HL comes into the clinic with the following symptoms: nausea, vomiting, and diarrhea. The patient has a history of drug abuse and possible Hepatitis C. HL is currently taking the following prescription drugs:

Synthroid 100 mcg daily

Nifedipine 30 mg daily

Prednisone 10 mg daily

Reflect on the patient’s symptoms, medical history, and drugs currently prescribed.

Think about a possible diagnosis for the patient. Consider whether the patient has a disorder related to the gastrointestinal and hepatobiliary system or whether the symptoms are the result of a disorder from another system or other factors such as pregnancy, drugs, or a psychological disorder. Episodic/Focused SOAP Note Template Sample Essay.

Consider an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.

With these thoughts in mind:
Post
 an explanation of your diagnosis for the patient including your rationale for the diagnosis. Then, describe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.

Episodic/Focused SOAP Note Template SAMPLE Assignment 3

Book same as assignment 2

To prepare :

Review Chapter 49 of the Arcangelo and Peterson text, as well as the Krummenacher et al. and Scourfield articles in the Learning Resources.

Reflect on whether or not the prevalence of HIV cases might be attributed to increased complacency due to more advanced drug treatment options for HIV/AIDS.

Consider how health care professionals can help to change perceptions and make people more aware of the realities of the disease.

Think about strategies to educate HIV positive patients on medication adherence, as well as safe practices to reduce the risk of infecting others. Episodic/Focused SOAP Note Template Sample Essay.

With these thoughts in mind:

By Day 3

Post
 an explanation of whether or not you think the prevalence of HIV cases might be attributed to increased complacency due to more advanced drug treatment options.Then, explain how health care professionals can help to change perceptions and increase awareness of the realities of the disease. Finally, describe strategies to educate HIV positive patients on medication adherence, as well as safe practices to reduce the risk of infecting others.

Episodic/Focused SOAP Note Template
 SAMPLE

Patient Information:

Initials, Age, Sex, Race

S.

CC
(chief complaint) a BRIEF statement identifying why the patient is here – in the patient’s own words – for instance “headache”, NOT “bad headache for 3 days” Episodic/Focused SOAP Note Template Sample Essay.

HPI
: This is the symptom analysis section of your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis. Paint a picture of what is wrong with the patient. Use LOCATES Mnemonic to complete your HPI. You need to start EVERY HPI with age, race, and gender (e.g., 34-year-old AA male). You must include the seven attributes of each principal symptom in paragraph form not a list. If the CC was “headache”, the LOCATES for the HPI might look like the following example:

Location: head

Onset: 3 days ago

Character: pounding, pressure around the eyes and temples

Associated signs and symptoms: nausea, vomiting, photophobia, phonophobia

Timing: after being on the computer all day at work

Exacerbating/ relieving factors: light bothers eyes, Aleve makes it tolerable but not completely better

Severity: 7/10 pain scale

Current Medications
: include dosage, frequency, length of time used and reason for use; also include OTC or homeopathic products.

Allergies: 
include medication, food, and environmental allergies separately (a description of what the allergy is ie angioedema, anaphylaxis, etc. This will help determine a true reaction vs intolerance).

PMHx
: include immunization status (note date of 
last tetanus
 for all adults), past major illnesses and surgeries. Depending on the CC, more info is sometimes needed

Soc Hx
: include occupation and major hobbies, family status, tobacco & alcohol use (previous and current use), any other pertinent data. Always add some health promo question here – such as whether they use seat belts all the time or whether they have working smoke detectors in the house, living environment, text/cell phone use while driving, and support system.

Fam Hx
: illnesses with possible genetic predisposition, contagious or chronic illnesses. Reason for death of any deceased first degree relatives should be included. Include parents, grandparents, siblings, and children. Include grandchildren if pertinent.

ROS
: cover all body systems that may help you include or rule out a differential diagnosis You should list each system as follows: 
General:
 
Head
: 
EENT
: etc. You should list these in bullet format and document the systems in order from head to toe.

Example of Complete ROS:

GENERAL:  No weight loss, fever, chills, weakness or fatigue.

