Tag: Clinical-Nursing

NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations

Main Question Post

Discussion Week 1

Organizational Foundations

An organizations vision, mission, and values act as guidance to where the organization is going and provides purpose to the work and services they provide (Marquis & Huston, 2015).  A fundamental concept that leaders must embrace is that an organization can only aspire to vision it has established as the acts as a path to the destination (Marquis & Huston, 2015).  NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations. The purpose of this post is to describe my organization’s mission, vision, and values, outline how leaders in the organization support the mission, vision, and values, discuss the culture and climate of the organization and differences between them and lastly, discuss the significance of understanding this information as a nursing leader.

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Mission, Vision, and Values

ThedaCare has a long standing history of serving the community and enriching the lives of the people it serves.  The mission statement that guides the organization is centered on improving the health of the communities that they serve (ThedaCare, 2017).  The vision is “peace of mind for all we serve” (ThedaCare, 2017). NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations.  The values that align and support the mission and the vision include putting the customer first, possessing a thirst for learning, being courageous, and loving our work (ThedaCare, 2017).

Congruency Leadership with Organization

Leaders within the ThedaCare organization not only know and understand the mission, vision, and values of the organization they live them.  An action that demonstrates the mission, vision, and values includes volunteer work in the community.  Additionally, leader’s aid in shaping a culture through front line staff that represents and lives our mission, vision, and values.  Daily huddles are held where information is shared relating to system work that is happening and how it correlates with our outlined values NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations. Leaders hold themselves and the employees that they are leading accountable for their actions and patient outcomes. ThedaCare is transparent not only to the 7,000 employees but to the community and the people it serves.  The examples provided are just a few ways that demonstrate how leadership supports the organization’s mission, vision, and values.

Culture and Climate

Culture and climate are two fundamental key concepts that differ greatly, but both play a critical role in shaping an organization.  Culture is collectively custom and value driven (Marquis & Huston, 2015).  Climate refers to the perception of employees regarding the organization (Marquis & Huston, 2015).  Culture and climate are often blurred, but it is essential as a leader to understand the differences and the role that leadership plays in creating and influencing each of them. NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations.

Culture

Business Dictionary.com (2013) stated: “organizational culture includes an organization’s expectations, experiences, philosophy, and values that hold it together, and it is expressed in its self-image, inner workings, interactions with the outside world, and future expectations” (para, 1).  ThedaCare has an expectation that employees will demonstrate the mission, vision, and values part of development planning is discussion and developing individualized plans with employees to understand and grow in alignment with the organization.  NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations Values guide the trajectory of behaviors acting as guidelines for those who are in the organization to follow (Nelson & Gardent, 2011).  Having a community focus and servant attitude towards the people we serve has enriched our community and made the organization more than just a job, but instead created a synergistic positive atmosphere where people are helping people, and we all are better because of it.

Climate

            
An organizations climate refers to the employee’s perception of the organization (Marquis & Huston, 2015).  Currently, within ThedaCare the adoption of the shared governess model as aided is shaping a positive climate.  Employees feel engaged and valued as they have decision making power related and a voice in implementing evidence-based practice (EBP) into workflows and standards. NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations The culture heavily influences Employee’s perception of the organization.

Significance as Nurse Leader

It is critical that leaders understand the mission, vision, and values of an organization.  The individuals that the leader is mentoring to are watching and following their example.  It is essential that leaders are conducting their actions and behaviors in a manner that is congruent with the organization.  An organizations culture and climate are closely related and impact one another.  A leader needs to possess a firm grasp on the climate and culture to lead effectively ultimately shaping and molding both in a positive direction to create a positive environment that steers followers closer to the mission, vision, and values. NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations.

Summary

            
An organization’s mission, vision, and values set the trajectory of where they are going.  ThedaCare has a long standing history of serving and enriching the community it serves.  Leaders within ThedaCare understand and support the mission, vision, and values as demonstrated by their leadership in daily work and operations. Culture relates to expectations, values, and philosophy whereas climate relates to employee perception. Nurse leaders play a fundamental role in shaping culture and climate along with upholding their followers towards the organization’s mission, vision, and values NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations.

References

Business Dictionary.com. (2013). 
Organizational culture: Definition. 
Retrieved from http://www.businessdictionary.com/definition/organizational-culture.html

Laureate Education, Inc. (Executive Producer). (2012c). Factors that influence organizational cultures: Coastal Medical Associates, Salisbury, MA. Baltimore, MD. Author.

Marquis, B. L., & Huston, C. J. (2015). 
Leadership roles and management functions in nursing: Theory and application 
(8
th
 ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.

Nelson, W. A., & Gardent, P. B. (2011).  Organizational values statements. 
Healthcare Executive, 26
(2), 56-59.

ThedaCare. (2017). Mission, Vision, Values. Retrieved May 29, 2017, from https://www.thedacare.org/about-us/Mission%20Vision%20Values.aspx NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations.

 

NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations

As you strive to grow in your leadership skills and abilities, you will find that the context in which you work influences your motivation and areas of focus. In a similar vein, your commitment to developing professionally can contribute toward organizational effectiveness.

To that end, it is critical to recognize the importance of organizational culture and climate. In particular, through this week’s Learning Resources, you may consider several questions: How do an organization’s mission, vision, and values relate to its culture? What is the difference between culture and climate? NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations. Moreover, how are culture and climate manifested within the organization?

For this Discussion, you explore the culture and climate of your current organization or one with which you are familiar. You also consider decisions and day-to-day practices and the way they relate to the organization’s mission, vision, and values.

To prepare:

Review the information related to planning and decision making in health care organizations presented in the textbook, Leadership Roles and Management Functions in Nursing: Theory and Application. Consider how planning and decision making relate to an organization’s mission, vision, and values, as well as its culture and its climate.

Familiarize yourself with the mission, vision, and values of your organization or one with which you are familiar. Consider how the statements and actions of leaders and others within the organization support or demonstrate the organizational mission, vision, and values. In addition, note any apparent discrepancies between word and deed. Think about how this translates into expectations for direct service providers. Note any data or artifacts that seem to indicate whether behaviors within the organization are congruent with its mission, vision, and values NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations.

Begin to examine and reflect on the culture and climate of the organization. How do culture and climate differ?

Why is it important for you, as a master’s-prepared nurse leader, to be cognizant of these matters?

Post a description of your selected organization’s mission, vision, and values. Describe relevant data, or artifacts, words, and actions of leaders and others in the organization that support, or perhaps appear to contradict the organization’s mission, vision, and values statement. In addition, discuss the organization’s culture and its climate, differentiating between the two. Explain why examining these matters is significant to your role as a nurse leader NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations.

Learning Resources

Required Readings

Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.

Chapter 1, “Decision Making, Problem Solving, Critical Thinking, and Clinical Reasoning: Requisites for Successful Leadership and Management” . Chapter 1 provides information relevant to this week’s Discussion and serves as a foundation for topics explored in future weeks of the course NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations. The authors note that decision making, problem solving, critical thinking, and critical reasoning are integral to both leadership and management and beneficial as one examines leadership and management issues. As you read this chapter, focus primarily on the “Decision Making in Organizations” section.

Chapter 7, “Organizational Planning” . This chapter introduces planning and highlights some of the trends that are likely to impact health care organizations now and in the future. It also addresses vision and mission statements, which are essential for guiding planning and decision making in health care settings. NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations.

