Category: Nursing

Assessing and Treating Pediatric Clients With Mood Disorders Essay Example

Therapy for Pediatric Clients with Mood Disorders

An African American Child Suffering From Depression

BACKGROUND INFORMATION

The client is an 8-year-old African American male who arrives at the ER with his mother. He is exhibiting signs of depression.

• Client complained of feeling “sad”

• Mother reports that teacher said child is withdrawn from peers in class

• Mother notes decreased appetite and occasional periods of irritation

• Client reached all developmental landmarks at appropriate ages

• Physical exam unremarkable

• Laboratory studies WNL

• Child referred to psychiatry for evaluation

• Client seen by Psychiatric Nurse Practitioner

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MENTAL STATUS EXAM

Alert & oriented X 3, speech clear, coherent, goal directed, spontaneous. Self-reported mood is “sad”. Affect somewhat blunted, but child smiled appropriately at various points throughout the clinical interview. He denies visual or auditory hallucinations. No delusional or paranoid thought processes noted. Judgment and insight appear to be age-appropriate. He is not endorsing active suicidal ideation but does admit that he often thinks about himself being dead and what it would be like to be dead. Assessing and Treating Pediatric Clients With Mood Disorders Essay Example.

The PMHNP administers the Children’s Depression Rating Scale, obtaining a score of 30 (indicating significant depression)

RESOURCES

§ Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale–Revised. Los Angeles, CA: Western Psychological Services.

Decision Point One

Select what the PMHNP should do:

Begin Zoloft 25 mg orally daily Begin Zoloft 25 mg orally daily

Begin P

Begin Paxil 10 mg orally daily

axil 10 mg orally daily

Begin Wellbutrin 75 mg orally BID Begin Wellbutrin 75 mg orally BID

Examine Case Study: An African American Child Suffering From Depression. 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.

• At each decision point stop to complete the following:

o Decision #1

 Which decision did you select? Assessing and Treating Pediatric Clients With Mood Disorders Essay Example.

 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?

o 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? Assessing and Treating Pediatric Clients With Mood Disorders Essay Example.

o 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?

• Also include how ethical considerations might impact your treatment plan and communication with clients.

Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.

The references should be within 5 years.

Clinical Scenario

This assignment involves a client who is 8 years old who is an African American male who presents at the Emergency Room with his mother. The client was exhibiting signs of depression and had complaints of feeling sad. The mother reportedly informed that the teacher had examined that the child was withdrawn from peers in class. Assessing and Treating Pediatric Clients With Mood Disorders Essay Example The mother had also noted that the child had a decreased appetite with occasional irritation periods despite reports that he had reached all landmarks of development at the appropriate ages. The physical examination was unremarkable while the laboratory studies WNL.

The mental status exam revealed that the client was alert and oriented X3, his speech was clear, coherent spontaneous and goal oriented. The client self-reported a sad mood and had an affect which was somewhat blunted. The client denied visual and auditory hallucinations and no delusional or paranoid processes of thought were noted Assessing and Treating Pediatric Clients With Mood Disorders Essay Example. The client also appeared to have an appropriate, did not endorse active suicidal ideation but admitted that he often thought about being dead and what it would feel like to be dead. In administering the Children’s Depression Rating Scale, a score of 30 was obtained, indicating the client had significant depression

Decision Point One

           
The primary mental nurse practitioner should begin Zoloft 25 mg orally daily. Zoloft is a selective serotonin reuptake inhibitor that is used as a first line drug for the management of major depressive disorder and other mental health disorders. It works by increasing the amount of serotonin in the brain to improve symptoms of anxiety and depression (Cummings, Caporino & Kendall, 2014).  Similarly, the client, in this case, had been diagnosed with major depression which required relevant medications.

With this medication, I was hopeful that the symptoms the client experienced a sad mood, a blunted affect and irritations would be done away with. Instead, he would have a happy mood, an increased appetite, a fluent affect and no thoughts about being dead. Zoloft helps to improve sleep, mood, appetite and the level of energy such that, the overall interest of an individual in daily life is restored (Cox, et al., 2014). It also influences a significant reduction in anxiety and thoughts that are unwanted.

Instead, the client returned to the clinic in four weeks, stating that, although he improved in terms of mood, appetite and other life’s aspects, he had frequent suicidal thoughts that negatively influenced his life in general. Despite being the first line of treatment for depression in children, Zoloft is known to increase suicidal behavior and thoughts in children, adolescents and even young adults (Cooper, et al., 2014).  This risk increases within the first few months of treatment or in case of dosage changes Assessing and Treating Pediatric Clients With Mood Disorders Essay Example. It is for this reason that it has a black box warning from the Food and Drug Administration to alert healthcare providers and patients on how dangerous some of the side effects of drugs may change. For patients already having suicidal behavior and thoughts, administering Zoloft is likely to worsen the situation as it is in this case (Cooper, et al., 2014). This means that to reduce these side effects, the dosage can be reduced. However, the effects of suicidal thoughts and behavior would still be existent. Therefore, the best option would be to stop the Zoloft 25 mg orally daily.

Decision 2

The second decision would be to begin praxis 10mg orally daily. Praxil is a selective serotonin reuptake inhibitor that is indicated for the management of depression. It functions by influencing chemical balance in the brain which is associated with anxiety and depression disorders (Walkup, 2017). Similarly, the client, in this case, had been diagnosed with depression and had experienced intense symptoms of mood changes, reduced appetite, and feelings similar to suicidal thoughts and behavior. Praxil has the ability of increased appetite, mood, level of energy and sleep and helps to reduce unwanted thoughts Assessing and Treating Pediatric Clients With Mood Disorders Essay Example. With this decision, it was certain that by administering praxil 10mg orally daily, the client would have no more negative symptoms of behavior, mood or emotions. Besides, it was expected that he would not experience any suicidal thoughts.

After two weeks, the client returned to the clinic accompanied by his mother with complaints of losing weight for the last two weeks when therapy was started. Praxil inhibits growth among pediatric patients such that, periodic monitoring of weight and height is needed and clients are urged to take medications with food (Bachmann et al., 2016).  An alternative option would be to reduce the dosage to 5mg orally daily. However, with this dosage therapeutic outcomes cannot be achieved. Similarly, the dosage for the client, in this case, cannot be increased. Increasing the dosage will influence clinical worsening and unusual behavioral changes. Assessing and Treating Pediatric Clients With Mood Disorders Essay Example.

The Food and Drug Administration warns that high doses of praxil beyond the recommended guidelines increases the risk of suicidal behavior and thoughts in children especially during the first weeks of treatment. It is even worse among children with depressive symptoms who present with a history of suicidal ideation before treatment requiring that, children are closely monitored during the course of treatment for strange behaviors and worsening of depression (Cooper, et al., 2014). The best decision would, therefore, be to discontinue the medication by rapidly tapering the dosage since abrupt discontinuation of praxil has also proven to cause adverse symptoms.

Decision 3

At this point, the best decision would be to start Wellbutrin 75 mg orally BID. Wellbutrin has been noted to be a better antidepressant among children as compared to tricyclic’s as it also has a totally different mechanism of action as compared to selective serotonin reuptake inhibitors. It has also been approved by the Food and Drug Administration for managing depression. Assessing and Treating Pediatric Clients With Mood Disorders Essay Example. It works as a norepinephrine-dopamine reuptake inhibitor, increasing the amount of norepinephrine produced by the body (Bachmann, et al., 2016).  This helps to balance inactive and dull moods which are as a result of depression. Therefore, by administering this drug, it was expected that the client’s symptoms of a sad mood, irritation and appetite loss will gradually reduce and eventually resolve.  Similarly, it was certain that the client’s symptoms of suicidal thoughts will gradually resolve and that he will fully regain his health status after treatment (Bachmann, et al., 2016).

After two weeks, the client returned with complaints of weight loss and a suppressed appetite but no reports of seizures. Wellbutrin is known to cause loss of appetite as well as low blood sugars. This increased risk for seizures is associated with hypoglycemia. The dosage cannot be increased or reduced in this case. Increasing the dosage will result in more advanced adverse side effects and reducing the dosage will hinder the achievement of therapeutic outcomes (Walkup, 2017).  The best option would be maintaining the dosage at 75mg orally daily and adhering to dietary recommendations of eating mid-morning, midafternoon and bedtime snacks. Similarly, the child’s weight will have to be monitored closely. These effects are only expected to be more intense during the first few weeks of treatment, after which they will gradually decline Assessing and Treating Pediatric Clients With Mood Disorders Essay Example.

How Ethical Considerations Might Impact Treatment Plan and Communication with Clients

           
Working which children and adolescents can pose significant challenges for mental health providers. Major ethical considerations for this population are confidentiality and patient autonomy and require varied approaches that are highly dependent on a child’s and family’s characteristics to address (Coyne et al., 2014). Irrespective of age, children have the right to confidentiality and mental health providers are required to disclose information to parents or other people with the child’s informed consent. Similarly, children have a right to be part of decision making regarding their treatment. By observing these ethical considerations, it is certain that the therapeutic relationship between the client and mental health practitioner will be long term and promote the development of trust (Coyne et al., 2014).  This increases the chances of treatment success and reduces the likelihood of resistance. With regards to communication, a therapeutic relationship that is built on trust promotes a safe and conducive environment where the client and mental health provider can openly and freely communicate to achieve more specific and targeted health outcomes(Coyne et al., 2014). Assessing and Treating Pediatric Clients With Mood Disorders Essay Example.

References

Bachmann, C. J., Aagaard, L., Burcu, M., Glaeske, G., Kalverdijk, L. J., Petersen, I., & Hoffmann, F. (2016). Trends and patterns of antidepressant use in children and adolescents from five western countries, 2005–2012. 
European Neuropsychopharmacology
, 
26
(3), 411-419.

Cummings, C. M., Caporino, N. E., & Kendall, P. C. (2014). Comorbidity of anxiety and depression in children and adolescents: 20 years after. 
Psychological Bulletin
, 
140
(3), 816.

Cox, G. R., Callahan, P., Churchill, R., Hunot, V., Merry, S. N., Parker, A., & Hetrick, S. E. (2014). Psychological therapies versus antidepressant medication, alone and in combination for depression in children and adolescents. 
Cochrane database of systematic reviews
, (11).

Cooper, W. O., Callahan, S. T., Shintani, A., Fuchs, D. C., Shelton, R. C., Dudley, J. A.,  & Ray, W. A. (2014). Antidepressants and suicide attempts in children. 
Pediatrics
, peds-2013. Assessing and Treating Pediatric Clients With Mood Disorders Essay Example.

Coyne, I., Amory, A., Kiernan, G., & Gibson, F. (2014). Children’s participation in shared decision-making: Children, adolescents, parents and healthcare professionals’ perspectives and experiences. 
European Journal of Oncology Nursing
, 
18
(3), 273-280.

Walkup, J. T. (2017). Antidepressant efficacy for depression in children and adolescents: industry-and NIMH-funded studies. 
American Journal of Psychiatry
, 
174
(5), 430-437. Assessing and Treating Pediatric Clients With Mood Disorders Essay Example.

Critique of Systematic Research Review (SRR): Nursing Handoffs Essay

Nursing handoffs is a type of report between two clinicians that are responsible for patients care and is an important part of transferring patient information (what, how, who and where) from one healthcare provider to another in clinical practice (Smith and Schub, 2014). Ineffective, inconsistent and incongruent communication during these handoffs continues to be a problem and a threat to patient safety. Effective handoffs are instrumental in providing for the successful quality of care that the patient is to receive (Holly and Poletick 2014). Medical errors, treatment delays, inappropriate treatment and/or care omissions can happen as a result of miscommunication during handoffs which could potentially lead to patient harm, longer stays, readmissions and/or increased costs. Critique of Systematic Research Review (SRR): Nursing Handoffs Essay.

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Search Process

The authors of this article performed a search looking for only qualitative research articles that were based on the nurse’s experiences at the time of shift change/nursing handoffs. One hundred and twenty-five qualitative articles between 1988 and 2012 met the initial inclusion criteria and 50 articles were evaluated and a final sample of 29 qualitative articles was analyzed and utilized for this study and included (Holly and Poletick 2014). Only articles that described nurse to nurse shift reporting was used.

Articles

The articles chosen are as follows (Holly and Poletick 2014):

21 ethnographic studies – study of people and cultures

2 qualitative descriptive studies – subjective research that studies the characteristics of a population. Critique of Systematic Research Review (SRR): Nursing Handoffs Essay.

3 case studies – a detailed, up close and in depth research method of a subject

1 phenomenological study – study of experiences

1 appreciative enquiry study – involves bringing large, diverse groups of people together to study

1 action research study – research initiated to solve a problem

 

The data collection methods in the research articles included observations, interviews, document reviews and questionnaires.

Search Terms

The terms that were used for their search included (Holly and Poletick 2014):

Communication

Nurse’s report(s)

Intershift report(s)

Shift report

Nursing shift report

Handoff(s)

Sign-off

Signoff

Handoff report

Handoff communication

Information transfer

Handover

Handover communication

Handover report

Qualitative research

 

Databases

 

The following databases were used for their search (Holly and Poletick 2014):

CINAHL

Pre-CINAHL

Healthstar

ScienceDirect

Dissertation Abstracts International

Theses Canada

DARE

PyschINFO

BioMed Central

TRIP

SI Current Contents

Web of Science/Web of Knowledge

Scirus

gov

 

Findings

The articles were retrieved using the Qualitative Assessment Review Instrument (QARI) (www.joannabriggs.edu.au) which allows the authors to aggregate their findings with relation to their study (Holly and Poletick 2014). One hundred and seventeen findings were identified and these were then grouped into sixteen categories that were based on commonality and relevance to the nursing handoff report (Holly and Poletick 2014) and these findings were further subjected to a metasynthesis that produced these two findings that can thus be used as a basis for future evidenced-based practice:

‘Individual nurses influence patient care nurse as the gatekeeper if information handed off that is used for subsequent care decisions’ (Holly and Poletick 2014)

‘There is an embedded hierarchy in relation to the handy over of information that serves as a method of enculturation to the nursing unit’ (Holly and Poletick 2014) Critique of Systematic Research Review (SRR): Nursing Handoffs Essay.

In reference to item number one: the authors found evidence to suggest incongruence among the nurses reports (written, oral and patient observation) with an overall congruence rate of 70% and the most common deficit was omission (Holly and Poletick 2014). It was also discovered that relevant information was omitted and irrelevant information as often conveyed.

In reference to number two: shift report is when information and responsibility is passed on to the next shift. It is a great time to facilitate staff cohesion and for support. It can also be a forum for team building. The authors noticed that the quality of information exchanged during shift report was unpredictable – few questions asked and dialogue between staff was often vague and lacked precision (Holly and Poletick 2014).

On a positive note, shift reporting provides a place where new nurses can be oriented to the culture, language and rituals of the unit being worked on. This time helps to increase the cohesiveness of the teams with increased consistency. As a result this can help to increase information being given during report time. Little approval is given verbally and often nonverbal cues or gestures (i.e. head nods, eye contact) are used.

Recommendations

           
The final results of this study showed the need for a more improved handoff technique. The authors state that the nurse is the gatekeeper for clinicians versus patients and the research showed that nurses are very ineffective in this area. Critique of Systematic Research Review (SRR): Nursing Handoffs Essay. The key recommendation for improving nursing handoffs would be the improvement of communication which would include a reduction of omission, improved written report and a better communication between nurses and physicians. Other options of improving nursing shift reports would be to institute a written report to go along with a verbal report that can be passed down from shift to shift. A reliable handoff should include 3 important elements: (1) face to face, 2-way communication, (2) a universal structured written form or template and (3) the handoff needs to share the problem of the patient’s clinical situation (Halm, 2013). As sated previously a simple suggestion to improving shift change handoffs is to institute a universal structured from. One could use mnemonic devices to help in making sure that important information is transferred from one clinician to the next. A few examples are SBAR (situation, background, assessment, recommendation) or I PASS the BATON (Introduction, patient, assessment, situation, safety concerns, background, actions, timing, ownership, next) (Halm, 2013). Halm (2013) states that ‘consistently discussing information in a standardized sequence can also aid pattern recognition for clinicians’. In other words, if we all consistently use the same methods for shift change reports then, ideally, information should not be missed. Holly and Poletick (2014) states that ‘the role of a nurse as decision-make of what information is chosen to be acted up and/or handed off’ is a major finding of their research article. Critique of Systematic Research Review (SRR): Nursing Handoffs Essay. Technology allows customized reports to be created and it would be a benefit for institutions to take advantage of this ability to create a standardized form to use during nursing handoffs.