HEENT:  Eyes:  No visual loss, blurred vision, double vision or yellow sclerae. Ears, Nose, Throat:  No hearing loss, sneezing, congestion, runny nose or sore throat.

SKIN:  No rash or itching.

CARDIOVASCULAR:  No chest pain, chest pressure or chest discomfort. No palpitations or edema.

RESPIRATORY:  No shortness of breath, cough or sputum.

GASTROINTESTINAL:  No anorexia, nausea, vomiting or diarrhea. No abdominal pain or blood.

GENITOURINARY:  Burning on urination. Pregnancy. Last menstrual period, MM/DD/YYYY.

NEUROLOGICAL:  No headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control.

MUSCULOSKELETAL:  No muscle, back pain, joint pain or stiffness.

HEMATOLOGIC:  No anemia, bleeding or bruising.

LYMPHATICS:  No enlarged nodes. No history of splenectomy.

PSYCHIATRIC:  No history of depression or anxiety.

ENDOCRINOLOGIC:  No reports of sweating, cold or heat intolerance. No polyuria or polydipsia.

ALLERGIES:  No history of asthma, hives, eczema or rhinitis. Episodic/Focused SOAP Note Template Sample Essay.

O.

Physical exam
: From head-to-toe, include what you see, hear, and feel when doing your physical exam. You only need to examine the systems that are pertinent to the CC, HPI, and History. 
Do not use “WNL” or “normal.” You must describe what you see. 
Always document in head to toe format i.e. General: Head: EENT: etc.

Diagnostic results
: Include any labs, x-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidenced and guidelines)

A
.

Differential Diagnoses 
(list a minimum of 3 differential diagnoses).Your primary or presumptive diagnosis should be at the top of the list. For each diagnosis, provide supportive documentation with evidence based guidelines.

This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.

Episodic/Focused SOAP Note Template
 References

You are required to include at least three evidence based peer-reviewed journal articles or evidenced based guidelines which relates to this case to support your diagnostics and differentials diagnoses. Be sure to use correct APA 6
th
 edition formatting.

ExampleFocused SOAP Note for a patient with chest pain

S.

CC: “Chest pain”

HPI: The patient is a 65 year old AA male who developed sudden onset of chest pain, which began early this morning.  The pain is described as “crushing” and is rated nine out of 10 in terms of intensity. The pain is located in the middle of the chest and is accompanied by shortness of breath. The patient reports feeling nauseous. The patient tried an antacid with minimal relief of his symptoms.

PMH: Positive history of GERD and hypertension is controlled

FH: Mother died at 78 of breast cancer; Father at 75 of CVA.  No history of premature cardiovascular disease in first degree relatives.

SH : Negative for tobacco abuse, currently or previously; consumes moderate alcohol; married for 39 years

ROS

General
–Negative for fevers, chills, fatigue

Cardiovascular
–Negative for orthopnea, PND, positive for intermittent lower extremity edema

Gastrointestinal
–Positive for nausea without vomiting; negative for diarrhea, abdominal pain

Pulmonary
–Positive for intermittent dyspnea on exertion, negative for cough or hemoptysis Episodic/Focused SOAP Note Template Sample Essay.

 

O.

VS: BP 186/102; P 94; R 22; T 97.8; 02 96% Wt 235lbs; Ht 70”

 

General
–Pt appears diaphoretic and anxious

Cardiovascular
–PMI is in the 5th inter-costal space at the mid clavicular line. A grade 2/6 systolic decrescendo murmur is heard best at the

second right inter-costal space which radiates to the neck.

A third heard sound is heard at the apex. No fourth heart sound or rub are heard. No cyanosis, clubbing, noted, positive for bilateral 2+ LE edema is noted.

Gastrointestinal
–The abdomen is symmetrical without distention; bowel

sounds are normal in quality and intensity in all areas; a

bruit is heard in the right para-umbilical area. No masses or

splenomegaly are noted. Positive for mid-epigastric tenderness with deep palpation.

Pulmonary
— Lungs are clear to auscultation and percussion bilaterally

 

Diagnostic results: EKG, CXR, CK-MB (support with evidenced and guidelines)

 

A.