Chapter 12, “Organizational Structure”. This chapter addresses organizational culture.

Business Dictionary.com. (2013) Organizational culture: Definition. Retrieved from http://www.businessdictionary.com/definition/organizational-culture.html

Nelson, W. A., & Gardent, P. B. (2011). Organizational values statements. Healthcare Executive, 26(2), 56–59.

Retrieved from the Walden Library databases.

This article focuses on the impact that organizational values statements have on an organization’s mission. For employees to follow value statements, leaders must effectively model those values day in and day out.

Plath, D. (2013). Organizational processes supporting evidence-based practice. Administration in Social Work, 37(2), 171–188. doi:10.1080/03643107.2012.672946

Retrieved from the Walden Library databases. NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations.

Rai, G. S. (2013). Job satisfaction among long-term care staff: Bureaucracy isn’t always bad. Administration in Social Work, 37(1), 90–99. doi:10.1080/03643107.2012.657750

Retrieved from the Walden Library databases.

Watkins, M. (2013, May). What is organizational culture? Retrieved from https://hbr.org/2013/05/what-is-organizational-culture

This site offers several descriptions of organizational culture. These perspectives provide the kind of holistic, nuanced view of organizational culture that is needed by leaders in order to truly understand their organizations—and to have any hope of changing them for the better.

Online Assessments

Note: Results from the following assessment are required for the course.

Keirsey Temperament Sorter (KTS-II). (n.d.). Retrieved from http://www.keirsey.com/

Please complete the online assessment and receive a free mini report. Additionally, more extensive reports are available for purchase and are optional. You should complete the Keirsey Temperament Sorter assessment early in the course so you will be prepared to discuss the results in Week 9 NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations.

Required Media

Laureate Education (Producer). (2012e). Foundations of an organization and organizational assessment. Baltimore, MD: Author.

In this week’s media presentation, experts from a diverse group of health care organizations share insights on how an organization’s mission, vision, and values influence its daily practices.

Laureate Education (Producer). (2012c). Factors that influence organizational cultures: Coastal Medical Associates, Salisbury, MA. Baltimore, MD: Author.

Laureate Education (Producer). (2012d). Factors that influence organizational cultures: Huntington Hospital, Pasadena, CA. Baltimore, MD: Author. NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations.

Optional Resources

You may find the following online assessments useful as you proceed through the course:

Appraisal 360. (n.d.). Retrieved from http://www.appraisal360.co.uk/

HumanMetrics. (n.d.). Jung Typology Test. Retrieved from http://www.humanmetrics.com/cgi-win/jtypes2.asp

Leadership-Tools.com. (2012). 360 degree feedback leadership tool. Retrieved from http://www.leadership-tools.com/360-degree-feedback-leadership.html

Union Rescue Mission. (Executive Producer). (2012). Stories from Skid Row [Video file]. Retrieved from http://urm.org/solution/stories-from-skid-row/ NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations

NURS 6053 INTERPROFESSIONAL ORGANIZATIONAL AND SYSTEMS LEADERSHIP

MAIN QUESTION POST

Mission, Vision, and Values

The mission of my organization, the University of Maryland Baltimore Washington Medical Center (BWMC), “is to provide the highest quality health care services to the communities we serve” (“Mission & Vision”, 2016).  The vision statement of the organization is “to be the preferred regional medical center through nationally recognized quality, personalized service and outstanding people” (“Mission & Vision”, 2016) NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations.  The organization did not have a values statement.  In support of the mission statement, the organization is active in the community.  They have established community health services that provide flu shot clinics, blood drives, blood pressure screenings, and health education classes about various topics and health conditions.  Based on my research, the organization falls short of being the preferred regional medical center and appears to contradict its vision statement currently.  “A vision presents what the organization wants to become and gives direction for the organization’s future” (Nelson & Gardent, 2011, p. 56).  The organization could reach its goal with the vision statement in the future.

In addition to not being rated one of the highest quality health organizations, there is relevant data and actions of leaders and others in the organization that contradict this organization’s mission and values.  Patients have complained about care received within the organization coupled with medication and surgical errors that occur, contradicts providing the highest quality healthcare.  Patients admitted to the inpatient floors complain of being stuck 10 to 15 times by staff attempting to initiate IV access.  The vascular access team (VAT) arrives at the bedside of these patients due to them being labeled as ‘hard sticks’ and are establishing IV access/drawing blood in one attempt.  Patients are also arriving from the emergency department with EJ’s (an IV in the neck in the external jugular) and the VAT is placing multiple IV’s in these same patients without difficulty.  Floor nurses are attempting to access implanted ports in their patients but are accessing the subcutaneous tissue in the chest instead.  There is an overwhelming amount of infiltrated IV’s left in patients, most of which are still left infusing.    Nurses are not familiar with the policies and procedures of the organization and therefore, are susceptible to unethical practices.  Nursing leaders within the organization are far removed from the clinical aspect of nursing and would prefer not to be made aware of issues until patients are injured or worse NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations.  A values statement is missing from the organization, which according to Nelson & Gardent (2011) represents the core principles within an organization’s culture and should be integrated in nursing decisions and behaviors.

Organizational Culture and Climate

“Organizational culture is the total of an organization’s values, language, traditions, customs, and sacred cows—those few things present in an institution that are not open to discussion or change” (Marquis & Huston, 2017, p. 305).  Comparably, BusinessDictionary.com (2016) defines organizational culture as “the values and behaviors that contribute to the unique social and psychological environment of an organization.  Organizational culture includes an organization’s expectations, experiences, philosophy, and values that hold it together, and is expressed in its self-image, inner workings, interactions with the outside world, and future expectations. It is based on shared attitudes, beliefs, customs, and written and unwritten rules that have been developed over time and are considered valid” (para. 1).  Organizational climate differs from culture, in that, it’s how employees perceive an organization and could be accurate or inaccurate (Marquis & Huston, 2017, p. 306) NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations.

BWMC’s culture has been that of ‘that’s how we’ve always done it’ when it comes to critical thinking skills from the nursing staff.  It has been increasingly difficult to establish a culture where evidence-based practice (EBP) is used.  This culture stems from management not emphasizing the importance of EBP (Marquis & Huston, 2017, p. 306).  The culture of the organization does not adapt well to change.  The climate of the organization varies with most staff feeling not supported by management in general.  Staff of the organization brought in a union at one point to try establishing a better rapport between nursing staff and management.  The climate and culture are similar when it comes to the VAT.  Most hospital staff cannot initiate IV access nor maintain access appropriately, yet the culture and climate has been that of abuse and taking their VAT for granted.  Nursing staff would consult the VAT for combative patients, inmates, patients with difficult family members, patients on isolation and patients with HIV/AIDS diagnosis just because they did not want to attempt IV access in these populations. NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations The previous culture, prior management established, was that of two people attempting two times and if without success, a VAT consult would be placed.  The current manager has changed the culture to nursing staff not having to attempt at all, just place a VAT consult.  The climate began to change on the VAT and on the floors.  The VAT began to feel abused and unappreciated and the floor nurses became increasingly needy and were losing their IV skills.  The hospital’s culture began to change, and nurses began thinking and behaving in a disrespectful and demeaning way towards the VAT nurses.  Eventually management sent out emails in hopes of changing the culture and climate of the organization, to become appreciative of the work VAT nurses accomplish.  The climate and culture improved slightly, and the VAT nurses noticed a difference in treatment by the floor nurses. NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations “Ultimately the most important way to spread organizational values is by having leadership behaviors reflect those values day in and day out” (Nelson & Gardent, 2017, p. 59).