Conclusion

Effective communication among healthcare clinicians is critical for an effective handoff to provide safe high quality care. The result of a better shift change report would include improved patient satisfaction, better patient outcomes and improved financial outcomes. The author’s goal in this research article was to improve our understanding of the shift change handoff report process. It was discovered that it is very important for standardization to be implemented in order for improvement to be made. It is the responsibility of nurses to provide proper care to their patients and it is of utmost importance to relay information to the following shifts in order for proper care to be given. Holly and Poletick (2014) states that ‘handoffs allow nurses the opportunity to exchange information that will be used to make subsequent care decisions about their patients’. This results in improved satisfaction, shorter inpatient stays and reduced cost to all.

References

Halm, M.A. (2013). Nursing handoffs: ensuring safe passage for patients.
American Journal Of Critical Care 22
(2), 158-162. doi:10.4037/ajcc2013454

Holly, C., & Poletick, E. B. (2014). A systematic review on the transfer of information during nurse transitions in care.
Journal Of Clinical Nursing
, (17-18), 2387.

Smith, N., & Schub, E. (2014). Nursing report: patient hand-off.
CINAHL Nursing Guide. Critique of Systematic Research Review (SRR): Nursing Handoffs Essay.

Assessing the Genitalia and Rectum Essay Assignment Example

Assessing the Genitalia and Rectum

Patients are frequently uncomfortable discussing with health care professional’s issues that involve the genitalia and rectum; however, gathering an adequate history and properly conducting a physical exam are vital. Examining case studies of genital and rectal abnormalities can help prepare advanced practice nurses to accurately assess patients with problems in these areas.

In this assignment, you will consider case studies that describe abnormal findings in patients seen in a clinical setting.

In this assignment, you will analyze a SOAP note case study that describes abnormal findings in patients seen in a clinical setting. You will consider what history should be collected from the patients, as well as which physical exams and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible conditions.

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GENITALIA ASSESSMENT

Subjective:

• CC: “I have bumps on my bottom that I want to have checked out.”

• HPI: AB, a 21-year-old WF college student reports to your clinic with external bumps on her genital area. She states the bumps are painless and feel rough. She states she is sexually active and has had more than one partner over the past year. Her initial sexual contact occurred at age 18. She reports no abnormal vaginal discharge. She is unsure how long the bumps have been there but noticed them about a week ago. Her last Pap smear exam was 3 years ago, and no dysplasia was found; the exam results were normal. She reports one sexually transmitted infection (chlamydia) about 2 years ago. She completed the treatment for chlamydia as prescribed. Assessing the Genitalia and Rectum Essay Assignment Example.

• PMH: Asthma

• Medications: Symbicort 160/4.5mcg

• Allergies: NKDA

• FH: No hx of breast or cervical cancer, Father hx HTN, Mother hx HTN, GERD

• Social: Denies tobacco use; occasional etoh, married, 3 children (1 girl, 2 boys)

Objective:

• VS: Temp 98.6; BP 120/86; RR 16; P 92; HT 5’10”; WT 169lbs

• Heart: RRR, no murmurs

• Lungs: CTA, chest wall symmetrical

• Genital: Normal female hair pattern distribution; no masses or swelling. Urethral meatus intact without erythema or discharge. Perineum intact with a healed episiotomy scar present. Vaginal mucosa pink and moist with rugae present, pos for firm, round, small, painless ulcer noted on external labia

• Abd: soft, normoactive bowel sounds, neg rebound, neg murphy’s, neg McBurney

• Diagnostics: HSV specimen obtained

Assessment:

• Chancre

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

To prepare:

With regard to the SOAP note case study provided:

• Review this week’s Learning Resources, and consider the insights they provide about the case study.

• Consider what history would be necessary to collect from the patient in the case study.

• Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?

• Identify at least five possible conditions that may be considered in a differential diagnosis for the patient. Assessing the Genitalia and Rectum Essay Assignment Example.

To complete:

Refer to Chapter 5 of the Sullivan text. Analyze the SOAP note case study. Using evidence based resources, answer the following questions and support your answers using current evidence from the literature.

• Analyze the subjective portion of the note. List additional information that should be included in the documentation.

• Analyze the objective portion of the note. List additional information that should be included in the documentation.

• Is the assessment supported by the subjective and objective information? Why or Why not?

• Would diagnostics be appropriate for this case and how would the results be used to make a diagnosis?

• Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least 3 different references from current evidence based literature. Assessing the Genitalia and Rectum Essay Assignment Example.

Introduction

For clients who present with genitourinary symptoms, it is necessary that a focused and comprehensive history is taken followed by a thorough examination.  Genitourinary problems are likely to trigger issues in other systems of the body. Similarly, difficulties that may arise in the various systems are likely to affect the quality of life and overall well-being of a client. Clinical nursing skills should possibly result in a list of the potential differential diagnoses and the definite diagnosis. With this approach, it is certain that a clinician will focus on the most appropriate tests that can confirm the diagnosis. This paper is an extensive discussion of the additional subjective and objective data that should be included in the assessment of clients presenting with genitourinary problems. A description of the use of diagnostics in making a diagnosis and possible differential diagnoses will also be provided. Assessing the Genitalia and Rectum Essay Assignment Example.

Additional Subjective Data to Include in the documentation.

The client will be asked to provide more information about additional symptoms associated with the bumps as I examine them to determine the color, pattern, size, and shape. The client will also be asked whether the bumps have appeared for the first time or they have also been there in the past, exact period and any previous medications used to manage them. It would also be necessary to ascertain and document if the client has noticed the bumps somewhere else in the body other than the genitals. According to Dains, Baumann & Scheibel (2016), general symptoms of a patient may relate to other systems within the body and produced by pathologies in the genitourinary tract. Information on associated symptoms such as a skin rash, recent weight loss, loss of hair, a fever, sores on the anus, dysuria, fatigue, and muscle aches should be documented alongside their relieving and aggravating factors is vital. The client will also be asked about the use of douches, fragrant and soaps and to rate the extent at which they are a bother to her general life on a scale of 0-10. Assessing the Genitalia and Rectum Essay Assignment Example.

Under the past medical and surgical history, past histories of genital herpes and other STIs apart from chlamydia should be documented. She will also be asked about the medications that were prescribed for chlamydia and by whom. The client should reveal if she has any skin conditions, psoriasis or eczema. The client’s full course of immunization, the age of asthma diagnosis and progress with its management should also be documented (Dains, Baumann & Scheibel, 2016). Previous female surgeries are also a vital part of the documentation.

It is also necessary that the client’s gynecological history is taken. Gynecological history includes the menstrual history where frequency, duration, volume, date of last menstrual period, contraception use and HIV is documented. The menstrual history will help to eliminate any possibilities of a pregnancy before further assessments and management (Jensen, 2018).  Still, on gynecological history, information about post-coital-bleeding, dyspareunia, and vulval itching should also be included. Post-coital bleeding and dyspareunia are symptoms of sexually transmitted illnesses. Assessing the Genitalia and Rectum Essay Assignment Example.

The client should also be asked if she performs self-breast exams. On the sexual history, it would be necessary to document the client’s preferences of her sexual practices and if she has unprotected sex, anal sex, the specific number of sexual partners, how often she has sex and if she knows the status of her sexual partners.  Her last sexual episode/encounter should be documented as this will help to approximate the duration it took for symptoms to present and possibly the definitive diagnosis.

The client is evidently married and a mother to 1 girl and 2 boys. Therefore, it would be essential to take her obstetric history. An obstetrics history provides a clinician with vital clues to the client’s health risks.  Previous congenital malformations which may result from STIs may indicate a predisposition to other STIs (Jensen, 2018). The client’s occupational history is very significant. An occupation that predisposes one to sexual encounters increases their risk for sexually transmitted illnesses which should be comprehensively addressed in the management to prevent STI risks in the future. Assessing the Genitalia and Rectum Essay Assignment Example.

Additional Objective Data to Include In the documentation.

It would be necessary to document the overall cleanliness, grooming, affect and stature of the client. On the HEENT exam, the throat should be assessed for redness, drainage, edema, enlarged tonsils, cold sores, lesions, and oral thrush to check for the systemic infection with HSV or other viruses. The documentation of the neck exam should include nodal tenderness, enlarged cervical nodes, jugular venous distension and goiters (Seidel, et al., 2015).  In the Chest exam, the client should be assessed for non-labored breathing, enlargement of axillary nodes, discharge, and tenderness over the nipples. Chest retractions and nasal flaring should be assessed and documented. Assessing the Genitalia and Rectum Essay Assignment Example.

In the CVS assessment, documentation about any pedal or general body edema and peripheral pulses should be included. In the genito-urinary exam, it would be mandatory to inspect the cervix and do a pap smear. The cervix will also be assessed for motion tenderness and general cervical tenderness. During this exam, signs of vaginal bleeding and foul-smelling vaginal discharge will be noted and documented. Palpation and documentation for inguinal tenderness and lymphadenopathy, whether the ulcer is the only one, indurated and its color should also be included (Seidel, et al., 2015). A rectal exam to ascertain any lesions, hemorrhoids, masses, and trauma will be necessary. A detailed skin exam to assess for pink color, warmth, and dryness will be included. Other areas with redness, lesions, and scarring, discoloration and patches will be examined and documented. Assessing the Genitalia and Rectum Essay Assignment Example.

Whether the Assessment Is Supported By Subjective and Objective Data

The assessment concluded that the client had a Chancre. A chancre often presents in veneral disease and it usually develops over the genital area.  More specifically, in females, chancres can also present over the vagina, anus or the vulva and take between 3 weeks to 3 months to present after infection. The chancre is often a painless ulcer, highly infectious and forms in the primary stage of syphilis which is a sexually transmitted illness (Dains, Baumann & Scheibel, 2016). Similarly, according to the subjective data, the client reportedly noticed a painless and rough lump over her genital area and reported no vaginal discharge. The client also agreed that she was sexually active and had had more than one partner in a year which increases her risk of a sexually transmitted infection. Based on the objective data, it was ascertained that the client had a round, small painless ulcer on the external labia. However, the abdominal examination and other examinations were normal. It is also due to the painless ulcer that an HSV specimen was taken for diagnostics. Therefore, the assessment of a chancre is correctly supported by both the objective and subjective data. Assessing the Genitalia and Rectum Essay Assignment Example.

The relevance of Diagnostics and Its Use to Make a Diagnosis

The diagnostics, in this case, was a HSV specimen which was taken for viral culture. In most cases, the results of a culture take between 1 to 7 days. Polymerase Chain Reaction can also be done to test for herpes simplex antibodies to confirm the diagnosis of herpes simplex (Dains, Baumann & Scheibel, 2016). Possibly, a tzanck smear can be done using the base of the vesicle which is also definitive for herpes simplex. In the findings, multinucleated giant cells may be found in case the samples would be taken from a herpes lesion that is intact. According to Dains, Baumann & Scheibel (2016), a serology test in the forms of VDRL, RPR or a non-treponemal pallidum test would be done to rule out syphilis. To rule out Chlamydia and Gonorrhea, rapid Nucleic Acid Amplification tests would be the most recommended (Tao, et al., 2017).

View on the Current Diagnosis

Primary syphilis often presents with a chancre which is a form of ulcer lesion that develops at the inoculation site.  It often starts off a papule and gradually develops into a painless, firm, indurated ulcer (Wolujewicz & Bates, 2016). Most clients cannot be aware as it presents no symptoms and the ulcer often heals on itself within 3-6 weeks. The ulcerative lesions usually appear exactly 2 weeks following exposure. Syphilis can be confirmed through serology as it is also supported by the subjective and objective data. Assessing the Genitalia and Rectum Essay Assignment Example.

Possible Differential Diagnoses

The most potential differential diagnoses, in this case, include syphilis, herpes simplex II and acute contact dermatitis. Basing on the fact that the client had multiple sexual partners within a year, she is at a potential risk of syphilis whose diagnosis can be confirmed with a serological test. To add on, by the lesion being located on the labia, it allows for contact directly with a syphilis sore (Wolujewicz & Bates, 2016). Besides, the patient reported that the ulcer was painless with no itchiness or burning prior to the eruption, this is an indication of syphilis. The client’s subjective and objective data also supports syphilis as a potential differential diagnosis but not without further history taking and diagnostics. To ascertain the possibilities of syphilis, extensive data & information on the lesion borders, clarity of its base and how central it is would be vital.

The likelihood of Herpes progenitalis also referred to as Herpes Simplex II is high.  However, the presence of a single ulcer limits this possibility since superficial vesicles can either be eroded or not. Depending on the client’s description of the ulcer, it was firm. In herpes simplex II, while primary infections are extensive, recurrent infections are often localized yet patchy with several lesions (Dains, Baumann & Scheibel, 2016). Besides, the lesions are not only painful but can result in a burning sensation with urination. Assessing the Genitalia and Rectum Essay Assignment Example.

Although the differential diagnosis of acute contact dermatitis is unlikely since the client presents with no history of topical allergens, it is possible. The history of the client’s recent activities in terms of contact with caustic chemicals and garden work may support this differential. However, if the sore could be contact related the erythema regions would be large. Assessing the Genitalia and Rectum Essay Assignment Example.

References

Dains, J. E., Baumann, L. C., & Scheibel, P., (2016).  Advanced health assessment and clinical diagnosis in primary care (5th ed.).
St. Louis, MO: Elsevier Mosby.

Jensen, S. (2018). Nursing health assessment: A best practice approach.
Lippincott Williams & Wilkins.

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

Tao, G., Hoover, K. W., Nye, M. B., Peters, P. J., Gift, T. L., & Body, B. A. (2017). Infrequent testing of women for rectal chlamydia and gonorrhea in the United States. 
Clinical Infectious Diseases
, 66(4), 570-575.

Wolujewicz, A., & Bates, C. (2016). Syphilis on the face in primary care: a rare sign of an increasingly common problem. 
The British Journal of General Practice, 66(648), e528–e530
. Assessing the Genitalia and Rectum Essay Assignment Example.

HCIS140 Information Systems Worksheet

Information Systems

 
Complete
Parts A and B of this worksheet.

 
Cite
any outside sources. For additional information on how to properly cite your sources, check out the
Reference and Citation Generator
resource in the Center for Writing Excellence.

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Part A
 

Vocabulary Words

Definitions

Purpose

Type (If Applicable)

Information System

According to Kroenke, “Information system is a group of components that interact to produce information” (2015). It is an organized system for collecting and storing information that helps medical professionals to communicate and be more productive in treating patients.

It stores, manages, transmits, and captures information related to a person’s health status and medical history. It makes accessing the medical records of the patients a lot easier to access by the medical professionals.

Information System is a combination of hardware and software.

HCIS140 Information Systems Worksheet

Hardware

Hardware is the physical component of a computer.

The main purposes of a hardware are to accept input, process data, and provide output.

Hardware

CPU

The Central Processing Unit contains the arithmetic-logic unit and control unit (Burke and Weill, 2013).

The CPU is the brain of a computer and is responsible for making calculations, processing, searching, and sorting information.

CPU is a hardware.

Memory and Storage

It is where all the data are stored.

The purpose of memory and storage is to provide temporary and permanent storage.

Memory and Storage are hardware.

Input and Output Devices

An input is the data that a computer receives, while an output is the data that a computer sends.

HCIS140 Information Systems Worksheet

Input devices’ function is to take the data that humans understand and then translates it into a form that the computer can understand. Once the data is processed, the output devices translate it into a form that humans can understand such as, hard copy and soft copy (Burke and Weill, 2013).

Input and output devices are considered as hardware.

Software

A software is consist of programs that let the computer manage its resources. Without the software, the hardware does not have any use (Burke and Weill, 2013). Software refers to various programs to operate a computer.

The software enables the computer to perform the tasks that you want it to do. It helps individuals process and do what they want and need to do in the computer.

Software

Operating Systems

Operating systems are system software that manage both the hardware and software resources and provide services for the programs in a computer.  (Wikipedia website, 2017).

Operating systems ensures security by making sure that unauthorized users are not able to access a computer. It recognizes input, sends output, and keep track of the files and documents.

Operating systems are software.

HCIS140 Information Systems Worksheet

 

Section B

Explain the difference between computer hardware and software?

Since the computer hardware is generally any physical device used in or with the machine but software is a collection of codes which is installed in the computer hard drive and it is intangible. For example the mouse which we use to navigate is the computer hardware whereas the internet browser which allows us to visit various pages and the operating system that runs the browser is considered software. HCIS140 Information Systems Worksheet.

How can technology be used to bring health care information in areas of the world that lack electricity and landlines?