Differential Diagnosis:

1) Myocardial Infarction (provide supportive documentation with evidence based guidelines).

2) Angina (provide supportive documentation with evidence based guidelines).

3) Costochondritis (provide supportive documentation with evidence based guidelines).

Primary Diagnosis/Presumptive Diagnosis: Myocardial Infarction

Episodic/Focused SOAP Note Template Sample Essay

 

This section is not required for the assignments in this course (NURS 6512) but will be required for future courses. Episodic/Focused SOAP Note Template Sample Essay.

Application Assignment 2: Part 2 – Developing an Advocacy Campaign

To prepare:

Review Chapter 3 of Milstead, J. A. (2016). Health policy and politics: A nurse’s guide (5th ed.). Burlington, MA: Jones and Bartlett Publishers.

In the first assignment( HEALTH ADVOCACY CAMPAIGN DOCUMENT ATTACHED BELLOW), you reflected on whether the policy you would like to promote could best be achieved through the development of new legislation, or a change in an existing law or regulation. Refine as necessary using any feedback from your first Developing an Advocacy Campaign paper.

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Contemplate how existing laws or regulations may affect how you proceed in advocating for your proposed policy.

Consider how you could influence legislators or other policymakers to enact the policy you propose.

Think about the obstacles of the legislative process that may prevent your proposed policy from being implemented as intended. Developing an Advocacy Campaign.

To complete:

Part Two will have approximately 3–4 pages of content plus a title page and references. Part Two will address the following:

Explain whether your proposed policy could be enacted through a modification of existing law or regulation or the creation of new legislation/regulation.

Explain how existing laws or regulations could affect your advocacy efforts. Be sure to cite and reference the laws and regulations using primary sources. Developing an Advocacy Campaign.

Provide an analysis of the methods you could use to influence legislators or other policymakers to support your policy. In particular, explain how you would use the “three legs” of lobbying in your advocacy efforts.

Summarize obstacles that could arise in the legislative process and how to overcome these hurdles.

Paste the rubric at the end of your Developing an Advocacy Campaign paper.

Assessing Clients With Addictive Disorders

Addictive disorders can be particularly challenging for clients. Not only do these disorders typically interfere with a client’s ability to function in daily life, but they also often manifest as negative and sometimes criminal behaviors. Sometime clients with addictive disorders also suffer from other mental health issues, creating even greater struggles for them to overcome. In your role, you have the opportunity to help clients address their addictions and improve outcomes for both the clients and their families. For this Assignment, as you examine the 
Levy Family
 video in this week’s Learning Resources, consider how you might assess and treat clients presenting with addiction.

N: B EACH OF THE 5 EPISODES TO WATCH (REQIURED MEDIA) FOR THIS ASSIGNGMENT IS DOWNLOADEDN IN WORD FORMAT AS A TRANSCRIPT AND ATTACHED TO THIS ASSIGNMENT. 

Learning Objectives

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Students will:

· Assess clients presenting with addictive disorders

· Analyze therapeutic approaches for treating clients with addictive disorders

· Evaluate outcomes for clients with addictive disorders

To prepare:

· Review this week’s Learning Resources and consider the insights they provide.

· Review the 
Levy Family
video Episodes 1 through 5. Assessing Clients With Addictive Disorders

The Assessing Clients With Addictive Disorders Assignment

In a 2- to 3-page paper, address the following:

· After watching Episode 1, describe:

o What is Mr. Levy’s perception of the problem?

o What is Mrs. Levy’s perception of the problem?

o What can be some of the implications of the problem on the family as a whole?

· After watching Episode 2, describe:

o What did you think of Mr. Levy’s social worker’s ideas?

o What were your thoughts of her supervisor’s questions about her suggested therapies and his advice to Mr. Levy’s supervisor? Assessing Clients With Addictive Disorders

· After watching Episode 3, discuss the following:

o What were your thoughts about the way Mr. Levy’s therapist responded to what Mr. Levy had to say?

o What were your impressions of how the therapist worked with Mr. Levy? What did you think about the therapy session as a whole?

o Informed by your knowledge of pathophysiology, explain the physiology of deep breathing (a common technique that we use in helping clients to manage anxiety). Explain how changing breathing mechanics can alter blood chemistry.

o Describe the therapeutic approach his therapist selected. Would you use exposure therapy with Mr. Levy? Why or why not? What evidence exists to support the use of exposure therapy (or the therapeutic approach you would consider if you disagree with exposure therapy)?