Significance as Nurse Leader

Examining these matters is significant to my role as a nurse leader, assuming the position of creating the kind of organizational culture that will guarantee success (Marquis & Huston, 2017).  Individuals from all levels of the organization should be involved in developing the mission statement for an organization, so that all levels agree with the mission statement (Marquis & Huston, 2017).  As a nurse leader, utilizing the organizations mission statement as a decision-making tool will give the organization purpose (Marquis & Huston, 2017).  Analyzing  the culture and climate of my organization to emphasize EBP is significant in providing the highest quality care in our healthcare delivery system. NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations.
 

References

Business Dictionary.com. (2013)
Organizational culture: Definition
. Retrieved from http://www.businessdictionary.com/definition/organizational-culture.html

Marquis, B. L., & Huston, C. J. (2017). 
Leadership roles and management functions in nursing: Theory and application 
(9th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.

Mission & Vision. (2016, October 06). Retrieved November 26, 2017, from https://www.mybwmc.org/mission-vision

Nelson, W., & Gardent, P. (2011). Organizational values statements. 
Healthcare Executive,
 
26
(2), 56-59. Retrieved November 27, 2017, from https://eds-a-ebscohost-com.ezp.waldenulibrary.org/eds/pdfviewer/pdfviewer?vid=1&sid=07075686-c76a-44b1-b4db-9423df4fa049%40sessionmgr4007 NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations.

NURS 6531 : Practice Care of Adults – Practicum Experience 
Journal

Practicum Experience Journal

 
Student Name: Jxx

E-mail Address:

Practicum Placement Agency’s Name:

Preceptor’s Name:

Preceptor’s Telephone:

Preceptor’s E-mail Address:

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

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

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Practicum Objectives

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

 
Objective 1 – Scientific Foundation Competence

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

Objective 2 – Leadership Competencies

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

Objective 3 – Quality Care Competencies

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

Objective 4 – Ethical Competencies

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

Objective 5 – Health Delivery System Competencies

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

Objective 6 – Policy Competencies

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

Objective 7 – Technology & Information Literacy Competencies

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

 

Weekly Goals

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

 

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

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

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

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

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

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

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

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

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

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

 

References

Consensus Model for ARNP Regulation. Retrieved from

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

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

Philadelphia: F.A. Davis Co.

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

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

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

Child and Family Health Assessment Test Bank

Burns: Pediatric Primary Care, 6
th
Edition

Chapter 2: Child and Family Health Assessment

 

Test Bank

 

Multiple Choice

 

The parent of a toddler is concerned that the child may have autism. The primary care pediatric nurse practitioner completes a Modified Checklist for Autism in Toddlers (M-CHAT) tool, which indicates several areas of concern. What will the nurse practitioner do?

a.         Administer a Childhood Autism Rating Scale (CARS) in the clinic.

b.         Consult a specialist to determine appropriate early intervention strategies.

c.         Refer the child to a behavioral specialist for further evaluation. Child and Family Health Assessment Test Bank.

d.         Tell the parent that this result indicates that the child has autism.

 

ANS:   C

The M-CHAT is a screening tool and is useful for detecting behaviors that may indicate autism. This instrument has been found to have acceptable sensitivity, specificity, and significant positive predictive value. If these behaviors are detected, the PNP should refer the child to a specialist for further assessment, using more diagnostic tools. The CARS may be used but requires specialty training and proper credentials. Until the diagnosis is determined, strategies for intervention are not discussed. The M-CHAT is a screening tool and is not diagnostic. Child and Family Health Assessment Test Bank.

 

 

The mother of a newborn tells the primary care pediatric nurse practitioner that she is worried that her child will develop allergies and asthma. Which tool will the nurse practitioner use to evaluate this risk?

a.         Three-generation pedigree

b.         Review of systems

c.         Genogram

d.         Ecomap

 

ANS:   A

The three-generation pedigree is used to map out risks for genetic diseases in families, as well as conditions with modifiable risk factors. The review of systems is used to evaluate the history of the child’s body systems. The genogram is an approach to developing a family database to provide a graphic representation of family structure, roles, and problems of recurring significance in a family. The ecomap is used to identify relationships in the family and community that are supportive or harmful.

 

 

The primary care pediatric nurse practitioner is performing a well child check-up on a 20-month-old child. The child was 4 weeks premature and, according to a parent-completed developmental questionnaire, has achieved milestones for a 15-month-old infant. Which action is correct? Child and Family Health Assessment Test Bank.

a.         Perform an in-depth developmental assessment screen at this visit to evaluate this child.

b.         Reassure the parent that the child will catch up to normal development by age 2 years.

c.         Re-evaluate this child’s development and milestone achievements at the 2-year visit.

d.         Refer the child to a specialty clinic for evaluation and treatment of developmental delay.

 

ANS:   A

This child should be at a 19-month adjusted age for prematurity so, according to the parent screen, is 4 months behind. The PNP should perform a more in-depth screen to evaluate this delay. Waiting to see if the child will “catch up” or assuring the parent that this will happen will cause the delays to become more severe. A referral to a specialty clinic should not be made solely on the basis of the parent-completed questionnaire but only after further evaluation of possible delays.

 

 

When formulating developmental diagnoses for pediatric patients, the primary care pediatric nurse practitioner may use which resource?

a.         DC: 0-3R

b.         ICD-10-CM

c.         ICSD-3

d.         NANDA International

 

ANS:   A

The DC: 0-3R refers to the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood and is useful for developmental problem diagnosis. The ICD-10-CM is the International Classification of Diseases-Tenth Revision, Clinical Modification and is useful for identifying physiologic diseases. The ICSD-3 is the International Classification of Sleep Disorders – 3rd edition. NANDA International is used to label problems in the functional health domain. Child and Family Health Assessment Test Bank.

 

 

The primary care pediatric nurse practitioner is evaluating health literacy in the mother of a new preschool-age child. How will the nurse practitioner assess this?

a.         Ask the child how many books he has at home.

b.         Ask the mother about her highest grade in school.

c.         Ask the mother to determine the correct dose of a drug from a label.

d.         Ask the mother to read a health information handout aloud.

 

ANS:   A

The “newest vital sign,” or health literacy, can be determined quickly by asking the parent how many children’s books are in the home. Greater than 10 books in the home is an independent positive predictor of adequate parent health literacy. The other questions may determine a specific level of literacy in general but are not as efficient.

 

 

The primary care pediatric nurse practitioner learns that the mother of a 3-year-old child has been treated for depression for over 5 years. Which aspect of this child’s development will be of the most concern to the nurse practitioner?

a.         Fine motor

b.         Gross motor

c.         Social/emotional

d.         Speech and language

 

ANS:   D

Maternal depression in the first year of life has been associated with poorer language development at 3 years of age.