We know that mobile phones have incredible potential in the healthcare sector especially in the poor countries where there is a lack of electricity and landlines. Since we know that the medical care in these areas or countries is underdeveloped reason being no sufficient money to fund for expensive medical instruments or machines or lack of medical specialists. As we know that 8 out of 10 individual worldwide has a cell phone hence the utility increases more because they can access to the medical information.

The cell phone can be used as a telemedicine which provide remote clinicians to access specialists from a distant place efficiently. Since we know that this is happing in the Botswana, Africa.  It is also used as the medical imaging which occurs in three steps

Measurement of the patient

Computer processing of the measurement and production of image

Image display on the doctor side

3) Why is the use of information systems in health care important? Explain your answer. HCIS140 Information Systems Worksheet.

The information system has much more to offer in managing the healthcare cost and also helps to improve the quality of the healthcare. It also helps in decision making since it educates the people about healthcare which give them an upper hand. It generally address to the barriers like digital technology which includes cost, cultural factors etc.

References:

http://scicasts.com/specialreports/86-healthcare-it/1421-the-role-of-information-systems-in-todays-healthcare/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1360897/

http://www.techopedia.com/definition/7650/input-output-device-io-device

http://searchstorage.techtarget.com/definition/storage

http://www.webopedia.com/TERM/M/memory.html

http://www.techterms.com/definition/bit HCIS140 Information Systems Worksheet

http://searchstorage.techtarget.com/definition/byte

http://www.webopedia.com/TERM/C/CPU.html

http://www.teach-ict.com/gcse_computing/ocr/212_computing_hardware/cpu/miniweb/pg2.htm

http://ecomputernotes.com/fundamental/input-output-and-memory/list-various-input-and-output-devices HCIS140 Information Systems Worksheet

Cancer and Women’s and Men’s Health Essay Example

Assignment:

Cancer and Women’s and Men’s Health

The American Cancer Society estimates that by the end of 2012, more than 226,000 women will be diagnosed with breast cancer and more than 241,000 men will be diagnosed with prostate cancer (American Cancer Society, 2012a; American Cancer Society 2012b). With such prevalence of women’s and men’s cancers, patient education and preventive services are essential. In clinical settings, advanced practice nurses must assist physicians in educating patients on risk factors, preventive services, and for patients diagnosed with cancer, on potential drug treatments. The clinical implications of women’s and men’s cancer greatly depend on early detection, which is primarily achieved through preventive services. In this Cancer and Women’s and Men’s Health Essay Example Assignment, you consider the short-term and long-term implications of cancer and drug treatments associated with women’s and men’s health, as well as appropriate preventive services.

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To prepare:

• Select a type of cancer associated with women’s or men’s health such as breast, cervical, or ovarian cancer in women and prostate cancer in men.

• Locate and review articles examining the type of cancer you selected.

• Review the U.S. Preventive Services Task Force article in the Learning Resources. Think about available preventive services that providers might recommend for patients at risk of this type of cancer.

• Select two of the following factors: genetics, gender, ethnicity, age, or behavior. Reflect on how these factors might impact decisions related to preventive services. Cancer and Women’s and Men’s Health Essay Example.

• Consider drug treatment options for patients diagnosed with the type of cancer you selected including short-term and long-term implications of the treatments.

By Day 7

Write a 2- to 3- page paper that addresses the following:

• Describe available preventive services that providers might recommend for patients at risk of the type of cancer you selected.

• Explain how the factors you selected might impact decisions related to preventive services.

• Describe drug treatment options for patients diagnosed with the type of cancer you selected. Explain the short-term and long-term implications of these treatments.

Reminder: The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at http://writingcenter.waldenu.edu/57.htm). All papers submitted must use this formatting. Cancer and Women’s and Men’s Health Essay Example.

Prostate cancer and men’s health

Introduction

Prostate cancer is a type of cancer that affects the prostate gland in men. A normal prostate gland is a small organ that is walnut shaped and responsible for producing seminal fluids that transport and nourish sperms. In fact, it is one of the most common types of cancers among men with an 11.11% prevalence rate. It rarely presents among persons less than 40 years of age and has a 60% incidence rate among males older than 64 years of age. Once the prostate gland develops cancer, it will present malignant cells that are confined to the gland as a tumor that could either grow slowly or aggressively Cancer and Women’s and Men’s Health Essay Example. Aggressive growth of the tumor is an indication that it could spread to other body organs (Seyfield, 2012).

Preventive services for prostate cancer

There are a range of medically recommended approaches that can be applied in the prevention of prostate cancer. Although there is no sure way of preventing prostate cancer, these approaches can act as strategies for meaningfully reducing the cancer risk. The first approach involves ingesting a healthy diet that is high in vegetables and fruits while low in fats. Some of the fatty foods that should be avoided include cheese, milk, oils, nuts and meats. Even though the specific association between fatty diets and increased risk of prostate cancer development, medical studies show that the link between higher risk of prostate cancer and high amounts of fats in the diet is statistically significant. The implication is that men should eat foods that have low fat content, limit foods rich in fats, and reduce the amount of fat they eat. In addition, it is important to replace animal fats with plant fats. That is because animal fats are linked with higher risk of prostate cancer. Also, the diet should be rich in vegetables and fruits since they contain healthy nutrients and vitamins that improve immunity, reduce the risk of prostate cancer, and reduces the opportunities for eating high-fat foods. Eating fatty fish (such as herring, tuna and salmon) is encouraged since they contain omega-3 and -6 fatty acids. These fatty acids reduce the risk of prostate cancer occurrence (Palmieri, Bird & Simcock, 2013). The second approach involves maintaining a healthy weight through eating the required number of calories. Cancer and Women’s and Men’s Health Essay Example. That is because a BMI figure that exceeds 29 increases prostate cancer risk. The third approach is to exercise regularly to help in loosing and maintaining a healthy weight to reduce the risk of prostate cancer. The final approach is to have regular forums with medical personnel who would determine the risk for prostate cancer (based on demographics such as age and ethnicity) and present alternative risk reduction options that could include medication (Palmieri, Bird & Simcock, 2013) Cancer and Women’s and Men’s Health Essay Example.

Risk factors for prostate cancer

There are four risk factors that are noted when offering preventive services for prostate cancer. The first risk factor is obesity with BMI exceeding 29. The second risk factor is family history whereby past incidence of the condition occurring is an indication of a possibility that it could occur in future generations. In addition, the presence of BRCA1 or BRCA2 in matrilineal inheritance along with breast cancer among the female members of the family is an indication that there is a higher risk of the male members of the family developing prostate cancer Cancer and Women’s and Men’s Health Essay Example. The third risk factor is ethnicity whereby it is determined that persons of Black/African descent have a higher risk of developing prostate cancer when compared to men of other ethnicities. The final risk factor is age whereby higher incidences of the condition is noted among older men when compared to their younger counterparts. To be more precise, 60% incidence rate is reported among males older than 64 years of age (Weinberg, 2014). In this respect, obesity, family history, ethnicity and age are four risk factors that influence the risk for prostate cancer thus impacting preventive services decisions.

Drug treatment options for prostate cancer

The specific drug treatment for addressing the condition is dependent on the cancer prognosis, progression, spread and the patient’s health, as well as the potential side effects and benefits of the drug treatment. There are two main groups of drugs available for prostate cancer treatment. The first group is chemotherapy that focuses on killing rapidly growing cells. Drugs in this category include dacarbazine, cyclophosphamide, cisplatin, chlorambucil, carmustine, carboplatin, busulfan and altretamine Cancer and Women’s and Men’s Health Essay Example. Although chemotherapy can kill the fast growing cancer cells, chemotherapy has a negative side effect in the form of being non-selective and affecting health cells thus negatively affecting other organs and body systems (Palmieri, Bird & Simcock, 2013). The second group is hormone therapy that influences testosterone hormone levels in the body. That is because the hormone helps the cancer cells to grow so that halting testosterone supply in the body is expected to halt the growth of cancer cells and could even cause them to die out. Cancer and Women’s and Men’s Health Essay Example. Hormone therapy can either be presented to stop testosterone production or block the cancer cells from receiving the hormone. Medication that stop the hormone production are presented as luteinizing hormone-releasing hormone agonists, and they include abiraterone, ketoconazole, histrelin, triptorelin, goserelin and leuprolide. Medical that prevent the cancer cells from accessing testosterone hormone are anti-androgens and they include enzalutamide, nilutamide and bicalutamide. Cancer and Women’s and Men’s Health Essay Example. It is important to note that although hormone therapy can shrink or slow down the growth of cancer cells, they could present undesirable side effects that include weight gain, reduced sex drive, bone mass loss, hot flashes and erectile dysfunction (Palmieri, Bird & Simcock, 2013).

Summary

One must accept that prostate cancer is a source of concern among men where an 11.11% incidence rate is reported. In addition, one must acknowledge that there are preventive services that can be applied to facilitate management. The preventive services include eating a healthy diet that is high in vegetables and fruits while low in fats, eating the required calories and maintaining a healthy weight, and regular forums with medical personnel. Also, prostate cancer has risk factors that include BMI exceeding 29, family history of cancer, ethnicity and age. Although prostate cancer paints a grim prognosis, drug treatment can be applied to include chemotherapy that kills the cancer cells but could also kill healthy cells, and hormone therapy that influences the growth of cancer cells but could also present undesirable side effects that include weight gain, reduced sex drive, bone mass loss, hot flashes and erectile dysfunction Cancer and Women’s and Men’s Health Essay Example.

References

Palmieri, C., Bird, E. & Simcock, R. (2013).
ABC of cancer care
. Hoboken, NJ: John Wiley & Sons.

Seyfield, T. (2012).
Cancer as a metabolic disease: on the origin, management, and prevention of cancer
. Hoboken, NJ: John Wiley & Sons.

Weinberg, R. (2014).
The biology of cancer
(2
nd
ed.). New York, NY: Garland Science, Taylor & Francis Group, LLC Cancer and Women’s and Men’s Health Essay Example.

Ethics in pediatric and adolescent nursing essay

Ethical Dilemma: A Pediatric Patient

Adolescents experience many changes in transitioning into adulthood; it is the most plausible period in life to be referred as the time of “storm and stress” (Hockenberry & Wilson, 2014).  Self-image is a component in their development that can be easily altered through the thoughts of their peers, the labels in media, family views, etc., which can mislead their perception of health and individual growth.  An unfortunate and common impedance towards a healthy development in adolescence is eating disorders; anorexia nervosa being one of the most prevalent of all, can lead to considerable morbidity and mortality if left untreated (Smink, Hoeken, & Hoek, 2012). Ethics in pediatric and adolescent nursing essay Nurse’s face being placed in a difficult position when providing holistic care to the patient with anorexia nervosa becomes an ethical dilemma due to the conflicting beliefs between patients, their parent’s beliefs and the nurses/healthcare team.

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Ethical considerations in treating a hospitalized adolescent patient which the nurses face are conflicting values in their duty to providing an optimum level of care to promote an optimum level of health for the patient.  It is more difficult when the decisions for treatment go against that of the minor; and therefore, receiving treatment against the minor patient’s will; This then causing tension between the patient and nurse/healthcare provider in achieving a trusting-working relationship.

The American Nurses Association (ANA)has provided nurses with a scope of ethical standards, called the “Code of Ethics for Nurses” with detailed descriptions of the nine provisions, which aid in providing guidance to nurses in providing roles and obligations of nurses when delivering patient care and maintaining an ethical/moral healthcare environment between all healthcare providers (ANA, 2015). Ethics in pediatric and adolescent nursing essay Provision one states, “The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person” (ANA, 2015).  Although it is the nurse’s role to respect the rights of the patient without the need for the nurse to agree with decisions made.  The patient has “the moral and legal right to determine what will be done with and to their own person” (ANA, 2015) but when the decision of the patient are self-destructive, like the choice of anorexia; it is the nurse’s obligation to address the behavior and provide modifying behavior resources and help to eradicate the potential for any risks for the patient.  It is important to promote the patient’s autonomy; therefore, educating the patient and providing them with resources and opportunities to help him/her with making health-promoting decisions is an important aspect in caring for a patient dealing with anorexia.

Another provision made by the ANA that will aid the nurse in caring for the patient with anorexia is Provision four; “The nurse has the authority, accountability, and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to promote health and to provide optimal care”(ANA, 2015). Part of a nurse’s role is to create a trusting nurse-patient relationship, but with a patient that will refuse treatment as a pediatric patient hospitalized for treatment against his/her will this trusting relationship will most likely will be compromised.  Provision four understands this possible conflict and endorses nurses to assume authority and responsibility to accept or reject specific role demands in order to provide optimal nursing care. Ethics in pediatric and adolescent nursing essay.

All in all, the desired outcome of this ethical dilemma is to eliminate any health disparities to the patient by educating, caring, and promoting a healthy life to the pediatric patient.  Although some ethical dilemmas take time till they are resolved due to non-agreement to medical treatment and enablement of patient self-determination some resources that could help alleviate and hopefully eventually solve in the case of a pediatric patient hospitalized for treatment of anorexia are, family, providing physician, nutritionist, social worker, psychiatrist, and other healthcare staff; it is possible to provide holistic care for the patient and help alleviate or eliminate any conflict in treatment by following the standards of nursing and using the ANA Code of Ethics to aid in providing care Ethics in pediatric and adolescent nursing essay.

References

American Nurses Association. (2015).
Code of ethics for nurses with interpretive statements
. Retrieved from: http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics-For-Nurses.html

Hockenberry, M. & Wilson, D. (2014) Wong’s nursing care of infants and children (10th ed.). St. Louis, MO: Elsevier.

Smink, F. R. E., van Hoeken, D., & Hoek, H. W. (2012). Epidemiology of eating disorders: incidence, prevalence and mortality rates.
Current Psychiatry Reports
,
14
(4), 406–414. http://doi.org/10.1007/s11920-012-0282-y

Required Uniform Assignment: Ethical Dilemma

P
URPOSE

For this assignment, you will examine ethical dilemmas that exist in pediatric acute care settings, particularly
those involving genetics/genomics issues. You will also explore the resources available to assist patients,
families, and healthcare professionals in solving these dilemmas, and integrate the principle of the ANA code of
Ethics. Ethics in pediatric and adolescent nursing essay.

C
OURSE
O
UTCOMES

This assignment enables the student to meet the following course outcomes.

CO #1: Provides individualized comprehensive care for children and their families with multiple health problems in
institutions and community care settings from birth through adolescence. (PO #1)

CO #4: Utilizes critical thinking skills in clinical decision making in the care of pediatric clients. (PO #4) Ethics in pediatric and adolescent nursing essay.

CO #6: utilizes legal, ethical, and professional standards and principles, including those related to child abuse recognition
and intervention, as a basis for pediatric clinical decision
‐
making. (PO #6)

D
UE
D
ATE

Refer to Course Calendar for details. The Late Assignment Policy applies to this assignment.

T
OTAL
P
OINTS
P
OSSIBLE

100 points

R
EQUIREMENTS


Write a 2
‐
3 page paper (not including the title page and reference page) using APA format.


Describe an ethical dilemma you encountered in your clinical setting. Example topics related to
genetics/genomics issues include, but are not limited to: genetic testing, diagnosis of a genetic disorder,
genetic counseling (or lack thereof), pharmacogenomics, lifelong surveillance, and recruiting individuals
for genetics research. Keep in mind to maintain the privacy of all members involved in the dilemma.

P
REPARING THE
A
SSIGNMENT


Identify all the relevant and applicable principles within the ANA Code of Ethics that relates to your
dilemma.


Describe in detail how your dilemma relates to the principle(s) you have identified.


Discuss the outcome of the dilemma to the best of your knowledge Ethics in pediatric and adolescent nursing essay.


Discuss the resources within the clinical agency for dealing with such ethical dilemmas.


Utilize resources such as your textbook, journal articles, Internet sites, etc, to aid in your discussion and
to support your perspective about the situations.


Complete the assignment using APA formatting. Include a reference page in APA format of sources
used. You must use at least two references in this assignment (one will be the ANA Code of Ethics).