· In Episode 4, Mr. Levy tells a very difficult story about Kurt, his platoon officer.

o Discuss how you would have responded to this revelation. Assessing Clients With Addictive Disorders

o Describe how this information would inform your therapeutic approach. What would you say/do next?

· In Episode 5, Mr. Levy’s therapist is having issues with his story.

o Imagine that you were providing supervision to this therapist, how would you respond to her concerns?

· Support your approach with evidence-based literature. AND INCLUDE INTRODUCTION, CONCLUSION WITH REFERENCES.

Required Readings

Wheeler, K. (Ed.). (2014). 
Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice
 (2nd ed.). New York, NY: Springer Publishing Company.

Chapter 7, “Motivational Interviewing” (pp. 299–312)

Chapter      16, “Psychotherapeutic Approaches for Addictions and Related Disorders”      (pp. 565–596)

American Psychiatric Association. (2013). 
Diagnostic and statistical manual of mental disorders
(5th ed.). Washington, DC: Author. Assessing Clients With Addictive Disorders

Albrecht, U., Kirschner, N. E., & Grusser, S. M. (2007). Diagnostic instruments for behavioral addiction: An overview. 
German Medical Science Psycho-Social-Medicine
, 4, 1–11. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2736529/

Fisher, M. A. (2016). The ethical ABCs of conditional confidentiality. In 
Confidentiality limits in psychotherapy: Ethics checklists for mental health professionals
 (pp. 13–25). Washington, DC: American Psychological Association. doi:10.1037/14860-002

Required Media
 

N: B EACH OF THE 5 EPISODES TO WATCH (REQIURED MEDIA) FOR THIS ASSIGNGMENT IS DOWNLOADEDN IN WORD FORMAT AS A TRANSCRIPT AND ATTACHED TO THIS ASSIGNMENT. 

Laureate Education (Producer). (2013c). 
Levy family: Episodes 1
 [Video file]. Baltimore, MD: Author.

Note: 
The approximate length of this media piece is 2 minutes.

Laureate Education (Producer). (2013c). 
Levy family: Episodes 2
 [Video file]. Baltimore, MD: Author.

Note: 
The approximate length of this media piece is 2 minutes.

Laureate Education (Producer). (2013c). 
Levy family: Episodes 3
 [Video file]. Baltimore, MD: Author.

Note: 
The approximate length of this media piece is 6 minutes.

Laureate Education (Producer). (2013c). 
Levy family: Episodes 4
[Video file]. Baltimore, MD: Author. Assessing Clients With Addictive Disorders

Note: 
The approximate length of this media piece is 5 minutes.

Laureate Education (Producer). (2013c). 
Levy family: Episodes 5
 [Video file]. Baltimore, MD: Author.

Note: 
The approximate length of this media piece is 2 minutes.

Laureate Education (Producer). (2012c). 
In their own words
 [Video file]. Baltimore, MD: Author.

Note: 
The approximate length of this media piece is 23 minutes. Assessing Clients With Addictive Disorders.

In this Application of Theory Instructions Case Report assignment, learners are required to write a case report addressing the personal knowledge and skills gained in this course and potentially solving an identified practice problem.

General Guidelines:

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Use the following information to ensure successful completion of the assignment:

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center. This assignment requires that at least two additional scholarly research  sources related to this topic, and at least one in-text citation from each source be included. You are required to submit this Application of Theory Instructions Case Report assignment to Turnitin. Please refer to the  directions in the Student Success Center.

Directions:

Construct a 2,500-3,000-word (approximately 10-12 pages) case report that includes a problem or situation consistent with a DNP area of practice.

Requirements:

Use a minimum of any two theories discussed in the course to develop the case report.

Apply one or more theories to describe understanding of the problem or situation of focus.

Apply one or more theories to the recommended intervention or solution being proposed.