 

 

The primary care pediatric nurse practitioner sees a 3-year-old child who chronically withholds stools, in spite of the parents’ attempts to stop the behavior, requiring frequent treatments with laxative medications. Which diagnosis will the nurse practitioner use to facilitate third-party reimbursement? Child and Family Health Assessment Test Bank.

a.         Altered elimination pattern

b.         Elimination disorder

c.         Encopresis

d.         Parenting alteration

 

ANS:   C

Encopresis is a medical diagnosis, classified in the ICD-10-CM, and is recognized for reimbursement purposes. “Altered elimination pattern” and “Parenting alteration” are NANDA International diagnoses and are not recognized for reimbursement. “Elimination disorder” is a developmental diagnosis.

 

 

A child is in the clinic for evaluation of an asthma action plan. The primary care pediatric nurse practitioner notes that the child’s last visit was for a pre-kindergarten physical and observes that the child is extremely anxious. What will the nurse practitioner do initially?

a.         Ask the child’s parent why the child is so anxious.

b.         Perform a physical assessment to rule out shortness of breath.

c.         Reassure the child that there is nothing to be afraid of.

d.         Review the purpose of this visit and any anticipated procedures.

 

ANS:   D

The PNP should remember that young children are learning “scripts” for health care visits and may be stressed when recalling previous visits, especially if those involved immunizations. The PNP should explain the purpose and any anticipated procedures for this visit to help put the child at ease. Child and Family Health Assessment Test Bank.

 

 

When meeting with a new family, the primary care pediatric nurse practitioner develops a database that identifies family members and others living in the household, relationships with others outside the household, and significant behavioral and emotional problems. Which tool will the nurse practitioner use to record this information?

a.         CRAFFT

b.         Ecomap

c.         Genogram

d.         Pedigree

 

ANS:   C

The genogram is an approach to developing a family database to provide a graphic representation of family structure, roles, and problems of recurring significance in a family. The CRAFFT tool is used to assess substance abuse in adolescents. The ecomap is used to identify relationships in the family and community that are supportive or harmful. The pedigree is used to identify potential genetic disorders.

 

 

The primary care pediatric nurse practitioner evaluates a school-age child whose body mass index (BMI) is greater than the 97th percentile. The nurse practitioner is concerned about possible metabolic syndrome and orders laboratory tests to evaluate this. Which diagnosis will the nurse practitioner document for this visit?

a.         Metabolic syndrome

b.         Nutritional alteration: more than required

c.         Obesity

d.         Rule out type 2 diabetes mellitus

 

ANS:   C

A problem should never be included on the problem list that is not supported by subjective and objective data found and recorded in the database. This child has a BMI that suggests obesity, so this may be used as a diagnosis. Metabolic syndrome is a diagnosis that is determined by laboratory data, which has not been evaluated yet. Nutritional alteration is a NANDA diagnosis and not acceptable for reimbursement. “Rule out” should not be used as a diagnosis, but may be considered part of a plan. Child and Family Health Assessment Test Bank.

 

 

The primary care pediatric nurse practitioner performs a developmental assessment on a 3-year-old child and notes normal cognitive, fine-motor, and gross-motor abilities. The child responds appropriately to verbal commands during the assessment but refuses to speak when asked questions. The parent tells the nurse practitioner that the child talks at home and that most other adults can understand what the child says. The nurse practitioner will :

a.         ask the parent to consider a possible speech delay and report any concerns.

b.         continue to evaluate the child’s speech at subsequent visits.

c.         refer the child for a speech and hearing evaluation.

d.         tell the parent to spend more time in interactive conversations with the child.

 

ANS:   B

Development should be monitored over time and within the context of the child’s overall well-being, rather than at an isolated testing session. The child has normal development in observed measures and appears to hear and understand well. By parental report, the child is able to speak. The PNP should continue to evaluate speech over time, since this refusal to speak may be associated with shyness or intimidation in the clinic. It is not necessary to tell the parent that the child has a possible speech delay. Unless an actual speech delay is observed, a referral is not indicated, nor is it necessary to implement a home therapy.

 

 

The primary care pediatric nurse practitioner is performing a well child assessment on an adolescent and is concerned about possible alcohol and tobacco use. Which assessment tool will the nurse practitioner use? Child and Family Health Assessment Test Bank.

a.         CRAFFT

b.         HEEADSSS

c.         PHQ-2

d.         RAAPS

 

ANS:   A

The CRAFFT tool is a six-question tool used to screen for adolescent substance abuse. The HEEADSSS is used as a psychosocial screening tool. The PHQ-2 is a rapid screen for depression. The RAAPS is used to assess risk behaviors that contribute to most morbidity, mortality, and social problems in teens.

 

 

The primary care pediatric nurse practitioner is assessing a toddler whose weight and body mass index (BMI) are below the 3rd percentile for age. The nurse practitioner learns that the child does not have regular mealtimes and is allowed to carry a bottle of juice around at all times. The nurse practitioner plans to work with this family to develop improved meal patterns. Which diagnosis will the nurse practitioner use for this problem?

a.         Failure to thrive

b.         Home care resources inadequate

c.         Nutrition alteration – less than required

d.         Parenting alteration

 

ANS:   D

Because the PNP is planning to intervene by helping the parents to provide appropriate food habits, the correct diagnosis should be “Parenting alteration.” “Failure to thrive” is a medical diagnosis and requires a medical and social evaluation to rule out organic causes or detect neglect. “Home care resources inadequate” would be used if the PNP suspects that the family lacks adequate funds to purchase food. “Nutrition alteration” is a NANDA diagnosis and would be used if the PNP planned to consult with a dietician or give nutritional information. Child and Family Health Assessment Test Bank.

 

 

 

Week 9 Quiz

 

Question 1

0 / 1 point

A client presents to clinic for the first time. The provider discovers that the client was diagnosed with Prader-Willi Syndrome. What symptoms does the provider expect to find during this encounter?

Hyperphasia, obesity, and strabismus

Lethargy, stridor, and irritability

Low-set ears, short stature, and webbed neck

Flat nasal bridge, epicanthal folds, and heart murmur

Question 2

Child and Family Health Assessment Test Bank

0 / 1 point

A client with Prader-Willi syndrome, well-known to the clinic, presents today for an annual physical. This client is at higher risk and should be screened for what medical condition?

Depression

Pyloric Stenosis

Celiac disease

Type 2 diabetes mellitus

Question 3

0 / 1 point

A new client presents to the clinic to establish care. On exam, the provider notes the following: a long narrow face, high-arched palate and dental crowding, prominent ears, strabismus, macroorchidism, short stature, cognitive impairments and stereopathies. What would be the most likely diagnosis?

Fragile X

Prader-Willi

Angelman

Beckwith-Weidemann

Question 4

1 / 1 point

If a client is positive for any of the following categorical clinical findings and developmental deficiencies: Failure to thrive, Central obesity, Enamel hypoplasia, Scoliosis, Motor delays, Mild intellectual disability and Compulsive hyperphagia; what would be the most likely diagnosis?

Fragile X

Prader-Willi

Angelman

Beckwith-Weidemann

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Child and Family Health Assessment Test Bank

 

Question 5

0 / 1 point

If a client is positive for any of the following categorical clinical findings and developmental deficiencies: Seizures, Global developmental delays, Abnormal gait, arms held high/flexed elbows, Hypotonic trunk with hypertonic limbs (commando crawl), Feeding/growth problems, Acquired microcephaly, Speech delay, Spontaneous (persistent) social smile/fits of laughter, and Loves water. What would be the most likely diagnosis?