N328 RUA Ethical Dilemma for JUL16.docx
Revised 06/2016
2
N328 Pediatric Nursing
D
IRECTIONS AND
A
SSIGNMENT
C
RITERIA
Assignment
Criteria
Points
%
Description
Dilemma
Description
(15 points)
15
15%
Describe the ethical dilemma, including how you became aware of the
situation and who was involved (family, health, care providers, etc…)
Identify the
Principle(s) from
the ANA Code of
Ethics
(10 points)
10
10%
Include all the ethical principles that are relevant and applicable to the
situation. Include a brief description of each principle identified.
Relate Principles
from ANA Code
of Ethics to the
Dilemma
(30 points)
30
30%
Describe how the ANA Code of Ethics principles relate to the dilemma.
Provide specific examples from the situation to demonstrate this
relationship.
Utilize resources such as your textbook, journal articles, professional
internet sites, etc. to aid in your discussion and to support your
perspective about the situations.
Must have at least 2 references, one being the ANA Code of Ethics and one
journal article from a primary source.
Discuss the
Outcome of the
Dilemma
(15 points)
15
15%
How did the situation develop over the time frame you were caring for the
patient? What outcome was hoped for, if no resolution occurred during
that time frame?
Identify the
Resources at the
Clinical Agency
to Assist Dealing
with Ethical
Dilemmas
(20 points)
20
20%
What resources are available? Which were being used and for what
reason(s)? In your opinion, were any other resources available, but not
being used and should have been used in this situation? Provide
rationales for your opinions. Support with literature (highly
recommended).
Writing Style,
APA format,
grammar,
spelling, and
mechanics
(10 points)
10
10%
Proper APA format, grammar, mechanics, and spelling.
Total
100
100

The main aim of the Pediatric Acute Care Unit is to prepare graduate nurses for specific opportunities in the care of unstable intensely ill children.  These graduates are prepared to provide services in hospital inpatient and outpatient situations such as the Emergency Room and pediatric intensive care, and mastering the crucial care of an extensive variety of clinical problems realized from infancy through young adulthood (Jaynes & Lundy, 2014)

There are ethical dilemmas in this setting ranging from genetics and genomics issues. I came to make this conclusion after visiting one such unit and found a nurse who was having these challenges with his patients and their families (Ladd, Smith, & Pasquerella, 2008)

Privacy and Confidentiality, the nurse was required to observe confidentiality with his adolescent patient and surviving with a revelation of diagnosis to him. His parents were also not adhering to his treatment. There were unpredicted responses from family members after he directed who should have access and control to his genetic information (Garvin & Meares, 2000)

Discrimination .This nurse had been required by the employer to take genetic examinations as a condition of hire. He was concerned about his results being misused, like in employment discrimination and also the genetic information being used to deny insurance coverage or to determine who is hiring or firing (Garvin & Meares, 2000) Ethics in pediatric and adolescent nursing essay

Unequitable access to Genomic equipment, this care had limited equipment, making genomic treatments challenging to offer. He mainly relied on governmental organizations that assisted him in endorsing genetic and genomic treatment by creating numerous tools and assets that address the role of genetics in public health. (Ladd, Smith, & Pasquerella, 2008)

Aiding treatments for genetic ailments affecting a small number of people was also a challenge. He realized that not many people were ready to fund for the treatment in marginalized groups such as the street children since the question about the beneficiary of such treatment was paramount among the potential funders. (Jaynes & Lundy, 2014)

Influence of genetic information. How did the person’s genetic information affect individual and society’s insight of that individual, how did this information affect members of minority communities. He was tasked with explaining to his patients the need for well-versed decision making and making them understand the nature, risks, and benefits of the procedure. (Garvin & Meares, 2000) Ethics in pediatric and adolescent nursing essay

Logical property matters surrounding access to and use of genetic Information. The nurse was involved in finding the patient kinfolk histories. There were situations where it is necessary to collect medical information from the patient’s family members, forcing him to explain the procedure to them and support their written agreement for the release of their medical information (Ladd, Smith, & Pasquerella, 2008)

Decent, lawful and social aspects that influence the conversion of genetic information to improved health (Jaynes & Lundy, 2014)

Issues of conducting genetic research.GWAS studies advocate for the use of traditional accord, binary, and tiered accord. Traditional consent had some participants who only participated and didn’t agree to share their data. This restricted the number of individuals willing to participate in it. A binary accord also saw participants who chose not to share their data (Ladd, Smith, & Pasquerella, 2008) Ethics in pediatric and adolescent nursing essay

Using the genetic information in non-health care situations; Genetic testing on DNA can be done on stored blood that has been collected for other works. Data sets of DNA are being established. The nurse found himself his workmates using their patient’s DNA sample for extra research and testing without the patients’ knowledgeable consent (Garvin & Meares, 2000)

The impact of genomics on the race ethnicity and individual identity are; Baby screening results were linked to psychological jeopardies among parents such as parental guilt in parents who were carriers. Infants recognized as carriers led to misunderstanding between parents, interfering with parent-child relationship resulting in social discrimination (Fowler, 2008)

ANA code of ethics

Respect for humankind. In the provision of care, the nurse ought to abide by the beliefs of the individual. The nurse considers the values of all persons in the professional relationship (Fowler, 2008)

Relationships to patients; Health care is worldwide regardless of patient’s variances. The nurse creates helpful links with patients and respect for the morals and beliefs of the patient should not demand the nurse condone those beliefs on an individual level. (Association, 2011)

Nature of health complications; the nurse should not allow the illness of the patient to control his/her worth. This encompasses the relatives of the patient and the health field. The nurse should offer unbiased information and provide security to the patient even when those measures accelerate death. This prevents suffering in the dying process. The nurse does not act with the individual intent of ending a patient’s life (ANA code of ethics)

Right to self-determination; Patients have the right to choose what is to be done to them and part of this includes the right to information needed to make progressive decision on health care (ANA code of ethics) Ethics in pediatric and adolescent nursing essay

Relationships with colleagues; the nurse upholds caring relationships and is compassionate with commitment to fair handling of others (ANA code of ethics)

Interests of the patient are prime; the vital interest of the nurse is to provide unique care based on the necessities of the patient. The nurse guarantees the patient that he finds the plan of care acceptable (Association, 2011)

Conflict of interest for nurses. Nurses may encounter circumstances with conflicts of interest. The nurse shouldn’t exploit the patient for personal gain. This principle can prevent using Genetic Information in Non-Health Care Settings since it advocates for the nurse to others what he would like done towards him (Association, 2011)

Privacy. The nurse acts as an advocate for the patient’s right to privacy. He safeguard’s the patient’s privacy and sensitive information. This can be used to solve privacy and confidentiality. Dilemma (ANA code of ethics)

Guarding the patients in research; The patient has the right to make a well-versed conclusion on their partaking is an investigation, nurses have an accountability to ensure patients are offered with information on any research performed. This principle relates closely to the challenge of information confidentiality (Fowler, 2008) Ethics in pediatric and adolescent nursing essay

Moral self-respect. Nurses have the moral obligation to self as they do to others. They must uphold self-respect, character, and integrity. This can be used to solve the issue on using Genetic Information in Non-Health Care Settings (Association, 2011)

Dilemma outcomes

Difficult interactions with patients and their families on issues like ensuring confidentiality, especially in adolescent care are common.

Challenges in incurable circumstances like accepting the decision of coworkers of admitting the patient in ICU

Health professionals are disagreeing with the breach of confidentiality or inappropriate use of medicines.

Coping with violence against children and neglect where no one was willing to fund them.

The following resources were available at the clinical agency I happened to visit:

Journal of pediatric health care

Journal of pediatric nursing

Pediatric nursing journal

Ethics in pediatric and adolescent nursing essay

A copy of ANA code of ethics.

However, I noticed that these resources were not well utilized and only the ANA code of ethics was being used widely due to its availability. The other resources were scarce and couldn’t be utilized as required.

 

References

Association, A. N. (2011).
Code of Ethics for Nurses with Interpretive Statements.
Retrieved from https://books.google.com/books?isbn=1558101764

Fowler, M. D. (2008).
Guide to the Code of Ethics for Nurses.
Retrieved from https://books.google.com/books?isbn=1558102582

Garvin, C., & Meares, P. A. (2000).
The Handbook of Social Work Direct Practice.
Retrieved from https://books.google.com/books?isbn=0761914994

Jaynes, S., & Lundy, K. S. (2014).
Community Health Nursing.
Retrieved from https://books.google.com/books?isbn=1449691498

Ladd, R. E., Smith, S., & Pasquerella, L. (2008).
Ethical Issues in Home Health Care.
Retrieved from https://books.google.com/books?isbn=0398085978 Ethics in pediatric and adolescent nursing essay

Worldview Analysis and Personal Inventory Essay Examples.

Based on the required topic study materials, write a reflection about worldview and respond to following:

In 250-300 words, explain the Christian perspective of the nature of spirituality and ethics in contrast to the perspective of postmodern relativism within health care.

In 250-300 words, explain what scientism is and describe two of the main arguments against it.

In 750-1,000 words, answer each of the worldview questions according to your own personal perspective and worldview: (a) What is ultimate reality? (b) What is the nature of the universe? (c) What is a human being? (d) What is knowledge? (e) What is your basis of ethics? (f) What is the purpose of your existence?

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Remember to support your reflection with the topic study materials.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center. Worldview Analysis and Personal Inventory Essay Examples.

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

Introduction

The term spirituality has many different interpretations.  It can be defined in numerous ways as it relates to different worldviews.  This paper will discuss worldview based on the different concepts of pluralism, scientism and postmodernism.  James Sire’s seven basic worldview questions will also be addressed.  How does one define the term worldview?  James Sire (2004) defines a worldview as:

a commitment, a fundamental orientation of the heart, that can be expressed as a story or in a set of presuppositions (assumptions which may be true, partially true or entirely    false) which we hold (consciously or subconsciously, consistently or inconsistently)     about the basic constitution of reality, and that provides the foundation on which we live and move and have our being (p. 122).

Pluralism

Pluralism is the term used in many different arenas of philosophy, it is the expression that there are many different belief systems or worldviews that are similarly valid and significant.  When it comes to religion, it means there are multiple religious beliefs that exists with different interpretations and “no single religion can claim absolute truth” (newworldencyclopedia.org, 2015).  It is where all strive for the common good under different theories and explanation. Worldview Analysis and Personal Inventory Essay Examples.

Scientism

    
The term scientism is another worldview that is based solely in methods of research that conveys the entire truth about the world and reality (pbs.org, n.d.).  This theory comes from the dominant influence of scientific knowledge.  Theorists believe that science is the absolute power to tell the truth about the world and that it is the single foundation of human principles.

 

Postmodernism

    
The simplest way to describe postmodernism theory is the rejection of a common and impartial truth (allaboutworldview.org, n.d.).  These theorists deny the existence of God. They believe that there are truths that apply only through a certain group of people and based on individual insight.

What is Prime Reality?

    
In the Christian worldview, prime reality is that God exists.  It is believed that God is real and that He is the creator of mankind.  He is the eternal being who has the power to preserve all things.  He is trusted by all of mankind in time of pain and suffering, and serves as a guide until the very end.  God is the foundation of all reality.  He is the underpinning of the Christian worldview. Worldview Analysis and Personal Inventory Essay Examples.

What is the Nature of the World Around You?

The world is a creation of God.  Where there is God, there is order not chaos.  There is faith and hope through Him.  Chaos is created by those who do not believe in Him or who are lost from God’s ways.  World preservation is maintained and is dependent on God.  The world definitely has an element of Spirit in it thus allowing miracles to happen.

What is a Human Being?

A human being is a person who is created in the image of God and one who has a responsibility to Him.  It is a precious and delicate form of God’s creation that must not be taken for granted.  A human being is sensitive, intelligent, respectable and honorable.  In the Christian worldview, mankind is given perseverance, courage and faith.

 

 

What Happens to a Person at Death?

   
In the Christian worldview, it is believed that there another form of life after death.  The relationship with God continues in the afterlife.  Just as the body of Jesus Christ was resurrected after death, Jesus says “I am the resurrection and the life. He who believes in Me, though he may die, he shall live” (John 11:25).  Depending on what choices one has made in life, a person may be resurrected or condemned after death.

Why is it Possible to Know Anything at All?

When God created mankind, He included intelligence.  One must use this God-given gift in the daily life in order to survive.  Knowledge is a very powerful element and must be treated as such.  It is how one is able to make sound decisions and understand the nature of their existence.  It is from the teachings of God that knowing anything is possible Worldview Analysis and Personal Inventory Essay Examples.

How Do People Know What is Right or Wrong?

People learn what is right or wrong through the word of the Lord.  Children are taught by their parents’ good moral values from infancy.  Throughout life, mistakes are made through unwise decisions and poor choices that people make.  It is exceedingly conceivable that people learn from their mistakes, and make better judgment next time around.  Additionally, the strong belief in the teachings of God serves as a powerful influence towards choosing what it right from wrong.

What is the Meaning of Human History?

In the Christian worldview, the meaning of history is what reveals God’s plan for mankind.  Christianity uses the information based on history to spread the word of God.  It is through the historical evidence in the Bible that life, death and resurrection of Jesus Christ is learned.  Customs, moral values and cultures are learned through the history of humanity.  Christian faith is communicated through the solid evidence that history has provided.

Conclusion

Worldviews are essential, whether we see it or not.  It offers as the underpinning for moral values, decisions and actions.  It can be conscious or unconscious, consistent or inconsistent, true, partially true or completely false Worldview Analysis and Personal Inventory Essay Examples.  Understanding one’s personal worldview may be interpreted based on the answers given to the seven basic life questions and to get to the deepest meaning of anyone’s worldview.

 

References

James W. Sire, Naming the Elephant: Worldview as Concept (Downers Grove, Ill.: Inter-Varsity

Press, 2004).

Pluralism. (2015). Retrieved from
http://www.newworldencyclopedia.org/entry/Pluralism

Postmodern Philosophy. (n.d.). Retrieved from

http://www.newworldencyclopedia.org/entry/Pluralism

Scientism. (n.d.). Retrieved from
http://www.pbs.org/faithandreason/gengloss/sciism-body.html

Worldview Analysis and Personal Inventory Essay Examples

Qualitative and quantitative research critique and ethical considerations and Literature Evaluation Table.

Write a critical appraisal that demonstrates comprehension of two qualitative research studies. Use the ”Research Critique Guidelines – Part 1” document to organize your essay. Successful completion of this assignment requires that you provide rationale, include examples, and reference content from the studies in your responses.

Use the practice problem and two qualitative, peer-reviewed research article you identified in the Topic 1 assignment to complete this assignment.

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In a 1,000–1,250 word essay, summarize two qualitative studies, explain the ways in which the findings might be used in nursing practice, and address ethical considerations associated with the conduct of the study. Qualitative and quantitative research critique and ethical considerations and Literature Evaluation Table

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

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

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

 

Literature Evaluation Table

Summary of Clinical Issue (200-250 words):

 

When used improperly, pain medicines can cause problems in the body, including the kidneys. According to the National Kidney Foundation, as many as 3 percent to 5 percent of new cases of chronic kidney failure each year may be caused by the overuse of these painkillers. Once kidney disease occurs, continued use of the problem drug makes it worse Qualitative and quantitative research critique and ethical considerations and Literature Evaluation Table.

Acetaminophen It is often effective for mild to moderate pain. Its safety depends on how it is used. People who take too much or take it too often risk side effects or worse. Acetaminophen is also found in combination with other ingredients in many cold, sinus, and cough medications. If you take these drugs together, the dose can add up. Ibuprofen and other NSAIDs block prostaglandins, natural body chemicals that normally dilate blood vessels leading to the kidneys. Blocking prostaglandins may lead to decreased blood flow to the kidneys, which means a lack of oxygen to keep the kidneys alive. Qualitative and quantitative research critique and ethical considerations and Literature Evaluation Table. That can cause acute kidney injury. A simple blood test may show a rise in creatinine if your kidneys are being affected, usually seen within the first three to seven days of NSAID therapy. In people with high blood pressure, taking NSAIDs long-term may worsen underlying high blood pressure. Also, people with existing kidney problems more often get in trouble with NSAIDs.

 
 

PICOT Question: In patients with normal renal function who have had recent surgery are nonsteroidal anti-inflammatory drugs (NSAIDs) associated with adverse renal effects?

 

Criteria

Article 1

Article 2

Article 3

APA-Formatted Article Citation with Permalink

Bloom, L., Boyle, K. E., Myers, A. E., Blacketer, C., & Weinstein, R. (2019). Frequency of nonaspirin NSAID-relevant coexisting medical conditions in the primary-care setting: A retrospective database review. 
Therapeutics and Clinical Risk Management,Volume 15
, 579-588. doi:10.2147/tcrm.s189833

 

 

Lai, K. M., Chen, T., Chang, C., Chen, H., & Lee, Y. (2019). Association between NSAID use and mortality risk in patients with end-stage renal disease: A population-based cohort study. 
Clinical Epidemiology,Volume 11
, 429-441. doi:10.2147/clep.s204322

Qualitative and quantitative research critique and ethical considerations and Literature Evaluation Table

 

Gawande, A., Gupta, G. K., Gupta, A., Wanjari, S. J., Goel, V., Rathore, V., . . . Nijhawan, S. (2019). Acute-on-Chronic Liver Failure: Etiology of Chronic and Acute Precipitating Factors and Their Effect on Mortality. 
Journal of Clinical and Experimental Hepatology
. doi:10.1016/j.jceh.2019.04.050

 

How Does the Article Relate to the PICOT Question?