Develop the case report across the entire scenario from the identified clinical or health care problem through proposing an intervention, implementation, and evaluation using an appropriate research instrument. Application of Theory Instructions Case Report.

Describe the evaluation of the selected research instrument in the case report.

Lastly, explain in full the tenets, rationale for selection (empirical evidence), and clear application using the language of the theory within the case report.

In addition, your case report must include the following:

Introduction with a problem statement.

Brief literature review.

Description of the case/situation/conditions explained from a theoretical perspective.

Discussion that includes a detailed explanation of the synthesized literature findings.

Summary of the case. Application of Theory Instructions Case Report.

Proposed solutions to remedy gaps, inefficiencies, or other issues from a theoretical approach.

Identification of a research instrument to evaluate the proposed solution along with a description of how the instrument could be evaluated.

Conclusion. Application of Theory Instructions Case Report.

Discussion: Professional Development and Certification Essay

Consider the following scenario:

Isabel recently earned certifications offered by the American Association of Critical Care Nurses and the American Organization of Nurse Executives for nurse managers and leaders. She was especially proud of this accomplishment and was confident it would serve her well as she continued her career. At a conference last week, she had found herself talking with a colleague about certification. To her surprise, her colleague suggested that she look into certification through the Project Management Institute. It had not occurred to Isabel that she might need or want that type of certification, but upon further reflection she could see how important it was to be able to manage projects effectively. Professional Development and Certification Essay. She wondered how pursuing this type of certification might further her professional development and lead to new opportunities down the road. At the very least, she decided it was worth exploring further.

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As you are aware, numerous nursing organizations offer opportunities for professional development, community service, and information gathering. There are also many certifications you can obtain through professional societies or organizations. Certifications recognize an individual’s specialty area knowledge and skills and can lead to professional empowerment. By obtaining certifications, you can help improve your quality of practice and increase your earning potential. Professional Development and Certification Essay.

In this Discussion, you consider development opportunities afforded through professional associations and examine how earning certifications can advance your career. Discussion: Professional Development and Certification

To prepare FOR Discussion: Professional Development and Certification:

Reflect on your professional goals. These goals may relate to the practicum professional development objectives you established in Week 1 (Document Attached), but you are encouraged to take a broader view of what you would like to accomplish in the immediate future, as well as five or 15 years from now. Identify at least one goal that is especially important to you.

Think about the benefits of becoming involved in professional organizations and obtaining certifications.

If you already have a specialty or clinical certification, reflect on how this has impacted the achievement of your professional goals thus far.

Review information about two or more of the professional organizations listed in the Learning Resources. Consider the following questions:

As you explore each organization’s website, review the mission, vision, and value statements. Also examine the strategic plan, if possible. How do these align with your interests and your professional goals? Professional Development and Certification Essay.

Investigate whether the organization offers networking opportunities with fellow professionals. Is there a local or regional chapter you could join?

What are the potential benefits of obtaining a certification through each organization? Examine the criteria for certification.

Evaluate your readiness and desire to become certified through each organization. What hesitations, if any, do you have?

How and why might this certification be useful to you and/or enhance your professional development? Professional Development and Certification Essay.

Post a description of one or more of your professional goals. Explain a certification provided by a professional organization that would be of interest to you. Explain how and why this additional certification would be useful to you and/or enhance your professional development. Evaluate your readiness to obtain this certification, noting any reservations you may have.

Read a selection of your colleagues’ responses.

Respond to at least two of your colleagues on two different days, using one or more of the following approaches:

Ask a probing question, substantiated with additional background information, evidence, or research. Professional Development and Certification Essay.

Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.

Validate an idea with your own experience and additional research.

Discussion: Professional Development and Certification Required Readings (Please use all references mentioned below)

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Reminder: Review resources from previous courses as necessary.

Shekleton, M. E., Preston, J. C., & Good, L. E. (2010). Growing leaders in a professional membership organization. Journal of Nursing Management, 18(6), 662–668.

Matthews, J. H. (2012). Role of professional organizations in advocating for the nursing profession. Online Journal of Issues in Nursing, 17(1), 1. Professional Development and Certification Essay.