Fragile X

Prader-Willi

Angelman

Beckwith-Weidemann

Question 6

0 / 1 point

If a client is positive for any of the following categorical clinical findings and developmental deficiencies: Omphalocele or umbilical hernia, macroglossia, facial features: Nevus flammeus, helical pits, prominent eyes, anterior ear lobe creases, Large placenta/long umbilical cord, Hypoglycemia, Cardiomegaly, Dental malocclusion with maxillary underdevelopment, and Articulation issues. What would be the most likely diagnosis? Child and Family Health Assessment Test Bank.

Fragile X

Prader-Willi

Angelman

Beckwith-Weidemann

Question 7

1 / 1 point

If a client is positive for any of the following categorical clinical findings and developmental deficiencies: tall, long limbs, aortic root dilatation, mitral valve prolapse/regurgitation, ectopia lentis, myopia, retinal detachment, exotropia/strabismus, spontaneous pneumothorax, connective tissue problems, pectus deformities, joint hyperextensibility. What would be the most likely diagnosis?What would be the most likely diagnosis?

Turner

DiGeorge

Marfan

Huntington

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Question 8

0 / 1 point

What is true about diploid cells? (select all that apply)

Each contains 23 paired chromosomes.

Each one contains 23 chromosomes.

Replication produces two identical cells.

They replicate via the process of mitosis.

View FeedbackChild and Family Health Assessment Test Bank

 

Question 9

0 / 1 point

Cystic fibrosis is a genetic disorder that affects the cells that produce mucus, sweat, and digestive juices. It is considered a recessive disease caused by a gene mutation on both alleles inherited from the parents. Which type of genetic disorder is this?

Chromosome

Mitochondrial

Monogenetic

Multifactorial

Question 10

1 / 1 point

Which diagnostic test is most appropriate when a provider wishes to identify and evaluate the size, shape, and number of chromosomes of a client? Child and Family Health Assessment Test Bank

Chromosomal microarray

Fluorescence in-situ hybridization

Karyotype

Molecular testing

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Karyotype testing is used to identify and evaluate the size, shape, and number of chromosomes

 

 

The primary care pediatric nurse practitioner is obtaining a medical history about a child. To integrate both nursing and medical aspects of primary care, which will be included in the medical history?

a.         Complementary medications, alternative health practices, and chief complaint

b.         Developmental delays, nutritional status, and linear growth patterns

c.         Medication currently taking, allergy information, and family medical history

d.         Speech and language development, beliefs about health, and previous illnesses

 

ANS:   D

An assessment model that integrates the nursing and medical aspects of primary care uses three domains: developmental problems (speech and language development), functional health problems (beliefs about health), and diseases (chief complaint). The other examples all use domains associated with the traditional medical model and do not contain nursing aspects associated with functional health problems. Child and Family Health Assessment Test Bank.

Case 1: Volume 1, Case #1: The man whose antidepressants stopped working

Questions

One of the most effective medical interventions to significantly improve the health of patients doesn’t require the latest technology or expensive medication, but it involves helping them take their existing medicines as prescribed.

When you feel like your depression is under control, do you sometimes stop taking your medicine? The patient discontinued his Effexor although it appeared to be effective. It is essential to find out the patient’s reason for not adhering to prescribed medication and come up with a solution together.

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Taking medication every day is a real inconvenience for some people. Do you ever feel hassled about sticking to your antidepressant? It is difficult to come up with a schedule to take medications every day for some patients. Collaboratively we need to come up with a convenient time to take the antidepressant and the other prescribed medication for them to be effective. The man whose antidepressants stopped working.

How often do you have difficulty remembering to take your antidepressant medication? Health literacy plays a key role as well. It is difficult for patients to take a medicine when they do not understand why it is prescribed, what conditions or diseases it treats, or what preventive effects it provides.

As a Nurse practitioner, when patients reveal nonadherence, it is essential to assure them that it is a positive step that they felt comfortable talking about it.  Emphasis should be on collaboration to identify the challenges and decide how to achieve mutually agreed-upon goals (Brown, & Bussell, 2011).

Family

The patient is married, the questions I would ask the wife specifically,

Do you know what medication your husband is taking? And do you know why he is taking it? Family support is vital in patients with depression, in situations when patients forget or are not motivated to take the medication. What side effects is the patient experiencing? The patient’s family may notice symptoms that the patient is not reporting that may need to be addressed. The man whose antidepressants stopped working.

Physical examination and diagnostic tests

Appearance and affect

Most patients with major depressive disorder present with a normal appearance. In patients with more severe symptoms, a decline in grooming and hygiene can be observed, as well as a change in weight. Patients may show psychomotor retardation, which manifests as a slowing or loss of spontaneous movement and reactivity, as well as demonstrate a flattening or loss of reactivity in the patient’s affect, i.e., emotional expression (Halverson,2018).

Speech may be normal, slow, monotonic, or lacking in spontaneity and content. Pressured speech may suggest anxiety or mania, whereas disorganized speech should prompt an evaluation for psychosis. Racing thoughts could also be an indication of anxiety, mania, or hypomania (Halverson, 2018).

These laboratory studies might include the following: Complete blood cell (CBC) count, thyroid-stimulating hormone (TSH), Vitamin B-12, Dexamethasone suppression test (Cushing disease, but also positive in depression), Electrolytes, including calcium, phosphate, and magnesium levels (Halverson,2018) The man whose antidepressants stopped working.

Differential diagnosis

Hypothyroidism:  is often associated with altered cognitive function and depression. The patient is experiencing psychomotor retardation, fatigue, and sluggishness, all of that may cause depression.

Manic-depressive episode

Hyperthyroidism

Pharmacological agents and dosing

Add Seroquel as an augment.  Seroquel is also used together with antidepressant medications to treat major depressive disorder in adults (Drugs, com, 2018). Seroquel 50 mg/day and increased the dose as recommended in increments of 50 mg/day depending on the clinical response and tolerability of the patient up to 300 mg a day (Drugs.com, 2018). 1st day 50 mg, 2nd day 100 mg, 3rd day 200 mg and 4th day 300 mg (Drugs.com 2018). According to drugs.com (2018). Seroquel acts on numerous receptors in the brain to calm and help diminish psychotic thoughts. It is can also be used in addition to antidepressants and anxiety (Drugs.com, 2018). It may be beneficial for this patient because of the patient’s anxiety and sleep difficulties. Patients on Seroquel show improvement within one week although it may take several weeks for behavior and cognition to stabilize (Stahl, 2013).

Increase Buspirone to 60 mg/day, 30 mg in the morning and 30 mg in at bed time. BuSpar is used to treat symptoms of anxiety (Drugs.com, 2018). Certain people respond well to lower doses, while others require higher dosages to get a good effect. In this particular case, the patient is on a low dose; dose may need to be increased for a therapeutic effect The man whose antidepressants stopped working.

Contraindications

There are no specific contraindications related to ethnicity in buspirone but, the CNS effects in any individual patient affects function. Therefore, individuals may not operate machinery or automobile (drugs.com, 2018).

No specific contraindication related to ethnicity that I found with Seroquel, but Anaphylactic reactions have been reported in patients treated with Seroquel. Therefore, Seroquel should not be used in patients hypersensitive to quetiapine (Drugs.com, 2018).