It researches on use of NSAID with coexisting conditions.

It researches the use of NSAID and mortality rates with CKD patients

Prevalence of acute on chronic liver failure, underlying etiology and precipitating factors.

 

Quantitative, Qualitative (How do you know?)

Qualitative

Qualitative

Quantitative

Purpose Statement

To find the effects of NSAID with coexisting conditions.

Qualitative and quantitative research critique and ethical considerations and Literature Evaluation Table

 investigate the association between the use of NSAIDs and the risk of mortality in patients with end-stage renal disease.

 

Research Question

Frequency of non-aspirin NSAID-relevant coexisting medical conditions in the primary-care setting

 

Association between NSAID use and mortality risk in patients with end-stage renal disease: a population-based cohort study

 

Estimating the prevalence of acute on chronic 
liver failure
 in our institute, etiology of underlying chronic 
liver
 disease, precipitating acute event and mortality rate.

 

Outcome

the prevalence of renal disease was low in all three databases

In the study cohort, 2,623 (78%) patients used NSAIDs during the follow-up period. The median follow-up period was 4.0 years, during which 1,515 patients died. The results of multivariable analysis demonstrated that compared with NSAID nonuse, the use of any NSAIDs, nonselective NSAIDs, and selective cyclooxygenase-2 inhibitors was associated with a significantly increased risk of all-cause mortality

 

Out of 386 patients, 150 patients were admitted with acute on chronic 
liver
failure with a prevalence of 39%. In 41% of patients, infection was the precipitating factor for ACLF either in the form of Sepsis, spontaneous bacterial peritonitis, Lower respiratory tract infection or skin, and soft tissue infections. Alcohol was the second most precipitating factor (32%), followed by upper gastrointestinal hemorrhage (12%) and drugs (2%).

 

 Where did the study take place?

USA

Taiwan

Rajiv Gandhi Government General Hospital

 

Sample

Patients aged ≥18 years in 2013 with a visit to a PCP in the same year were included in the study. Only patients with ≥1 year of enrollment prior to their first PCP visit in 2013 were included, so that medical history was available to review.

 

A total of 3,383 patients with newly diagnosed end-stage renal disease requiring long-term dialysis between 1998 and 2012 were included in the current study, and the study outcome was evaluated until December 31, 2013.

 

386 patients in Rajiv Gandhi Government General Hospital

Qualitative and quantitative research critique and ethical considerations and Literature Evaluation Table

Method

A retrospective database review was performed.

 Time-dependent Cox regression models were applied to examine the association between NSAID use and mortality risk.

 

Database review

Key Findings of the Study

Overall, the prevalence of renal disease was low in all three databases relative to cardiovascular and gastrointestinal bleeding risk factors. Similar percentages of women and men were diagnosed with renal disease within each database. In each database, a higher percentage of individuals with a musculoskeletal diagnosis had a CMCOI compared to the total study population

 

The results suggest that NSAID use was associated with an increased risk of mortality in the patients with end-stage renal disease. Future randomized controlled trials are needed to validate these observational findings.

 

Out of 386 patients, 150 patients were admitted with acute on chronic 
liver failure
 
with a prevalence of 39%. In 41% of patients, infection was the precipitating factor for ACLF either in the form of Sepsis, spontaneous bacterial peritonitis, Lower respiratory tract infection or skin, and soft tissue infections. Alcohol was the second most precipitating factor (32%), followed by upper gastrointestinal hemorrhage (12%) and drugs (2%)

 

Recommendations of the Researcher

The analyses reinforce the critical role HCPs can play in identifying patients with nonaspirin NSAID-relevant coexisting conditions, providing those patients with ongoing guidance on appropriate choice and use of OTC analgesics, and educating patients about the impact that aging, health status, concomitant conditions, and medicines has on selection of all medicines, including analgesics.

 

Qualitative and quantitative research critique and ethical considerations and Literature Evaluation Table

Future randomized controlled trials are needed to validate these observational findings.

 

A multi-centre study involving a larger number of patients are needed to know the clinical characteristics, other precipitating factors and to form a standard treatment protocol for this dynamic syndrome.

 

 

Criteria

Article 4

Article 5

Article 6

APA-Formatted Article Citation with Permalink

Lee, A., Cooper, M., Craig, J., Knight, J., & Keneally, J. (2004). Effects of nonsteroidal anti-inflammatory drugs on postoperative renal function in adults with normal renal function. 
Cochrane Database of Systematic Reviews
. doi:10.1002/14651858.cd002765.pub2

 

 

Plantinga, L., Grubbs, V., Sarkar, U., Hsu, C., Hedgeman, E., Robinson, B., . . . Powe, N. (2011). Nonsteroidal Anti-Inflammatory Drug Use Among Persons With Chronic Kidney Disease in the United States. 
The Annals of Family Medicine,9
(5), 423-430. doi:10.1370/afm.1302

 

Brown, E. A., & Davison, S. N. (2014). Pain Management in Chronic Kidney Disease. 
Management of Chronic Kidney Disease,
297-304. doi:10.1007/978-3-642-54637-2_22

 

How Does the Article Relate to the PICOT Question?

It measures NSAID relation to CKD in post op patients

It relates to the topic due to describing the use of NSAIDS in individuals with CKD

Discusses how to properly manage pain in people with CKD.

Quantitative, Qualitative (How do you know?)

Qualitative

Qualitative

 

Qualitative

Purpose Statement

The primary objective of this review was to determine the effects of NSAIDs on postoperative renal function in adults with normal preoperative renal function.

 

Due to avoidance of nonsteroidal anti-inflammatory drugs (NSAIDs) is recommended for most individuals with chronic kidney disease (CKD), we sought to characterize patterns of NSAID use among persons with CKD in the United States.

 

 

This article will focus on identifying the challenges of pain management for CKD patient undergoing surgical intervention and explores avenues to overcome these difficulties through simplifying some of the published guidelines in this field to provide optimum pain control for this patient population.

 

Research Question

Effects of nonsteroidal anti-inflammatory drugs on postoperative renal function in adults with normal renal function.

 

Nonsteroidal Anti-Inflammatory Drug Use Among Persons With Chronic Kidney Disease in the United States

Qualitative and quantitative research critique and ethical considerations and Literature Evaluation Table

 

Postoperative pain management in patients with chronic kidney disease

 

Outcome

Twenty-three trials (1459 patients) fulfilled the selection criteria for this review. NSAIDs reduced creatinine clearance by 16 mL/min (95%CI 5 to 28) and potassium output by 38 mmol/day (95%CI 19 to 56) on the first day after surgery compared to placebo. There was no significant difference in serum creatinine on the first day (0 umol/L, 95%CI -3 to 4) compared to placebo. No significant reduction in urine volume during the early postoperative period was found. There was no significant difference in serum creatinine in the early postoperative period between patients receiving diclofenac, ketorolac, indomethacin, ketoprofen or etodolac.

 

Reported current use of NSAIDs was not uncommon in the US population (3.7% overall). Persons with moderate to severe CKD were slightly more likely than those with no or mild CKD to report current use of NSAIDs (
Figure 3A
). The great majority of currently used NSAIDs were available over-the-counter (
Figure 3A
). Among those with CKD, current NSAID use was similar among those were aware and those who were unaware of their CKD status.

Acetaminophen is considered the safest analgesic agent in ESRD and should be used routinely as an analgesic foundation. With chronic use, however, acetaminophen itself may cause nephrotoxicity. Although some authors suggest there is no need to adjust the acetaminophen maximum daily dose in patients undergoing intermittent hemodialysis, the 4 g/day recommended maximum dose may not be applicable for the majority of patients due to the presence of other factors that increase the risk of toxicity.

 

Setting

(Where did the study take place?)

N/A

Sample

NSAIDs with either each other or placebo for treatment of postoperative pain, with relevant postoperative renal outcome measures, in adult surgical patients with normal renal function.

 

A total of 12,065 adult (aged 20 years or older)

 

Method

The inclusion criteria were randomised or quasi-randomised comparisons.

Participants in the cross-sectional National Health and Nutrition Examination Survey (1999–2004) responded to a questionnaire regarding their use of over-the-counter and prescription NSAID

 

Key Findings of the Study

NSAIDs caused a clinically unimportant transient reduction in renal function in the early postoperative period in patients with normal preoperative renal function.

Among those with moderate to severe CKD who were currently using NSAIDs, 10.2% had a current NSAID prescription and 66.1% had used NSAIDs for 1 year or longer. Among those with CKD, disease awareness was not associated with reduced current NSAID use:

 

Pharmacotherapy pain management strategies for patients with CKD change as kidney function becomes progressively impaired. When devising a strategy, physicians must strive to protect the kidney from further damage as well as avoid developing serious side effects due to accumulations of analgesic agents or their metabolites.

 

Recommendations of the Researcher

NSAIDs should not be withheld from adults with normal preoperative renal function because of concerns about postoperative renal impairment.

 

Physicians and other health care clinicians should be aware of use of NSAIDs among those with CKD in the United States and evaluate NSAID use in their CKD patients.

 

Further clinical studies are required to address the optimal medication regimen that can be used for postoperative pain management in the different stages of CKD, including hemodialysis.

 

Write a critical appraisal that demonstrates comprehension of two quantitative research studies. Use the ”Research Critique Guidelines – Part II” document to organize your essay. Successful completion of this assignment requires that you provide a rationale, include examples, and reference content from the study in your responses.

Use the practice problem and two quantitative, peer‐reviewed research articles you identified in the Topic 1 assignment to complete this assignment.

In a 1,000–1,250 word essay, summarize two quantitative studies, explain the ways in which the findings might be used in nursing practice, and address ethical considerations associated with the conduct of the study.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

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

 

Research Critique Guidelines

To write a critical appraisal that demonstrates comprehension of the research study conducted, address each component below for qualitative study in the Topic 2 assignment and the quantitative study in the Topic 3 assignment.

Successful completion of this assignment requires that you provide a rationale, include examples, or reference content from the study in your responses. Qualitative and quantitative research critique and ethical considerations and Literature Evaluation Table.

Qualitative Study

Background of Study:

· Identify the clinical problem and research problem that led to the study. What was not known about the clinical problem that, if understood, could be used to improve health care delivery or patient outcomes? This gap in knowledge is the research problem.

· How did the author establish the significance of the study? In other words, why should the reader care about this study? Look for statements about human suffering, costs of treatment, or the number of people affected by the clinical problem.

· Identify the purpose of the study. An author may clearly state the purpose of the study or may describe the purpose as the study goals, objectives, or aims.

· List research questions that the study was designed to answer. If the author does not explicitly provide the questions, attempt to infer the questions from the answers.

· Were the purpose and research questions related to the problem?

Method of Study:

· Were qualitative methods appropriate to answer the research questions?

· Did the author identify a specific perspective from which the study was developed? If so, what was it?

· Did the author cite quantitative and qualitative studies relevant to the focus of the study? What other types of literature did the author include?

· Are the references current? For qualitative studies, the author may have included studies older than the 5-year limit typically used for quantitative studies. Findings of older qualitative studies may be relevant to a qualitative study.

· Did the author evaluate or indicate the weaknesses of the available studies?

· Did the literature review include adequate information to build a logical argument?

· When a researcher uses the grounded theory method of qualitative inquiry, the researcher may develop a framework or diagram as part of the findings of the study. Was a framework developed from the study findings? Qualitative and quantitative research critique and ethical considerations and Literature Evaluation Table.

Results of Study

· What were the study findings?

· What are the implications to nursing?

· Explain how the findings contribute to nursing knowledge/science. Would this impact practice, education, administration, or all areas of nursing?

Ethical Considerations

· Was the study approved by an Institutional Review Board?

· Was patient privacy protected?

· Were there ethical considerations regarding the treatment or lack of?

Conclusion

· Emphasize the importance and congruity of the thesis statement.

· Provide a logical wrap-up to bring the appraisal to completion and to leave a lasting impression and take-away points useful in nursing practice.

· Incorporate a critical appraisal and a brief analysis of the utility and applicability of the findings to nursing practice.

· Integrate a summary of the knowledge learned.

Quantitative Study

Background of Study:

· Identify the clinical problem and research problem that led to the study. What was not known about the clinical problem that, if understood, could be used to improve health care delivery or patient outcomes? This gap in knowledge is the research problem.

· How did the author establish the significance of the study? In other words, why should the reader care about this study? Look for statements about human suffering, costs of treatment, or the number of people affected by the clinical problem.

· Identify the purpose of the study. An author may clearly state the purpose of the study or may describe the purpose as the study goals, objectives, or aims.

· List research questions that the study was designed to answer. If the author does not explicitly provide the questions, attempt to infer the questions from the answers.

· Were the purpose and research questions related to the problem?

Methods of Study

· Identify the benefits and risks of participation addressed by the authors. Were there benefits or risks the authors do not identify?

· Was informed consent obtained from the subjects or participants?

· Did it seem that the subjects participated voluntarily in the study?

· Was institutional review board approval obtained from the agency in which the study was conducted?

· Are the major variables (independent and dependent variables) identified and defined? What were these variables? Qualitative and quantitative research critique and ethical considerations and Literature Evaluation Table.

· How were data collected in this study?

· What rationale did the author provide for using this data collection method?

· Identify the time period for data collection of the study.

· Describe the sequence of data collection events for a participant.

· Describe the data management and analysis methods used in the study.

· Did the author discuss how the rigor of the process was assured? For example, does the author describe maintaining a paper trail of critical decisions that were made during the analysis of the data? Was statistical software used to ensure accuracy of the analysis?

· What measures were used to minimize the effects of researcher bias (their experiences and perspectives)? For example, did two researchers independently analyze the data and compare their analyses?

Results of Study

· What is the researcher’s interpretation of findings?

· Are the findings valid or an accurate reflection of reality? Do you have confidence in the findings?

· What limitations of the study were identified by researchers?

· Was there a coherent logic to the presentation of findings?

· What implications do the findings have for nursing practice? For example, can the findings of the study be applied to general nursing practice, to a specific population, or to a specific area of nursing?

· What suggestions are made for further studies? Qualitative and quantitative research critique and ethical considerations and Literature Evaluation Table

Ethical Considerations

· Was the study approved by an Institutional Review Board?

· Was patient privacy protected?

· Were there ethical considerations regarding the treatment or lack of?

Conclusion

· Emphasize the importance and congruity of the thesis statement.

· Provide a logical wrap-up to bring the appraisal to completion and to leave a lasting impression and take-away points useful in nursing practice.

· Incorporate a critical appraisal and a brief analysis of the utility and applicability of the findings to nursing practice.

· Integrate a summary of the knowledge learned.

Reference

Burns, N., & Grove, S. (2011). 
Understanding nursing research
 (5th ed.). St. Louis, MO: Elsevier.

Critique and ethical considerations

Article 1.

“Bloom, L., Boyle, K. E., Myers, A. E., Blacketer, C., & Weinstein, R. (2019). Frequency of nonaspirin NSAID-relevant coexisting medical conditions in the primary-care setting: A retrospective database review.
Therapeutics and Clinical Risk Management
, 15, 579-588. doi: 10.2147/tcrm.s189833”

Summary

Bloom et al. (2019) present the results of a retrospective database review to determine how coexisting medical conditions and non-steroidal anti-inflammatory drugs (NSAIDs) influence treatment modalities as noted in primary care practices. The retrospective approach collected data from the claim databases of three medical facilities with a focus on patients either 18 years of age or older. The data was collected for the period covering 2013. The focus was on non-aspirin NSAID-relevant coexisting medical conditions of interest (CMCOI), asthma, cardiovascular risk factors, gastrointestinal bleeding risk factors, and renal insufficiency. Statistical analysis of the collected data determined that patients with musculoskeletal diagnosis reported a significantly higher risk of treatment challenges when compared to their counterparts without musculoskeletal diagnosis. Similarly, age was noted to influence treatment challenges, with an increase in age being matched by an increase in the occurrence of treatment challenges. The reported results indicate that non-aspirin NSAID-relevant CMCOI and age are useful statistical for use among primary care professionals with regards to predicting the occurrence of treatment challenges. In fact, the results show that even as patients advance in age, their medical conditions change and their reactions to different medications also change. Using the information, primary care professionals can identify patients at high risk and offer them guidance on how their age, health status, concomitant conditions, and medication influence treatment modalities (Bloom et al., 2019).