Discussion: Professional Development and Certification Note: Retrieved from the Walden Library databases.

The author addresses the importance of involvement in professional organizations for nursing professionals.

Discussion: Professional Development and Certification Note: Retrieved from the Walden Library databases.

“In order to grow leaders an organization must make a commitment to develop and maintain an infrastructure that supports leadership development activities” (Shekleton, Preston, & Good, 2010, p. 667). The authors discuss findings from a leadership development program.

American Association of Critical Care Nurses. (n.d.). Certification for nurse managers and leaders. Retrieved May 20, 2013, from 
http://www.aacn.org/wd/certifications/content/cnmlhome.pcms?menu=certification

The American Association of Critical Care Nurses Certification Corporation, in collaboration with the AONE credentialing center, offers certification for the nurse leader-manager.

American Medical Informatics Association. (2011). Clinical informatics becomes a board-certified medical subspecialty following ABMS vote. Retrieved from 
http://www.amia.org/news-and-publications/press-release/ci-is-subspecialty

 
This article addresses the movement to recognize clinical informatics as a subspecialty.

American Nurses Association. (2013). Leadership. Retrieved from 
http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/Leadership

The ANA offers a leadership institute for professional development. Professional Development and Certification Essay.

American Nurses Credentialing Center. (2013). ANCC certification center. 
Retrieved from http://www.nursecredentialing.org/certification.aspx

The ANCC is the largest and most prestigious credentialing organization. View the certifications available by specialty area.

American Organization of Nurse Executives. (2012). AONE credentialing center. Retrieved from 
http://www.aone.org/resources/certification/about_certifications.shtml

The AONE credentialing center, in collaboration with American Association of Critical Care Nurses Certification Corporation, offers certification for the nurse leader-manager.

Healthcare Information and Management Systems. (2013). Health IT certifications. Retrieved from 
http://www.himss.org/health-it-certification?navItemNumber=13588

The Office of the National Coordinator for Health Information Technology has specified certification criteria for electronic health records. Professional Development and Certification Essay.

NMA. (2012). Welcome to NMA! Retrieved from 

Home

This organization promotes the development of leadership competencies and interpersonal skills.

Project Management Institute. (2013). What are PMI certifications? Retrieved from 
http://www.pmi.org/Certification/What-are-PMI-Certifications.aspx

PMI recognizes that many professionals of varying skill and education levels are or will be involved with projects. The organization offers certification for professionals involved in project management. Discussion: Professional Development and Certification. Professional Development and Certification Essay.

NR 443 Caring for Populations: Milestone 1: Community Windshield Survey Form

Directions: Please refer to the Milestone 1: Community Windshield Survey Guidelines and grading rubric found in Doc Sharing for specific instructions in order to complete the information below. This assignment is worth 150 points. NR 443 Caring for Populations: Milestone 1: Community Windshield Survey Form.

Type your name above and your answers below directly on this form. Click Save as and save the file with the assignment name and your last name (e.g., “NR443 Windshield Survey Form_Smith”). When you are finished, submit the form to the Week 2 Caring for Populations: Windshield Survey Dropbox by the deadline indicated in your guidelines.

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Criteria

Community introduction:

Identify the community you will be using for this assignment. It should be the area where you live or the area surrounding your work setting.

Windshield survey

vitality

Indicators of social and economic conditions

Health resources

Environmental conditions related to health

Social functioning

Attitude toward healthcare

Conclusion:

Provide a summary of your findings and your conclusion. What problems did you identify? NR 443 Caring for Populations: Milestone 1: Community Windshield Survey Form.

References:

OPTIONAL: List any references that you cited.

 

NR443 Guidelines for Caring for Populations

Milestone 2: Assessment and Diagnosis

Purpose

The purpose of this paper is to provide an opportunity to utilize community assessment strategies, uncover a community health problem, and identify the components of the problem related to the community dynamics. NR 443 Caring for Populations: Milestone 1: Community Windshield Survey Form.

Course Outcomes

This assignment enables the student to meet the following Course Outcomes.