 

Check points

The patient needs to follow up in 4 weeks to check on symptom improvement and a blood pressure check due to Seroquel. Quetiapine may cause a lowering of blood pressure when rising from a sitting or lying position, or a racing heart rate (Stahl, 2013). Another follow up check is for fasting plasma glucose, fasting lipids within three months and then annually, but earlier and more frequently if the patient has gained more than 5% of initial weight (Stahl, 2013).

Taper off Ativan to 1 mg daily for one week, 0.5 mg daily for one week then discontinue medication to prevent withdrawal symptoms.  The man whose antidepressants stopped working Ativan needs to be discontinued because of its sedation effects. With added Seroquel and clonazepam on medication list, the patient does not need another sedative to the regimen. Another reason to discontinue Ativan is, can intensify cognitive slowing, cause dependence and produce changes in equilibrium that can contribute to increased risk of falls and fractures. Long-term use can lead to habituation and dependence (drug.com, 2018).

Lessons learned

Ethnic or regional differences can potentially contribute to differences in drug response (Yasundu, Zhang, & Huang, 2008). As a nurse practitioner, application of this information will be one factor that can contribute to the consideration of the risk-benefit ratio of drug therapy in a specific patient (Yasundu et al., 2008).

Major depression seems to be a recurrent illness that needs to be managed like any other chronic disease such as diabetes. Therefore, the patient may need to stay on an antidepressant for the rest of their life. And at the point of resistance, patients may need their medications augmented with other antidepressants.

Along with medications, talk therapy like cognitive-behavioral, psychodynamic, and interpersonal therapy is one of the first approaches that a person with treatment-resistant depression might try (Griffin, 2018).

Research has shown that therapy can help with treatment-resistant depression specifically. The best evidence is with cognitive-behavioral therapy (CBT), which encourages people to see how their thoughts and behaviors contribute to their depression (Griffin, 2018). The man whose antidepressants stopped working.

 

References

Brown, M. T., & Bussell, J. K. (2011). Medication Adherence: WHO Cares? Mayo Clinic Proceedings, 86(4), 304–314.
http://doi.org/10.4065/mcp.2010.0575

Daly, E. J., & Trivedi, M. H. (2007). A review of quetiapine in combination with antidepressant therapy in patients with depression. Neuropsychiatric Disease and Treatment, 3(6), 855–867.

Drugs.com, (2018) Buspirone. Retrieved from https://www.drugs.com/buspar.html

Drugs.com, (2018). Seroquel. Retrieved from 
https://www.drugs.com/tips/seroquel-patient-tips

Halverson, L. J (2018). Depression. Retrieved from https://emedicine.medscape.com/article/286759-overview

Griffin, R. M (2018). Treatment-Resistant Depression: Your Continuum of Care. Retrieved from https://www.webmd.com/depression/features/treatment-resistant-depression-your-continuum-of-care#1 The man whose antidepressants stopped working

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press

Yasundu, S. U., Zhang, L. & Huang, S. M., (2008). The role of ethnicity in variability in response to drugs. focus on clinical pharmacology studies. Clinical pharmacology & Therapeuticsm, 84(3). 417-423. Retrieved from https://web.archive.org/web/20170809004704/https://www.fda.gov/downloads/Drugs/ScienceResearch/…/UCM085502.pdf The man whose antidepressants stopped working

Hi Mary,

Great discussion this week, I agree nurse practitioners must be aware of the risks of antidepressant resistance in some patients, then treat patients accordingly. Treatment-resistant depression can leave patients feeling hopeless and discouraged and demoralized because they are not getting any better.  Patients with the diagnosis of severe depression Electroconvulsive Therapy (ECT) can be a life-changing procedure. According to Miller, (2017), medications have a success rate of 50-60% of patients getting better, while ECT succeeds at a rate of 70-90%. ECT also works faster; medications typically take up to eight weeks to show improvement, while with ECT, patients start feeling better in two weeks or less (Miller, 2017).  Pop culture has long represented the procedure as painful and involuntary, most notably in Ken Kesey’s novel-turned-film “One Flew Over the Cuckoo’s Nest,” in which ECT was performed without anesthesia. Fortunately, the stigma has begun to fade away, perhaps due in part to endorsement by public figures such as Kitty Dukakis and the late Carrie Fisher, who both experienced personal success with ECT (Familydoctor.org, 2017). I believe in inviting family members into the procedure room helps to reduce the stigma and fear. Also continues to break down misunderstanding and advocate for this life-saving treatment in patients for whom multiple medications have failed. And when it comes to suicidality, its effectiveness can mean the difference between life and death. The man whose antidepressants stopped working

References

Familydoctor.org, (2017). Electroconvulsive Therapy (ECT). Retrieved from https://familydoctor.org/how-electroconvulsive-therapy-works/

Miller. S. (2017). Treating Mental Illness with Electroconvulsive Therapy. Retrieved from https://healthcare.utah.edu/healthfeed/postings/2017/02/ect.php

 

Reply # 2

Hi

Thank you for a great discussion this week. The patient continues to have the depression after remission. He may also benefit from cytochrome P450 (CYP450) tests to help determine how the body metabolizes a drug (Mayoclinic, 2018). The human body uses cytochrome P450 enzymes to process medications. The variations in these enzymes, medications may affect each person differently (Mayoclinic, 2011) The man whose antidepressants stopped working.

Drug-gene testing also called pharmacogenomics or pharmacogenetics is the study of how genes affect the body’s response to medication (CDC,2011). The test looks for changes or variations in the genes that determine whether a drug could be an effective treatment for or whether the patient could have side effects from a specific medication (Mayoclinic,2018).

The cytochrome P450 enzyme includes the CYP2D6 enzyme, which processes many antidepressants and antipsychotic medications. By checking DNA for certain gene variations, CYP450 tests can offer clues about how the body may respond to a particular antidepressant. CYP450 tests can also identify changes in other enzymes, such as the CYP2C19 enzyme (Mayoclinic, 2018). The man whose antidepressants stopped working.

Genotyping tests, such as cytochrome P450 tests, may speed up the identification of medications that are more likely to be better processed by the body. Ideally, better processing would lead to fewer side effects and improved effectiveness (Mayoclinic, 2018).

References

Center for Disease Control and Prevention, (CDC). CYP450 Genotyping to Predict Response to SSRIs Used to Treat Non-psychotic Depression in Adults: EGAPP Recommendation. Retrieved from https://www.cdc.gov/genomics/gtesting/egapp/recommend/cyp450.htm.

Mayoclinic, (2018) Cytochrome P450 (CYP450) tests. Retrieved from  https://www.mayoclinic.org/tests-procedures/cyp450-test/about/pac-20393711 The man whose antidepressants stopped working

MN568 Unit 6 Exam Question 1 2 / 2 points

A patient is seen with a sudden onset of flank pain accompanied by nausea, vomiting, and diaphoresis. In addition to nephrolithiasis, which of the following should be added to the list of differential diagnoses?

Question options:

a) Pancreatitis

b) Peptic ulcer disease

c) Diverticulitis

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d) All of the above

Question 2 2 / 2 points

Which of the following would be an appropriate treatment for a patient with mild BPH?

Question options:

a) Refer to a urologist for surgery.

b) Prescribe a trial of tamsulosin.

c) Recommend cranberry supplements.

d) Reevaluate symptoms in 1 to 3 months. MN568 Unit 6 Exam.

Question 3 2 / 2 points

The result of the patient’s 24-hour urine for protein was 4.2 g/day. The clinician should take which of the following actions?