Using findings in nursing practice

The findings from Bloom et al. (2019) are useful to nursing personnel who act as primary care professionals. That is because NSAIDs are a common medication that are typically prescribed or recommended for almost all medical conditions. Although commonly used, NSAIDs are associated with substantial side effects and complications for a particular demographic of patients. Despite the labels for NSAIDs listing these side effects and complications, patients and medical personnel would often overlook them thereby presenting opportunities for them to occur with potentially fatal effects. Through identifying this demographic of patients, nurses are able to anticipate the care complications and offer appropriate advice on how to either address or prevent the complications. Besides that, they can use their position as primary care professionals to reinforce the importance of the advice contains in the labels as instructions and not simply suggestions. Overall, the findings allow nursing practice to contribute towards the safe use of NSAIDs as well as improving care outcomes through anticipating and addressing treatment challenges.

Ethical considerations for the study

Bloom et al. (2019) does not mention how ethical concerns were addressed in the study. However, there is a need to address the ethical aspects of retrospective database review studies, especially with regards to the primary concern of issues pertaining to confidentiality and informed consent. Besides that, the study received approval from The New England Institutional Review Board (NEIRB, 12–284), specifying that the study did not meet the definition of human-subject research thus not requiring its approval. Qualitative and quantitative research critique and ethical considerations and Literature Evaluation Table

The study is based on information that is already available as medical records with the researcher only required to retrieve the information. This is an indication that the ethical concern about confidentiality and informed concern is an inherent concern since the researchers do not have direct contact with patients. The concern is further highlighted by the fact that medical records are not collected with the explicit intention of informing research studies. As such, there is no a-priori informed consent for the records to be used in research studies. In essence, using the records is ethically questionable since confidential information is accessed and could be misused thereby jeopardizing the relationship between patients and doctors. This is particularly true when sensitive data is accessed by persons not bound by patient-doctor confidentiality, leading to unwanted disclosure that would distress and cause difficulties for the patient. Given the nature of medical records and the difficulty in getting informed consent from patients, retrospective studies using these records can address the ethical concerns about informed consent and confidentiality through four approaches. Firstly, minimal information should be collected and only if necessary. The collected information should only include routine clinical information that does not require informed consent. Secondly, any information that could identify the patients should be eliminated or coded to conceal the patients’ identities. Thirdly, safeguards should be implemented to ensure the ethical use of the collected information, such as having protocols for the information storage and authorized access. Finally, ethical clearance should be sought from an Institutional Review Board (IRB) that provides the required oversight (Sarkar & Seshadri, 2014).

Article 2.

“Lai, K. M., Chen, T., Chang, C., Chen, H., & Lee, Y. (2019). Association between NSAID use and mortality risk in patients with end-stage renal disease: A population-based cohort study.
Clinical Epidemiology
, 11, 429-441. doi: 10.2147/clep.s204322”

Summary

Lai et al. (2019) presents the results of a study that investigated the association between NSAIDs use and risk of mortality for persons diagnosed with end-stage renal disease. It acknowledges that pain is a concern among persons diagnosed with end-stage renal disease and it is not uncommon for NSAIDs to be administered. However, it notes that although the pain associated with the disease is a concern and NSAIDs can partially address this concern, of greater concern is the risks associated with the use of NSAIDs. The study seeks to document the risks, providing evidence to show that the adverse effects are tangible thus informing patients and clinicians. Towards this end, the study applies a retrospective approach that collects data from the Taiwan National Health Insurance Research Database. Qualitative and quantitative research critique and ethical considerations and Literature Evaluation Table. The selected population sample is for 1 million patients records selected from among 27 million patients records covering the period between 1997 and 2013. The study determined that 78% (2,623) of persons diagnosed with end-stage renal disease and requiring long-term dialysis used NSAIDs. During the study period that covered four years, 1,515 patients in the study population died. The study determined that the use of NSAIDs significantly increased the risk of all-cause mortality for persons diagnosed with end-stage renal disease (Lai et al., 2019).

Using findings in nursing practice

The study results are useful for improving care outcomes for persons diagnosed with end-stage renal disease. Using the study results, nursing practice can recommend alternatives to NSAIDs that reduce the risk of mortality. In addition, the results can be used to justify stringent monitoring of patients using NSAIDs so as to reduce the risk of mortality (Lai et al., 2019).

Ethical considerations for the study

Lai et al. (2019) mentions that the study was approved by the Joint Institutional Review Board of Taipei Medical University, and the requirement of patient-informed consent was waived (TMU-JIRB No. N201506025). The approval is an indication that the study did not pose any avoidable risk to the participants. Still, the study makes use of medical records thus raising ethical concerns with regards to confidentiality and informed consent since it would be difficult to obtain consent from all participants before the information was used. Although there is no mention of how these concerns were addressed, there is an indication that they were addressed through four approaches. Firstly, minimal information was collected with focus on what was necessary to inform the study and does not require informed consent. Secondly, information was coded to conceal the patients’ identities. Finally, ethical clearance was sought from an IRB that provided the required oversight (Sarkar & Seshadri, 2014). Qualitative and quantitative research critique and ethical considerations and Literature Evaluation Table.

 

References

Bloom, L., Boyle, K. E., Myers, A. E., Blacketer, C., & Weinstein, R. (2019). Frequency of nonaspirin NSAID-relevant coexisting medical conditions in the primary-care setting: A retrospective database review.
Therapeutics and Clinical Risk Management
, 15, 579-588. doi: 10.2147/tcrm.s189833

Lai, K. M., Chen, T., Chang, C., Chen, H., & Lee, Y. (2019). Association between NSAID use and mortality risk in patients with end-stage renal disease: A population-based cohort study.
Clinical Epidemiology
, 11, 429-441. doi: 10.2147/clep.s204322

Sarkar, S. & Seshadri, D. (2014). Conducting record review studies in clinical practice.
Journal of Clinical & Diagnostic Research
, 8(9), JG01-JG04. doi: 10.7860/JCDR/2014/8301.4806 Qualitative and quantitative research critique and ethical considerations and Literature Evaluation Table

NR320 Mental Health Nursing Exam Study guide

What are the common attitudes of society to those with mental illness?

Stigma created

Labeling people which encourages stigma

What is the role of the nurse advocate in mental illness?

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Being a client advocate in psychiatric nursing means helping the client fulfill needs that, without assistance and because of the client’s illness, may go unfulfilled. Individuals with mental illness are not always able to speak for themselves.

Nurses serve in this manner to protect the client’s rights and interests. Strategies include educating clients and their families about their legal rights, ensuring that clients have sufficient information to make informed decisions or to give informed consent, and assisting clients to consider alternatives and supporting them in the decisions they make.

Nurses may act as advocates by speaking on behalf of individuals with mental illness to secure essential mental health services. NR320 Mental Health Nursing Exam Study guide.

Nurses also advocate for their patients indirectly by serving in organizations that support and serve to improve health care for all individuals, and by participating in policy-making legislation that affects health care of the public.

The nurse acts as client advocate to ensure that the following three major elements of informed consent have been addressed:

Knowledge:
The client has received adequate information on which to base his or her decision.

Competency:
The individual’s cognition is not impaired to an extent that would interfere with decision making or, if so, that the individual has a legal representative.

Free will:
The individual has given consent voluntarily without pressure or coercion from others. NR320 Mental Health Nursing Exam Study guide.

What is therapeutic use of self and how is this used by the nurse?

Therapeutic use of self: someone who is open

By having the ability to use their own personality consciously and in full awareness in an attempt to establish association and to structure nursing interventions.

Nurses must possess self-awareness, self- understanding, and a philosophical belief about life, death and the overall human condition.

The nurse needs to be aware of their feelings and how it can impact how you take care of the patient, eg parent taking care of pedophile

Example of use of self: when you approach them with a problem they make themselves available to you, and spend time with you to explain the issue so you understand, vs saying “it’s in the book” therefore putting it all on you and closing themselves to you

 

Define boundaries and give an example of how the nurse uses this.

A boundary indicates a border or a limit. It determines the extent of acceptable limits. Many types of boundaries exist. Examples include the following:

▀
Material boundaries.
These are physical property that can be seen, such as fences that border land.

▀
Social boundaries.
These are established within a culture and define how individuals are expected to behave in social situations.

▀
Personal boundaries.
These are boundaries that individuals define for themselves. They include
physical distance boundaries
, or just how close individuals will allow others to invade their physical space; and
emotional boundaries
, or how much individuals choose to disclose of their most private and intimate selves to others. NR320 Mental Health Nursing Exam Study guide.

▀
Professional boundaries.
These boundaries limit and outline expectations for appropriate professional relationships with clients. They separate therapeutic behavior from any other behavior that, well intentioned or not, could lessen the benefit of care to clients

 

Over helping or doing for the patient what they should do for themselves

Controlling

The nurse needs are met at the expense of the patient

Giving advice to the patient

Self-disclosure

Gift-giving

Touch

Friendship or romantic association

Sharing personal information or work concerns with the client

Receiving of gifts or continued contact/ communication with the client after discharge

Favoring a client’s care over another

Keeping secrets with a client NR320 Mental Health Nursing Exam Study guide

Changing dress style for working with a particular client

Swapping client assignments to care for a particular client

Giving special attention or treatment to one client over others

Spending free time with a client

Frequently thinking about the client when away from work

 

Discuss Maslow’s hierarchy of needs and how this is used with mental health patients.

 

Basic needs need to be met before progressing to the next level

Maslow described self-actualization as being “psychologically healthy, fully human, highly evolved, and fully mature.” He believed that “healthy,” or “self-actualized,” individuals possessed the following characteristics:

An appropriate perception of reality

The ability to accept oneself, others, and human nature

The ability to manifest spontaneity

The capacity for focusing concentration on problem solving

A need for detachment and desire for privacy

Independence, autonomy, and a resistance to enculturation

An intensity of emotional reaction

A frequency of “peak” experiences that validates the worthwhileness, richness, and beauty of life

An identification with humankind

The ability to achieve satisfactory interpersonal relationships

A democratic character structure and strong sense of ethics

Creativeness

A degree of nonconformance

 

What are the criterion for inpatient hospitalization?

If in danger of self or others

Group Two

What is the duty to warn and how is this used in mental health?

Duty to Warn:
you have to warn and break confidentiality if someone tells you they are going to hurt someone

 

under certain circumstances, a therapist might be required to warn an individual, notify police, or take whatever steps are necessary to protect the intended victim from harm.

This duty to protect can also “occur in instances when patients, because of their vulnerable state and their inability to distinguish potentially harmful situations, must be protected by healthcare providers

What is the difference between typical and Atypical antipsychotics?

Typical: first generation

Examples:

Chlorpromazine (Thorazine), Fluphenazine (Prolixin), Thioridazine (Mellaril), Thiothixene (Navane), Trifluoperazine (Stelazine), Haloperidol (Haldol)

IM, long term therapy

Atypical: second generation

Examples: 

Zyprexa, Risperdal, Seroquel, Geodon, Abilify

Clozaril- used as a last resort due to the dangerous side effect of agranulocytosis

Side Effects: less, weight gain, sedation

Side Effects: EPS, anticholinergic, NMS

Interactions: hypotension when taken with antihypertensive

newer, more expensive, less side effects, sexual side effect

Extreme gain weight: develop diabetes

Tell the pt about SS so they can decide if they want to refuse

What to say if they ask about your opinion; weigh pros and cons, empathy: I’ve seen it work on others, talk to family, sounds like you’re having a hard time making a decision (what more do you need to know, I’ll get back to you after google,

 

What are signs and symptoms of Neuroleptic Malignant Syndrome?

NMS; emergency, patients are going to die (bc of fever) 2 weeks after med

Fever, change in LOC, muscle rigidity, Hyperflexia (lower extremities), tremor, clonus, increased bowel sounds (diarrhea), autonomic instability (hypertensive), tachycardia, agitation, diaphoresis (sweating)

absolutely stop meds, transfer them to ER

Neuroleptic malignant syndrome
(NMS) (more common with the typical than the atypical antipsychotics) *This is a relatively rare, but potentially fatal, complication of treatment with antipsychotic drugs. Routine assessments should include temperature and observation for parkinsonian symptoms. *Onset can occur within hours or even years after drug initiation, and progression is rapid over the following 24 to 72 hours.

What is Seratonin Syndrome and when does it occur?

Monoamine Oxidase Inhibitors (MAOI
’
s)

– inhibit both types of enzymes (MOA A and MAO B) that metabolizes

serotonin and norepinephrine

Causing Serotonin syndrome (anxiety/restlessness, hyperthermia, myoclonus (involuntary twitching)

What is the Low Tyramine Diet and what foods are prohibited?

Hypertensive crisis occurs if the individual consumes foods containing tyramine while receiving MAOI therapy

Low Tyramine diet: red wine, aged cheese, smoked and process meats, salami, sausage, peperoni, corned beef, chicken or beef liver, soy sauce, brewer yeast

What are signs and symptoms of akathesia?

Trouble standing still

Restless

Paces the floor

Feet in constant motion, rocking back and forth

Ask “what are you taking, are you always restless?”

 

Group 3

Define CBT and discuss how this is used?

Aaron Beck

The individual identifies thought distortions

Examines evidence for those thought distortions

Reformats negative thinking and replaces with more realistic thoughts

Learn to use healthy coping mechanisms in order to not return to thought distortions

Some type of negative thinking

“I always fail my test” take that thought and go through the facts “do you fail the test 100% of the time?”

What feelings do you get “I’m a loser”

With this example a positive behavior would be studying more

talk yourself out of it, “ok, stop I know what I’m doing, I know I’ve studied and a B would be OK”

“I’m the black ship in my family”

What to say: is to really true, is no one really speaking to you?

Eventually: healthy coping (CBT in groups or individually)

What we think about something it affects how you feel and the behavior

Goals of cognitive therapy

Monitor his or her negative, automatic thoughts.

Recognize the connections between cognition, affect, and behavior.

Examine the evidence for and against distorted automatic thoughts.

Substitute more realistic interpretations for these biased cognitions.

Learn to identify and alter the dysfunctional beliefs that predispose him or her to distort experiences.

Cognitive therapy is highly structured and short-term, lasting from 12 to 16 weeks

suggested that if a client does not improve within 25 weeks of therapy, a reevaluation of the diagnosis should be made.

 

Automatic Thoughts-Thoughts that occur rapidly in response to a situation and without rational analysis. They are often negative and based on erroneous logic.

What is operant conditioning and how is it used in the inpatient area?

Operant: Voluntary behavior reinforced positive/ negative reinforcement

Operant conditioning
occurs when a specific behavior is reinforced. A positive reinforcement is a response to the specific behavior that is pleasurable or offers a reward. A negative reinforcement is a response to the specific behavior that prevents an undesirable result from occurring.

Anger responses can be learned through operant conditioning. For example, when a child wants something and has been told “no” by a parent, he or she might have a temper tantrum. If, when the temper tantrum begins, the parent lets the child have what is wanted, the anger has been positively reinforced (or rewarded).

An example of learning by negative reinforcement follows: A mother asks the child to pick up her toys and the child becomes angry and has a temper tantrum. If, when the temper tantrum begins, the mother thinks, “Oh, it’s not worth all this!” and picks up the toys herself, the anger has been negatively reinforced (the child was rewarded by not having to pick up her toys).

What is the purpose of therapeutic communication?

“To relate therapeutically with a patient it is necessary for the nurse to understand his or her role and its relationship to the patient’s illness. They describe the role of the nurse as providing the client with the opportunity to accomplish the following:

Identify and explore problems in relating to others.

Discover healthy ways of meeting emotional needs.

Experience a satisfying interpersonal relationship.

 

What are open ended questions and how are they used in therapeutic communication?

Open-ended questions have an inviting quality and they encourage authentic responses and two-way communication in both personal and professional relationships.

Open-ended questions typically start with “why”, “how”, or phrases like “I would like to know more about”, “Tell me about”, or “I am interested in hearing more about.”

Name the 4 parts of the therapeutic nurse patient relationship and describe the tasks of each stage.

Preinteraction/Preorientation phase (Prior to meeting the patient)

Self-Assessment: Examine one’s own feelings, fears, and anxieties about working with a particular client.

Sizing each other up

Obtain information from secondary sources about the client from chart (significant others, health team members)

Orientation (Introductory) phase

Establish rapport

Establish parameters of relationship

Clarify roles of nurse and patient

You are the authority figure and the patient is there for help

Create an environment for trust and rapport.