CO 1. Evaluate the planning of delivery of care to individuals, families, aggregates, and communities in a variety of healthcare settings based on theories and principles of nursing and related disciplines. (PO 1)

CO2. Integrate clinical judgment in professional decision-making and implementation of the nursing process through analysis of community health nursing practice. (PO 4)

CO7. Accept accountability for personal and professional development as part of the life-long learning process. (PO 5) NR 443 Caring for Populations: Milestone 1: Community Windshield Survey Form.

This paper is expected to be no more than four pages in length (not including the title page and reference list). Typical papers are usually three pages. Below are the requirements for successful completion of this paper.

Introduction: This should catch the reader’s attention with interesting facts and supporting sources and include the purpose statement of the paper. This should be no more than one or two paragraphs.

Community: Identify the community by name that you will be using for this paper and provide a brief, general description of the community. Your community should be the area where you live or work. This should be one or two paragraphs. NR 443 Caring for Populations: Milestone 1: Community Windshield Survey Form.

Demographic and epidemiological data: Compile a range of demographic (population description) and epidemiological (causes of health problems and death) data for your community by examining census reports, vital statistic reports, city records, morbidity and mortality reports, and other agency sources. Using these data, describe the community and the problem. Compare your community data to state or national data. This comparison will help to identify a community health problem specific to your community. A summary of these data should beno more than one page.

Windshield survey: Provide a brief summary of the findings from your first assignment. Make sure to discuss elements that link your observations to your identified problem. This should be no more than one or two paragraphs.

Problem: Using the assessment data, identify the problem that you consider to be a priority concern. Provide a rationale for your choice and relate your choice to one of the Healthy People 2020 specific numbered objectives. Healthy People objectives are located within a topic area under the Objectives page. NR 443 Caring for Populations: Milestone 1: Community Windshield Survey Form. Your rationale should also include why this is specifically a problem in your community. This should be no more than three paragraphs. Include support of your rationale with at least two scholarly sources such as professional journal articles related to your problem.

Summary: The summary paragraph of your paper should include a statement about the problem, the population at risk for this problem, and the major direct or indirect factors that contribute to this problem. This information should be no more than one or two paragraphs.

Reference page: All references cited within the paper should be included on a separate References page.

Guidelines

Application: Use Microsoft Word 2010™ to create this assignment.

Use the categories above as APA headings for the sections of your paper.

Length: This paper is expected to be no more than four pages in length (not including the title page and reference list). Typical papers are three pages.

Submission: Submit your file via the basket in the Dropbox: Caring for Populations: Assessment and Diagnosis by 11:59 p.m. MT Sunday of Week 4.

Technical writing: APA format is required. Review APA tutorials in Doc Sharing and use the resources of Smarthinking for writing tutors.

Do not use first person (I, me, my, our) in this paper. Make the community the subject even in your windshield survey summary. NR 443 Caring for Populations: Milestone 1: Community Windshield Survey Form.

Save your paper with your last name in the document title (e.g., “Smith Assessment and Diagnosis”).

Late submission: See the course policy on late submissions.

Best Practices in Preparing the Paper

The following are best practices in preparing this project.

Complete the demographic, epidemiologic, and windshield survey prior to choosing a problem to focus on.

Choose a nursing problem specific to your community.

Make sure all elements of the paper are addressed and headings for each category are included.

Review directions thoroughly. NR 443 Caring for Populations: Milestone 1: Community Windshield Survey Form.

Cite all sources within the paper as well as on the References page.

Proofread prior to final submission.

Check for spelling and grammar errors prior to final submission.

Use the A column of the rubric below to ensure that you have included all the needed elements.

Abide by the CCN academic integrity policy.

NR 443 Milestone 3: Intervention and Evaluation

Purpose

The purpose of this PowerPoint presentation is to provide an opportunity to develop a community health nursing intervention and evaluation tool for your identified community health problem (described in Milestone 2: Assessment and Diagnosis) and identify the components of the nursing process as it applies to a community or population. NR 443 Caring for Populations: Milestone 1: Community Windshield Survey Form.