Question options:

a) Repeat the test.

b) Refer to a nephrologist.

c) Measure the serum protein.

d) Obtain a blood urea nitrogen (BUN) and creatinine.

Question 4 2 / 2 points

Which is the most potent and irritating dose of tretinoin?

Question options:

a) 0.05% liquid formulation

b) 0.1% cream

c) 1% foam

d) 0.02% cream

Question 5 2 / 2 points

Which of the following clinical manifestations are consistent with a patient in ARF?

Question options:

a) Pruritis

b) Glycosuria

c) Irritability

Question 6 2 / 2 points

Which of the following is an infraorbital fold skin manifestation in a patient with atopic dermatitis?

Question options:

a) Keratosis pilaris

b) Dennie’s sign

c) Keratoconus

d) Pityriasis alba

Question 7 2 / 2 points

The patient with BPH is seen for follow-up. He has been taking finasteride (Proscar) for 6 months. The clinician should assess this patient for which of these side effects?

Question options:

a) Erectile dysfunction

b) Glaucoma

c) Hypotension

d) Headache

Question 8 2 / 2 points

When using the microscope for an intravaginal infection, you see something translucent and colorless. What do you suspect? MN568 Unit 6 Exam

Question options:

a) A piece of hair or a thread

b) Hyphae

c) Leukocytes

d) Spores

Question 9 2 / 2 points

Your patient is in her second trimester of pregnancy and has a yeast infection. Which of the following is a treatment that you usually recommend/order in nonpregnant patients, but is listed as a Pregnancy category D?

Question options:

a) Vagistat vaginal cream

b) Monistat combination pack

c) Terazol vaginal cream

d) Diflucan, 150 mg

Question 10 2 / 2 points

A patient is seen in the clinic with hematuria confirmed on microscopic examination. The clinician should inquire about the ingestion of which of these substances that might be the cause of hematuria?

Question options:

a) NSAIDs

b) Beets

c) Vitamin A

d) Red meat

Question 11 2 / 2 points

Which of the following tests is most useful in determining renal function in a patient suspected of CRF? MN568 Unit 6 Exam

Question options:

a) BUN and creatinine

b) Electrolytes

c) Creatinine clearance

d) Urinalysis

Question 12 2 / 2 points

Eighty percent of men have noticeable hair loss by what age?

Question options:

a) 35

b) 50

c) 70

d) 85

Question 13 0 / 2 points

When looking under the microscope to diagnose an intravaginal infection, you see a cluster of small and oval to round shapes.What do you suspect they are?

Question options:

a) Spores

b) Leukocytes

c) Pseudohyphae

d) Epithelial cells

Question 14 2 / 2 points

Which of the following information is essential before prescribing Bactrim DS to a 24-year-old woman with a UTI?

Question options:

a) Last menstrual period

b) Method of birth control

c) Last unprotected sexual contact

d) All of the above

Question 15 2 / 2 points

What is the treatment of choice for a patient diagnosed with testicular cancer?

Question options:

a) Radical orchidectomy

b) Lumpectomy

c) Radiation implants

d) All of the above

Question 16 2 / 2 points

Which test is used to confirm a diagnosis of epididymitis?

Question options:

a) Urinalysis

b) Gram stain of urethral discharge

c) Complete blood cell count with differential

d) Ultrasound of the scrotum

Question 17 2 / 2 points

Sally, age 25, presents with impetigo that has been diagnosed as infected with Staphylococcus. The clinical presentation is pruritic tender, red vesicles surrounded by erythema with a rash that is ulcerating. Her recent treatment has not been adequate. Which type of impetigo is this?

Question options:

a) Bullous impetigo

b) Staphylococcal scalded skin syndrome (SSSS)

c) Nonbullous impetigo

d) Ecthyma

Question 18 2 / 2 points

An example of ecchymosis is:

Question options:

a) A hematoma

b) A keloid

c) A bruise

d) A patch

Question 19 2 / 2 points

An 82-year-old man is seen in the primary care office with complaints of dribbling urine and difficulty starting his stream. Which of the following should be included in the list of differential diagnoses?

Question options:

a) Benign prostatic hyperplasia (BPH)

b) Parkinson’s disease

c) Prostate cancer

d) All of the above

Question 20 0 / 2 points

A 30-year-old man is seen with a chief complaint of loss of libido. Which of the following laboratory tests would help establish a diagnosis?

Question options:

a) Testosterone level

b) Prostate-specific antigen

c) Nocturnal penile tumescence and rigidity

d) Prolactin level

Question 21 2 / 2 points

A 35-year-old man presents with complaints of painful erections, and he notices his penis is crooked when erect. What is the most likely diagnosis? MN568 Unit 6 Exam

Question options:

a) Peyronie’s disease

b) Damage to the pudendal artery

c) Scarring of the cavernosa

d) All of the above

Question 22 2 / 2 points

A 78-year-old man is diagnosed with C2 prostate cancer, and he asks the clinician what that means. In order to answer the patient, the clinician must have which of these understandings of the Jewett rating system?

Question options:

a) The cancer involves the seminal vesicles.

b) There is metastatic disease to regional lymph nodes.

c) The cancer is confined to the capsule.

d) There is metastasis to distant organs.

Question 23 0 / 2 points

During a DRE on a 75-year-old man, the clinician suspects the patient has prostate cancer. What physical finding should make the clinician suspicious?

Question options:

a) An enlarged rubbery gland

b) A hard irregular gland

c) A tender gland

d) A boggy gland

Question 24 2 / 2 points

Tinea unguium is also known as:

Question options: MN568 Unit 6 Exam

a) Onychomycosis

b) Tinea versicolor

c) Tinea manuum

d) Tinea corporis

Question 25 2 / 2 points

The patient is diagnosed with acute renal failure (ARF).Which of the following data obtained from the history should alert the provider that this is a case of prerenal azotemia?

Question options:

a) Recent heat stroke

b) Nephrolithiasis

c) Recent infection where gentamicin was used in treatment

d) All of the above

Question 26 2 / 2 points

Which of the following statements is accurate when you are removing a seborrheic keratosis lesion using liquid nitrogen? MN568 Unit 6 Exam

Question options:

a) Do not use lidocaine as it may potentiate bleeding.

b) Pinch the skin taut together.

c) Use gel foam to control bleeding.

d) This should be performed by a dermatologist only.

Question 27 2 / 2 points

A patient is diagnosed with urge incontinence. Before prescribing Detrol XL, the provider should question the patient about which of these contraindications to this medication?

Question options:

a) Diarrhea

b) Parkinson’s disease

c) Closed-angle glaucoma

d) Breast cancer

Question 28 2 / 2 points

Simon presents with alopecia areata with well-circumscribed patches of hair loss on the crown of his head. MN568 Unit 6 Exam How do you respond when he asks you the cause?

Question options:

a) “You must be under a lot of stress lately.”

b) “It is hereditary. Did your father experience this also?”

c) “The cause is unknown, but we suspect it is due to an immunologic mechanism.”

d) “We’ll have to do some tests.”

Question 29 2 / 2 points

A 58-year-old patient has been receiving leuprolide as treatment for prostate cancer. The clinician should instruct the patient about which of these side effects?

Question options:

a) Risk of osteoporosis

b) May have hot flushes

c) May have impotence

d) All of the above

Question 30 2 / 2 points

Josh, aged 22, has tinea versicolor. Which description is the most likely for this condition?