Contracting and collaborating in relationship

Talk about what they are capable of doing, what he needs to be doing, what they can handle, negotiating care plan NR320 Mental Health Nursing Exam Study guide

3.Working phase (most of the work you will do)

Explore areas in patients life that cause problems

Gather and analyze data (comprehensive assessment for analyzing)

Promoting patient problem solving

Facilitating and practicing behavioral changes

Teach new coping skills but they need to be expected to practice them while they are in the hospital to help them guide and modify any behaviors

Evaluate and redefine any problems

Constantly going through the care plan to make sure patient followed plan of care (do they need revision or more time?)

Expect the patient to use ineffective coping mechanisms until they could be taught otherwise

2 things that the patient or the nurse does:

Transference: Occurs when the client unconsciously displaces (or “transfers”) to the nurse feelings formed toward a person from the past, e.g., abusive fatheràmay act same way as their abusive father and the patient will automatically take their “baggage” and place it on you

Be aware how this can impact the patient’s feelings/relationship toward nurse

Countertransference: Refers to the nurse’s behavioral and emotional response to the client, e.g., abusive fatheràpatient is an abusive father and that can impact nurse’s feelings NR320 Mental Health Nursing Exam Study guide

Be aware how this can impact your feelings/relationship with the patient

Termination phase

Discuss ways to incorporate new coping system

Reinforcing education received during relationship

Mutually evaluating patient’s progress and goal attainment

Not just the nurse making the decision that patient could go home, it’s the whole team making that decision

Not delusional, having hallucinations, being able to use coping mechanisms learned

Are they safe to go back into community? NR320 Mental Health Nursing Exam Study guide

Group 4

What is a therapeutic relationship about?

Professional, goal directed, scientifically based

Basic communicationàto develop a trusting relationship for the best outcome for your patient

Establish trust

Demonstrate nonjudgmental attitude

Offers self and being empathetic

Uses active listening

Accepts and supports the client’s feelings

Consistency

Pacing: Patient’s pace, not the nurses

Listening

Constant self-assessment

May need to do this several times

Positive initial assessment

Promoting patient comfort, balancing control and establishing trust

Trust is gained over time

What are blurred boundaries? How can these occur in the inpatient area?

Professional boundary concerns commonly include warning signs such as:

Over helping or doing for the patient what they should do for themselves

Controlling them where you are asserting authority and assuming control for the patient’s own good. NR320 Mental Health Nursing Exam Study guide.

The Nurses needs are met at the expense of the patient’s needs

Taking money from a patient

Focus on patient’s needs and problems not nurses

Boundaries and roles remain plain and clear

No confusion on what the nurse’s and patient’s job is

Nonjudgmental attitude of nurse toward patient

Nurse does not enmesh or influence the patient

Hard with children because you want to parent them to fulfill your own needs not the patients

They will come to you and ask what they should do. You need to make sure they have the information to make a sound decision for themselves.

The Nurse does not make the decision

Enmesh: Don’t share with them what your problems are.  The focus is on the patient.  By sharing with the patient you confuse what your role is.

 

What is proxemics? What is the correct therapeutic distance between you and your patient?

Space between you and patient

What is a situational crisis? Why do individuals have them? NR320 Mental Health Nursing Exam Study guide

Dispositional/Situational: Occur when a life event upsets a patient’s equilibrium

Arises for external rather than internal source: usually unanticipated

Usually a situational stressor

Usually involves a loss or change that threatens a person’s self concept and self esteem

Loss of job, death of a loved one, change in financial status, divorce NR320 Mental Health Nursing Exam Study guide

Support system will help determine the severity of the crisis

Good support group will lessen the severity vs. if a person has to face it alone

What is a debrief and what is the purpose of them?

Post Assaultive stage: Critical debriefing

Talk about what happened, what are some things they could do next time

To prevent any further incidents

What is the main goal of de-escalation and physical management techniques?

Pre-assaultive stage: De-escalation stage

Exhibiting anxiety or agitation

Slowly starting to escalate

Nurse should be able to recognize this stage and intervene by distracting them, take nap, phone call, PRN, doctor 1:1

Make sure no one gets hurt

NR320 Mental Health Nursing Exam Study guide

Group 5

What are the anticholinergic side effects of the antipsychotics?

blurred vision, constipation, dry mouth, dizziness, and difficulty urinating.

Older people, and especially those with NCD, are particularly sensitive to these effects because of decreased cholinergic reserves. Many elderly individuals are also at increased risk for developing an anticholinergic toxicity syndrome because of the additive anticholinergic effects of multiple medications

What are some extrapyramidal side effects of the antipsychotics?

EPS symptoms

Side effect of med

Akathisia: what are you taking, are you always restless

Acute dystonia: diff muscle spasm in face, not as common.  More serious bc laryngeal spasm

Taradice dsykenisa: more serious, irreversible, stick tongue out a lot

All preventable, TD can’t go back

Result for long time treatment

AIMS assess symptoms of EPS

NR320 Mental Health Nursing Exam Study guide

What is dialectal behavioral therapy (DBT)? How is this used in mental health?

Dialectical behavior therapy (DBT) is a type of psychotherapy that was originally developed by Marsha Linehan, PhD, as a treatment for the chronic self-injurious and parasuicidal behavior of clients with borderline personality disorder. It is a complex, eclectic treatment that combines the concepts of cognitive, behavioral, and interpersonal therapies with Eastern mindfulness practices five functions of DBT:

To enhance behavioral capabilities

To improve motivation to change

To ensure that new capabilities generalize to the natural environment

To structure the treatment environment such that client and therapist capabilities are supported and effective behaviors are reinforced

To enhance therapist capabilities and motivation to treat clients effectively

What are the components of it? NR320 Mental Health Nursing Exam Study guide

Mindfulness: being focused and learning to live in the present moment, instead of focusing on a million things at once

Regulating emotions: reduce the intensity if emotional pain until the feeling passes

Distress Tolerance: learn the defuse stressful or painful situations resulting in better health

Interpersonal Effectiveness: understand how to set boundaries and clearly express your needs, : it encourages people to express their needs appropriately, adolescents, marital or relationships needs, not getting emotional support and start trying to get their attention in a bad way. Teach them to express their needs instead of doing things that won’t get the point across

 

What is evidence based practiced and how is it used in mental health?

In controlled studies, DBT has been shown to diminish self-destructive behaviors in clients with borderline personality disorder. Additionally, DBT has shown to decrease the drop-out rate from treatment and the number of hospitalizations. Improvement has also been shown in reducing anger and in global and social adjustment scores (Dimeff & Linehan,
2001
). This method of treatment is now being used with other disorders, including substance use disorders, eating disorders, schizophrenia, and post-traumatic stress disorder NR320 Mental Health Nursing Exam Study guide

What is incongruent communication ?

Group 6

Explain what a breach of privacy is and how it might occur in a facility?

 

Discuss intervention for CBT and how these might be used for a patient.

The individual identifies thought distortions

Examines evidence for those thought distortions

Reformats negative thinking and replaces with more realistic thoughts

Learn to use healthy coping mechanisms in order to not return to thought distortions

 

What is the therapist trying to do in CBT?

identifying negative thinking and emotions and restructuring them into positive thinking.

 

How do you evaluate the outcome of care for a patient, using the multidisciplinary team? NR320 Mental Health Nursing Exam Study guide

 

What are ways to work with patients to work on triggers nonaggressively?

 

What is the difference between sympathy and empathy?

Empathy vs. sympathy

Empathy is the ability to vicariously feel or identify what the patient is feeling, versus sympathy is where and individual begins to identify with the patient to the extent of feeling sorry for them.

Empathy opens up communication

Use of open ended sentences to gain more information

Sympathy will not gain additional information (shut them down)

This may result in a Nurse crossing the professional line. Warning signs:

Self-disclosure

Gift-giving

Touch

Friendship or romantic association

Sharing personal information or work concerns with the client

Receiving of gifts or continued contact/ communication with the client after discharge

 

What is akathisia

See pic above

a state of agitation, distress, and restlessness that is an occasional side-effect of antipsychotic and antidepressant drugs NR320 Mental Health Nursing Exam Study guide

Research Critiques and PICOT Statement Final Draft

Prepare this assignment as a 1,500-1,750 word paper using the instructor feedback from the previous course assignments and the guidelines below.

PICOT Question

Revise the PICOT question you wrote in the Topic 1 assignment using the feedback you received from your instructor.

The final PICOT question will provide a framework for your capstone project (the project students must complete during their final course in the RN-BSN program of study).

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Research Critiques

In the Topic 2 and Topic 3 assignments, you completed a qualitative and quantitative research critique on two articles for each type of study (4 articles total). Use the feedback you received from your instructor on these assignments to finalize the critical analysis of each study by making appropriate revisions.

The completed analysis should connect to your identified practice problem of interest that is the basis for your PICOT question.

Refer to ”Research Critiques and PICOT Guidelines – Final Draft.” Questions under each heading should be addressed as a narrative in the structure of a formal paper. Research Critiques and PICOT Statement Final Draft.

Proposed Evidence-Based Practice Change

Discuss the link between the PICOT question, the research articles, and the nursing practice problem you identified. Include relevant details and supporting explanation and use that information to propose evidence-based practice changes.

 

Research Critique Guidelines

Qualitative Study

Background of Study:

Identify the clinical problem and research problem that led to the study. What was not known about the clinical problem that, if understood, could be used to improve health care delivery or patient outcomes? This gap in knowledge is the research problem.

How did the author establish the significance of the study? In other words, why should the reader care about this study? Look for statements about human suffering, costs of treatment, or the number of people affected by the clinical problem. Research Critiques and PICOT Statement Final Draft.

Identify the purpose of the study. An author may clearly state the purpose of the study or may describe the purpose as the study goals, objectives, or aims.

List research questions that the study was designed to answer. If the author does not explicitly provide the questions, attempt to infer the questions from the answers.

Were the purpose and research questions related to the problem?

Method of Study:

Were qualitative methods appropriate to answer the research questions?

Did the author identify a specific perspective from which the study was developed? If so, what was it?

Did the author cite quantitative and qualitative studies relevant to the focus of the study? What other types of literature did the author include?

Are the references current? For qualitative studies, the author may have included studies older than the 5-year limit typically used for quantitative studies. Findings of older qualitative studies may be relevant to a qualitative study.

Did the author evaluate or indicate the weaknesses of the available studies?

Did the literature review include adequate information to build a logical argument?

When a researcher uses the grounded theory method of qualitative inquiry, the researcher may develop a framework or diagram as part of the findings of the study. Was a framework developed from the study findings? Research Critiques and PICOT Statement Final Draft.

 

Results of Study

What were the study findings?

What are the implications to nursing?

Explain how the findings contribute to nursing knowledge/science. Would this impact practice, education, administration, or all areas of nursing?

Ethical Considerations

Was the study approved by an Institutional Review Board?

Was patient privacy protected? Research Critiques and PICOT Statement Final Draft.

Were there ethical considerations regarding the treatment or lack of?

Conclusion

Emphasize the importance and congruity of the thesis statement.

Provide a logical wrap-up to bring the appraisal to completion and to leave a lasting impression and take-away points useful in nursing practice.

Incorporate a critical appraisal and a brief analysis of the utility and applicability of the findings to nursing practice.

Integrate a summary of the knowledge learned.

 

Quantitative Study

Background of Study:

Identify the clinical problem and research problem that led to the study. What was not known about the clinical problem that, if understood, could be used to improve health care delivery or patient outcomes? This gap in knowledge is the research problem. Research Critiques and PICOT Statement Final Draft.

How did the author establish the significance of the study? In other words, why should the reader care about this study? Look for statements about human suffering, costs of treatment, or the number of people affected by the clinical problem.

Identify the purpose of the study. An author may clearly state the purpose of the study or may describe the purpose as the study goals, objectives, or aims.

List research questions that the study was designed to answer. If the author does not explicitly provide the questions, attempt to infer the questions from the answers.

Were the purpose and research questions related to the problem?

 Methods of Study

Identify the benefits and risks of participation addressed by the authors. Were there benefits or risks the authors do not identify?

Was informed consent obtained from the subjects or participants?

Did it seem that the subjects participated voluntarily in the study?

Was institutional review board approval obtained from the agency in which the study was conducted?

Are the major variables (independent and dependent variables) identified and defined? What were these variables?

How were data collected in this study?

What rationale did the author provide for using this data collection method?

Identify the time period for data collection of the study. Research Critiques and PICOT Statement Final Draft.

Describe the sequence of data collection events for a participant.

Describe the data management and analysis methods used in the study.

Did the author discuss how the rigor of the process was assured? For example, does the author describe maintaining a paper trail of critical decisions that were made during the analysis of the data? Was statistical software used to ensure accuracy of the analysis?

What measures were used to minimize the effects of researcher bias (their experiences and perspectives)? For example, did two researchers independently analyze the data and compare their analyses?

Results of Study

What is the researcher’s interpretation of findings?

Are the findings valid or an accurate reflection of reality? Do you have confidence in the findings? Research Critiques and PICOT Statement Final Draft.

What limitations of the study were identified by researchers?

Was there a coherent logic to the presentation of findings?

What implications do the findings have for nursing practice? For example, can the findings of the study be applied to general nursing practice, to a specific population, or to a specific area of nursing?

What suggestions are made for further studies?

Ethical Considerations

Was the study approved by an Institutional Review Board?

Was patient privacy protected?

Were there ethical considerations regarding the treatment or lack of?

Conclusion

Emphasize the importance and congruity of the thesis statement.

Provide a logical wrap-up to bring the appraisal to completion and to leave a lasting impression and take-away points useful in nursing practice.

Incorporate a critical appraisal and a brief analysis of the utility and applicability of the findings to nursing practice. Research Critiques and PICOT Statement Final Draft.

Integrate a summary of the knowledge learned.

Reference

Burns, N., & Grove, S. (2011).
Understanding nursing research
(5th ed.). St. Louis, MO: Elsevier.

Critique and ethical considerations

Article 1.

“Bloom, L., Boyle, K. E., Myers, A. E., Blacketer, C., & Weinstein, R. (2019). Frequency of nonaspirin NSAID-relevant coexisting medical conditions in the primary-care setting: A retrospective database review.
Therapeutics and Clinical Risk Management
, 15, 579-588. doi: 10.2147/tcrm.s189833” Research Critiques and PICOT Statement Final Draft.

Summary

Bloom et al. (2019) present the results of a retrospective database review to determine how coexisting medical conditions and non-steroidal anti-inflammatory drugs (NSAIDs) influence treatment modalities as noted in primary care practices. The retrospective approach collected data from the claim databases of three medical facilities with a focus on patients either 18 years of age or older. The data was collected for the period covering 2013. Research Critiques and PICOT Statement Final Draft. The focus was on non-aspirin NSAID-relevant coexisting medical conditions of interest (CMCOI), asthma, cardiovascular risk factors, gastrointestinal bleeding risk factors, and renal insufficiency. Statistical analysis of the collected data determined that patients with musculoskeletal diagnosis reported a significantly higher risk of treatment challenges when compared to their counterparts without musculoskeletal diagnosis. Similarly, age was noted to influence treatment challenges, with an increase in age being matched by an increase in the occurrence of treatment challenges. The reported results indicate that non-aspirin NSAID-relevant CMCOI and age are useful statistical for use among primary care professionals with regards to predicting the occurrence of treatment challenges. In fact, the results show that even as patients advance in age, their medical conditions change and their reactions to different medications also change. Using the information, primary care professionals can identify patients at high risk and offer them guidance on how their age, health status, concomitant conditions, and medication influence treatment modalities (Bloom et al., 2019). Research Critiques and PICOT Statement Final Draft.

Using findings in nursing practice

The findings from Bloom et al. (2019) are useful to nursing personnel who act as primary care professionals. That is because NSAIDs are a common medication that are typically prescribed or recommended for almost all medical conditions. Although commonly used, NSAIDs are associated with substantial side effects and complications for a particular demographic of patients. Despite the labels for NSAIDs listing these side effects and complications, patients and medical personnel would often overlook them thereby presenting opportunities for them to occur with potentially fatal effects. Research Critiques and PICOT Statement Final Draft. Through identifying this demographic of patients, nurses are able to anticipate the care complications and offer appropriate advice on how to either address or prevent the complications. Besides that, they can use their position as primary care professionals to reinforce the importance of the advice contains in the labels as instructions and not simply suggestions. Overall, the findings allow nursing practice to contribute towards the safe use of NSAIDs as well as improving care outcomes through anticipating and addressing treatment challenges Research Critiques and PICOT Statement Final Draft.

Ethical considerations for the study

Bloom et al. (2019) does not mention how ethical concerns were addressed in the study. However, there is a need to address the ethical aspects of retrospective database review studies, especially with regards to the primary concern of issues pertaining to confidentiality and informed consent. Besides that, the study received approval from The New England Institutional Review Board (NEIRB, 12–284), specifying that the study did not meet the definition of human-subject research thus not requiring its approval.