Course Outcomes

Scenario

You are a Community/Public Health Nurse (C/PHN) working in your setting of choice. You have identified a community health problem and have analyzed the data collected from your windshield survey and assessment & diagnosis assignments (the first two milestones). NR 443 Caring for Populations: Milestone 1: Community Windshield Survey Form. You have decided on one nursing intervention and need your organization’s approval for funding of this intervention. Your leadership team has agreed to listen to your proposal.

Directions

Choose a community health nurse setting. Some examples of settings are school nurse, parish nurse, home health nurse, nurse working in the health department (be specific to what area in the health department, e.g., WIC, STD clinic, health promotion, maternal-child health, etc.)

Introduction: Introduce the identified problem, the purpose of the presentation, and reiterate at least one or two important findings that demonstrate this problem in your community (average of 1–2 slides)

Proposed Intervention: Propose one community health nursingintervention that would address one or more of the major direct or indirect factors that contribute to the problem. Keep in mind the Public Health Intervention Wheel (Nies& McEwen, p. 14, figure 1-3) as your framework (average of 3-4 slides). NR 443 Caring for Populations: Milestone 1: Community Windshield Survey Form. Your intervention needs to be specific:

o Who is your target population?

o Where is this intervention taking place?

o Will it take place one time or multiple times?

o How will you reach out to your target population?

How will you get your target population involved?

o What is the CH Nurses role in this intervention?

o Will you collaborate with anyone (e.g., physician’s office, church, local resources, etc.?)

o Is anyone else involved besides yourself (C/PHN)? NR 443 Caring for Populations: Milestone 1: Community Windshield Survey Form.

If yes, are they paid or volunteers?

o What level(s) of prevention is your intervention addressing (primary, secondary and/or tertiary prevention)?

Intervention Justification: Justify why the problem and your nursing interventions should be a priority.

o Based on what you have found in the literature, discuss why these interventions are expected to be effective. Include summarized information from at least two professional scholarly sources related to your interventions (average of 2-3 slides). NR 443 Caring for Populations: Milestone 1: Community Windshield Survey Form.

Proposed Evaluation: Your presentation must include at least one proposed quantitative or qualitative evaluation method that you would use to determine whether your intervention is effective. It should include the method you would use along with desired outcomes. Outcome measurement is a crucial piece when implementing interventions. There is a helpful tool in Doc Sharing to assist you with understanding qualitative and quantitative methods of evaluation. (average of 2-3 slides)

o Include discussion about the long-term and short-term impact on your community if the intervention is successful. Keep in mind your desired outcomes when analyzing the evaluation.

Summary: The summary should reiterate the main points of the presentation and conclude with what you are asking to be accomplished, e.g., “Based on ABC, it is imperative our community has XYZ. Thank you for your consideration.” NR 443 Caring for Populations: Milestone 1: Community Windshield Survey Form.

In addition to the slides described above, your presentation should include a title slide, and reference slide. Remember, you are presenting to your leadership team, so the slides should include the most important elements for them to know in short bullet pointed phrases. You may add additional comments in the notes section to clarify information for your instructor.

Guidelines

Application: Use Microsoft PowerPoint 2010.

Length: The PowerPoint slide show is expected to be no more than 20 slides in length (not including the title slide and reference list slide).

Submission: Submit your files via the basket in the Dropbox: “Caring for Populations: Intervention and Evaluation” by 11:59 p.m. Sunday of Week 6. NR 443 Caring for Populations: Milestone 1: Community Windshield Survey Form.

Save the assignment with your last name in the file title. Example: “Smith Intervention and Evaluation”

Late Submission: See the course policy on late submissions.

Tutorial: If needed, Microsoft Office has many templates and tutorials to help you get started.

Best Practices in Preparing PowerPoint

The following are best practices in preparing this project:

Be creative, but realistic with your intervention and evaluation tool.

Incorporate graphics, clip art or photographs to increase interest.

Slides should be easy to read with short bullet points and large font.

Review directions thoroughly. NR 443 Caring for Populations: Milestone 1: Community Windshield Survey Form.

Cite all sources within the slide show as well as on the reference page.

Proofread prior to final submission.

Spell check for spelling and grammar errors prior to final submission.

Abide by the CCN academic integrity policy.

NR 443 Caring for Populations: Milestone 1: Community Windshield Survey Form