The study is based on information that is already available as medical records with the researcher only required to retrieve the information. This is an indication that the ethical concern about confidentiality and informed concern is an inherent concern since the researchers do not have direct contact with patients. The concern is further highlighted by the fact that medical records are not collected with the explicit intention of informing research studies. As such, there is no a-priori informed consent for the records to be used in research studies. In essence, using the records is ethically questionable since confidential information is accessed and could be misused thereby jeopardizing the relationship between patients and doctors. This is particularly true when sensitive data is accessed by persons not bound by patient-doctor confidentiality, leading to unwanted disclosure that would distress and cause difficulties for the patient. Research Critiques and PICOT Statement Final Draft. Given the nature of medical records and the difficulty in getting informed consent from patients, retrospective studies using these records can address the ethical concerns about informed consent and confidentiality through four approaches. Firstly, minimal information should be collected and only if necessary. The collected information should only include routine clinical information that does not require informed consent. Secondly, any information that could identify the patients should be eliminated or coded to conceal the patients’ identities. Thirdly, safeguards should be implemented to ensure the ethical use of the collected information, such as having protocols for the information storage and authorized access. Research Critiques and PICOT Statement Final Draft. Finally, ethical clearance should be sought from an Institutional Review Board (IRB) that provides the required oversight (Sarkar & Seshadri, 2014).

Article 2.

“Lai, K. M., Chen, T., Chang, C., Chen, H., & Lee, Y. (2019). Association between NSAID use and mortality risk in patients with end-stage renal disease: A population-based cohort study.
Clinical Epidemiology
, 11, 429-441. doi: 10.2147/clep.s204322”

Summary

Lai et al. (2019) presents the results of a study that investigated the association between NSAIDs use and risk of mortality for persons diagnosed with end-stage renal disease. It acknowledges that pain is a concern among persons diagnosed with end-stage renal disease and it is not uncommon for NSAIDs to be administered. Research Critiques and PICOT Statement Final Draft. However, it notes that although the pain associated with the disease is a concern and NSAIDs can partially address this concern, of greater concern is the risks associated with the use of NSAIDs. The study seeks to document the risks, providing evidence to show that the adverse effects are tangible thus informing patients and clinicians. Towards this end, the study applies a retrospective approach that collects data from the Taiwan National Health Insurance Research Database. The selected population sample is for 1 million patients records selected from among 27 million patients records covering the period between 1997 and 2013. The study determined that 78% (2,623) of persons diagnosed with end-stage renal disease and requiring long-term dialysis used NSAIDs. During the study period that covered four years, 1,515 patients in the study population died. The study determined that the use of NSAIDs significantly increased the risk of all-cause mortality for persons diagnosed with end-stage renal disease (Lai et al., 2019) Research Critiques and PICOT Statement Final Draft.

Using findings in nursing practice

The study results are useful for improving care outcomes for persons diagnosed with end-stage renal disease. Using the study results, nursing practice can recommend alternatives to NSAIDs that reduce the risk of mortality. In addition, the results can be used to justify stringent monitoring of patients using NSAIDs so as to reduce the risk of mortality (Lai et al., 2019).

Ethical considerations for the study

Lai et al. (2019) mentions that the study was approved by the Joint Institutional Review Board of Taipei Medical University, and the requirement of patient-informed consent was waived (TMU-JIRB No. N201506025). The approval is an indication that the study did not pose any avoidable risk to the participants. Still, the study makes use of medical records thus raising ethical concerns with regards to confidentiality and informed consent since it would be difficult to obtain consent from all participants before the information was used. Research Critiques and PICOT Statement Final Draft. Although there is no mention of how these concerns were addressed, there is an indication that they were addressed through four approaches. Firstly, minimal information was collected with focus on what was necessary to inform the study and does not require informed consent. Secondly, information was coded to conceal the patients’ identities. Finally, ethical clearance was sought from an IRB that provided the required oversight (Sarkar & Seshadri, 2014).

References

Bloom, L., Boyle, K. E., Myers, A. E., Blacketer, C., & Weinstein, R. (2019). Frequency of nonaspirin NSAID-relevant coexisting medical conditions in the primary-care setting: A retrospective database review.
Therapeutics and Clinical Risk Management
, 15, 579-588. doi: 10.2147/tcrm.s189833

Lai, K. M., Chen, T., Chang, C., Chen, H., & Lee, Y. (2019). Association between NSAID use and mortality risk in patients with end-stage renal disease: A population-based cohort study.
Clinical Epidemiology
, 11, 429-441. doi: 10.2147/clep.s204322 Research Critiques and PICOT Statement Final Draft

Sarkar, S. & Seshadri, D. (2014). Conducting record review studies in clinical practice.
Journal of Clinical & Diagnostic Research
, 8(9), JG01-JG04. doi: 10.7860/JCDR/2014/8301.4806

 

PICOT statement and research critiques

PICOT statement

The PICOT question is presented as: “In patients with normal renal function who have had recent surgery (P), does the use of NSAIDs (I) increase the future risk of adverse renal effects (O) compared with non-use of NSAIDs (C) during recuperation (T)?”

The PICOT question has five elements as discussed:

P
: patient population – describes the unique demographic qualities that identify the study population. In this case, the study population is restricted to patient who recently underwent surgery and require pain medication for which NSAIDs are an option. Research Critiques and PICOT Statement Final Draft.

I
: indicator/intervention – describes the variable of interest in the study as a prognostic factor. In the present case, the prognostic factor is the use of NSAIDs that is suspected of significantly increasing adverse renal events among the patient population.

C
: control/comparison – describes the absence of the prognostic factor thereby facilitating effective comparison efforts. In the present case, the prognostic factor is the non-use of NSAIDs.

O
: outcome – describes the risk or rate of the adverse outcome occurred that is determined as adverse renal effects for the present study.

T
: time – identifies how long it takes to observe the study participants. In the present case, the time describes the recuperations time when the patient is an invalid and recuperating following the surgery. Research Critiques and PICOT Statement Final Draft.

Qualitative study critique

Bloom, L., Boyle, K. E., Myers, A. E., Blacketer, C., & Weinstein, R. (2019). Frequency of nonaspirin NSAID-relevant coexisting medical conditions in the primary-care setting: A retrospective database review.
Therapeutics and Clinical Risk Management
, 15, 579-588. doi: 10.2147/tcrm.s189833

Background of study

The study sought to determine how coexisting medical conditions and non-steroidal anti-inflammatory drugs (NSAIDs) influence treatment modalities as noted in primary care practices. It notes that NSAIDs use has become increasingly prevalent among patients visiting personnel. It further notes that the use of these medication is accompanied by an inherent risk linked to patient demographics that include concomitant medication, age and coexisting medical conditions. Despite the inherent risks and warnings from medical personnel on these risks, it is not uncommon for patients to continue using NSAIDs even when the risk of adverse effects is heightened. The study seeks to address this information gap by identifying the proportion of patients who are at high risk of reporting adverse reactions from using NSAIDs (Bloom et al., 2019). As such, the study seeks to provide qualitative evidence on the extent and distribution of NSAIDs among patients at high risk of reporting adverse reactions. Research Critiques and PICOT Statement Final Draft.

Method of study

To study applied a retrospective database review approach. The retrospective approach collected data from the claim databases of three medical facilities with a focus on patients either 18 years of age or older. Research Critiques and PICOT Statement Final Draft. The data was collected for the period covering 2013. The focus was on non-aspirin NSAID-relevant coexisting medical conditions of interest (CMCOI), asthma, cardiovascular risk factors, gastrointestinal bleeding risk factors, and renal insufficiency (Bloom et al., 2019). The methodology is appropriate since it focused on collecting the required information from the population of interest.

Results of study

The reported results indicate that non-aspirin NSAID-relevant CMCOI and age are useful statistical for use among primary care professionals with regards to predicting the occurrence of treatment challenges. In fact, the results show that even as patients advance in age, their medical conditions change and their reactions to different medications also change (Bloom et al., 2019). Using this information, primary care professionals can identify patients at high risk and offer them guidance on how their age, health status, concomitant conditions, and medication influence treatment modalities. Research Critiques and PICOT Statement Final Draft.

The findings from Bloom et al. (2019) are useful to nursing personnel who act as primary care professionals. That is because NSAIDs are a common medication that are typically prescribed or recommended for almost all medical conditions. Although commonly used, NSAIDs are associated with substantial side effects and complications for a particular demographic of patients. Despite the labels for NSAIDs listing these side effects and complications, patients and medical personnel would often overlook them thereby presenting opportunities for them to occur with potentially fatal effects. Through identifying this demographic of patients, nurses are able to anticipate the care complications and offer appropriate advice on how to either address or prevent the complications. Besides that, they can use their position as primary care professionals to reinforce the importance of the advice contains in the labels as instructions and not simply suggestions Research Critiques and PICOT Statement Final Draft. Overall, the findings allow nursing practice to contribute towards the safe use of NSAIDs as well as improving care outcomes through anticipating and addressing treatment challenges.

Ethical considerations

Although the study does not mention how ethical concerns were addressed in the study. However, there is a need to address the ethical aspects of retrospective database review studies, especially with regards to the primary concern of issues pertaining to confidentiality and informed consent. Besides that, the study received approval from The New England Institutional Review Board (NEIRB, 12–284), specifying that the study did not meet the definition of human-subject research thus not requiring its approval (Bloom et al., 2019). Research Critiques and PICOT Statement Final Draft.

The study is based on information that is already available as medical records with the researcher only required to retrieve the information. This is an indication that the ethical concern about confidentiality and informed concern is an inherent concern since the researchers do not have direct contact with patients. The concern is further highlighted by the fact that medical records are not collected with the explicit intention of informing research studies. As such, there is no a-priori informed consent for the records to be used in research studies. In essence, using the records is ethically questionable since confidential information is accessed and could be misused thereby jeopardizing the relationship between patients and doctors. This is particularly true when sensitive data is accessed by persons not bound by patient-doctor confidentiality, leading to unwanted disclosure that would distress and cause difficulties for the patient. Given the nature of medical records and the difficulty in getting informed consent from patients, retrospective studies using these records can address the ethical concerns about informed consent and confidentiality through four approaches. Firstly, minimal information should be collected and only if necessary. The collected information should only include routine clinical information that does not require informed consent. Secondly, any information that could identify the patients should be eliminated or coded to conceal the patients’ identities. Thirdly, safeguards should be implemented to ensure the ethical use of the collected information, such as having protocols for the information storage and authorized access Research Critiques and PICOT Statement Final Draft. Finally, ethical clearance should be sought from an Institutional Review Board (IRB) that provides the required oversight (Sarkar & Seshadri, 2014).

Conclusion

The research applied a qualitative approach that used a retrospective methodology. It notes that NSAIDs use is common among patients. In addition, it notes that although NSAIDs use is typically accompanied by warnings on use, these warnings are typically ignored. It further adds that patients and medical personnel often overlook the labels for NSAIDs listing these side effects and complications. The result is that NSAIDs use remains high among patients at high risk of adverse reactions. Given these results, the study recommends greater awareness of NSAIDs side effects and complications with a focus on identifying patients at high risk of adverse reactions and ensuring that their use of NSAIDs is controlled. Research Critiques and PICOT Statement Final Draft.

Quantitative study critique

Gawande, A., Gupta, G. K., Gupta, A., Wanjari, S. J., Goel, V., Rathore, V., . . . Nijhawan, S. (2019). Acute-on-Chronic Liver Failure: Etiology of Chronic and Acute Precipitating Factors and Their Effect on Mortality.
Journal of Clinical and Experimental Hepatology
. doi: 10.1016/j.jceh.2019.04.050

Background of study

Gawande et al. (2019) presents research results from a study on etiologies, course, and outcome in patients with acute-on-chronic liver failure (ACLF) was determined. In fact, it presents the results of a study that investigated the prevalence of ACLF as a health issue, the underlying etiology, precipitating factors for the health issue, and the associated mortality. It notes that ACLF is a medical condition that requires greater understanding in order to implement the appropriate interventions. In line with this awareness, the study objective was to collect information that informs ACLF. The underlying intention was to identify an appropriate risk factor and prevention strategy (Gawande et al., 2019). Research Critiques and PICOT Statement Final Draft.

Methods of study

The research applied a quantitative methodology. In this case, the study recruited 208 participants who included 182 males and 26 females. The participants were recruited between October 2015 and December 2017, all from the gastroenterology department of SMS Medical College and Hospital in Jaipur (Gawande et al., 2019). The research methodology is appropriate since it recruited a large sample that improved the results generalizability. Still, the methodology has a shortcoming with regards to not mentioning whether a third party verified the statistical analysis and study results, and the software used to conduct data analysis. These shortcomings allow for researcher bias.

Results of study

The study reported that the most common etiology for ACLF are alcohol (63.94%), viral hepatitis (15.4%), cryptogenic cirrhosis (13.94%), autoimmunity (4.3%), nonalcoholic steatohepatitis (1.4%), and Wilson disease (1%). Research Critiques and PICOT Statement Final Draft. Mortality for inpatients was reported at 37.5% (p<0.05). The study determined that the identified factors (alcohol, viral hepatitis, cryptogenic cirrhosis, autoimmunity, nonalcoholic steatohepatitis, and Wilson disease) are precipitating factors linked with etiology for ACLF, and they should be noted as factors that increase mortality. It concludes that the identified precipitating factors should be noted in liver health management since they are predictors of mortality (Gawande et al., 2019). The study results are useful for improving care outcomes for persons diagnosed with ACLF or at risk of developing liver disease. The findings offer statistical evidence to link the identified predictive factors ACLF occurrence and mortality. Using the study results nursing practice can present liver management protocols that offer the high risk factors to be noted to improve care outcomes. Of particular concern would be alcohol that is noted to significantly increase the risk of mortality for persons with ACLF (Gawande et al., 2019) Research Critiques and PICOT Statement Final Draft. Ethical considerations Gawande et al. (2019) mentions that the study was approved by an institutional review board (IRB) to imply that the study did not pose a threat to the participants with appropriate measures applied to adequately protect them. In addition, informed consent was sought from the participants. The measures applied in the study address concerns about beneficence (do no harm) and informed consent (Gawande et al., 2019). Babbie (2016) adds to the discussion by mentioning that in addition to beneficence and informed consent, the study should address confidentiality, respect for anonymity, and respect for privacy. It mentions that even as medical research focuses on advocacy, protecting dignity, preventing harm and caring, it should not forget to defend the rights of the research participants as an incongruent aspect of ethics. As such, there study should detail how it addressed ethical concerns about respect for privacy, confidentiality and anonymity. Still, IRB approval is an indication that these ethical concerns were addressed, although not mentioned in the literature (Babbie, 2016) Research Critiques and PICOT Statement Final Draft. Conclusion The research assesses the etiologies, course, and outcome in patients with ACLF. Towards this end, that study applied a quantitative methodology that recruited 208 participants with ACLF. Ethical approval was sought from an IRB to ensure that the participants’ rights were protected. The study results reported that the most common etiology for ACLF are alcohol (63.94%), viral hepatitis (15.4%), cryptogenic cirrhosis (13.94%), autoimmunity (4.3%), nonalcoholic steatohepatitis (1.4%), and Wilson disease (1%). Mortality for inpatients was reported at 37.5% (p<0.05). Based on these results, it is possible to improve ACLF care outcomes by reducing the risk factors.   References Babbie, E. (2016). The basics of social research (7 th ed.). Boston, MA: Cengage Learning. Bloom, L., Boyle, K. E., Myers, A. E., Blacketer, C., & Weinstein, R. (2019). Frequency of nonaspirin NSAID-relevant coexisting medical conditions in the primary-care setting: A retrospective database review. Therapeutics and Clinical Risk Management , 15, 579-588. doi: 10.2147/tcrm.s189833 Gawande, A., Gupta, G. K., Gupta, A., Wanjari, S. J., Goel, V., Rathore, V., . . . Nijhawan, S. (2019). Acute-on-Chronic Liver Failure: Etiology of Chronic and Acute Precipitating Factors and Their Effect on Mortality. Journal of Clinical and Experimental Hepatology , In Press. doi: 10.1016/j.jceh.2019.04.050 Research Critiques and PICOT Statement Final Draft Sarkar, S. & Seshadri, D. (2014). Conducting record review studies in clinical practice. Journal of Clinical & Diagnostic Research , 8(9), JG01-JG04. doi: 10.7860/JCDR/2014/8301.4806 Research Critiques and PICOT Statement Final Draft