Question options:

a) There are round, hypopigmented macules on his back.

b) Josh has red papules on his face.

c) There are crusted plaques in Josh’s groin area.

d) There are white streaks on his neck.

Question 31 2 / 2 points

The most common precancerous skin lesion found in Caucasians is:

Question options:

a) A skin tag

b) Actinic keratosis

c) A melanoma

d) A basal cell lesion

Question 32 2 / 2 points

Which scalp problem can be caused by a fever and certain drugs?

Question options:

a) Telogen effluvium (TE)

b) Trichotillomania

c) Psoriasis

d) Alopecia areata

Question 33 2 / 2 points

A 46-year-old man presents with urinary hesitancy and low back pain. He has no history of UTI. Digital rectal examination (DRE) reveals a normal prostate, and a diagnosis of prostatodynia is made. Which is the appropriate treatment? MN568 Unit 6 Exam.

Question options:

a) Terazosin 2 mg PO once a day

b) Ice pack to the scrotal area

c) Saw palmetto 320 mg per day

d) All of the above

Question 34 2 / 2 points

A 30-year-old patient presents with pain on urination. The urine microscopy of unspun urine shows greater than 10 leukocytes/mL, and a dipstick is positive for nitrites. What is the probable diagnosis?

Question options:

a) Lower urinary tract infection

b) Chlamydia infection

c) Candidiasis

d) Pyelonephritis

Question 35 2 / 2 points

Which of the following foods should be limited in a patient with CRF?

Question options:

a) Milk

b) Bananas

c) Soy sauce

d) All of the above

Question 36 2 / 2 points

An example of a primary skin lesion is a/an:

Question options:

a) Bulla

b) Scale

c) Excoriation

d) Fissure

Question 37 2 / 2 points

A 76-year-old man is seen in the office for complaints of urinary incontinence. The clinician should explore which of these causes of incontinence in men?

Question options:

a) Urethral polyps

b) Urinary tract infection (UTI)

c) Anticholinergic medication

d) All of the above

Question 38 2 / 2 points

A patient is seen in the clinic with a chief complaint of hematuria. To make a differential diagnosis, which of the following questions should be asked?

Question options:

a) “Do you have a history of liver disease?”

b) “What medications are you currently taking?”

c) “Have you noticed swelling in your ankles?”

d) All of the above

Question 39 2 / 2 points

A 78-year-old man is diagnosed with Stage D bladder cancer and asks the provider what that means. Which is the best response?

Question options:

a) “There is no such thing as Stage D cancer.”

b) “You have cancer that has spread to the surrounding tissue.”

c) “Your cancer has spread to other organs.”

d) “Your cancer can be cured by removing your bladder.”

Question 40 2 / 2 points

Treatment for epididymitis includes which of the following?

Question options:

a) Warm sitz baths

b) Scrotal elevation

c) Masturbation

d) All of the above

Question 41 2 / 2 points

A patient is seen in the office complaining of severe flank pain. The clinician should assess this patient for which risk factor for kidney stones?

Question options:

a) Hypertension

b) Constipation

c) Tubal ligation

d) Diabetes

Question 42 2 / 2 points

A 63-year-old man is seen in the clinic with a chief complaint of nocturia. Which of the following should be included in the differential diagnosis? MN568 Unit 6 Exam

Question options:

a) Psychogenic nocturia

b) Urethral polyp

c) Irritative posterior urethral lesion

d) Benign prostatic hypertrophy

Question 43 0 / 2 points

A patient with testicular cancer is being followed after completing treatment 1 year ago. He has been symptom-free with no evidence of disease. How often should he have a CT scan?

Question options:

a) Every month

b) Every 3 to 4 months

c) Every 6 to 12 months

d) Every year

Question 44 2 / 2 points

Mark has necrotizing fasciitis of his left lower extremity.Pressure on the skin reveals crepitus due to gas production by which anaerobic bacteria?

Question options:

a) Staphylococcal aureus

b) Clostridium perfringens

c) S. pyrogenes

d) Streptococcus

Question 45 2 / 2 points

Ian, age 62, presents with a wide, diffuse area of erythematous skin on his lower left leg that is warm and tender to palpation.There is some edema involved. You suspect:

Question options:

a) Necrotizing fasciitis

b) Kaposi’s sarcoma

c) Cellulitis

d) A diabetic ulcer

Question 46 2 / 2 points

Why do people of African descent have a lower incidence of non-melanoma skin cancer?

Question options:

a) They have an increased number of melanocytes.

b) Their darker skin protects from ultraviolet radiation.

c) Their skin is thicker.

d) Their immune system is stronger.

Question 47 2 / 2 points

A 23-year-old sexually active man is seen in the clinic with unilateral painful testicular swelling, and he is diagnosed with epididymitis.In order to prescribe the correct drug, the clinician must understand that which of these is the most common causative organism?

Question options:

a) Escherichia coli

b) Staphylococcus aureus

c) Chlamydia trachomatis

d) Pseudomonas aeruginosa

Question 48 2 / 2 points

When instructing your elderly client about treating her xerosis, what do you tell her?

Question options:

a) A daily hot bath may help the associated pruritus.

b) Rub the skin briskly to make sure it is completely dry after bathing.

c) Only take short tepid showers.

d) Use a gel that is alcohol-based after bathing to soften the skin.

Question 49 2 / 2 points

Which of the following instructions should be given to the patient with nephrolithiasis?

Question options:

a) Take ibuprofen, 600 mg every 8 hours.

b) Take Tums? for stomach upset.

c) Drink more black tea.

d) Increase intake of vegetables, like spinach.

Question 50 2 / 2 points

The 56-year-old man with chronic prostatitis should be treated with trimethoprim 80 mg-sulfamethoxazole 400 mg (TMP-SMX, Bactrim) for how long?

Question options:

a) 3 to 7 days

b) 14 to 21 days

c) 3 to 6 weeks

d) 6 to 12 weeks

MN568 Unit 6 Exam

Hospital-acquired infections PPT – ACE Star Model – NR451

The length of the PowerPoint presentation should be 15-20 slides; excluding the title and reference slides.

Below are the main topics or bullet points for your slides:

Title slide

Description of the Ace Star change model that you have used for this project.

Practice Issue (Using the one of the required articles)

Scope of the problem—use basic statistics from what you know of the problem in your work area.

Your team/stakeholders

Evidence to support your need for change—from your Evidence Summary

BUY A PLAGIARISM-FREE PAPER HERE

Action Plan

Timeline for the plan

The nurse’s role and responsibility in the pilot program

Procedure (what steps are to be taken to complete this change process, from start to finish?)

Forms that will be used (if applicable)

Resources available to the staff—including yourself

between 15-20 slides in length (not including the title slide and reference list slides) Hospital-acquired infections PPT – ACE Star Model – NR451.

Capstone Project Milestone 1:

Practice Issue and Evidence Summary Worksheets

For Use March 2018

 

Student Name:
XXXX XXXX                               
Date:

Directions

Refer to the guidelines for specific details on how to complete this assignment.

Type your answers directly into the worksheets below.

Submit to the Dropbox by the end of Week 3, Sunday at 11:59 p.m. MT.

Post questions about this assignment to the Q & A Forum. You may also email questions to the instructor for a private response Hospital-acquired infections PPT – ACE Star Model – NR451

 

Practice Issue Worksheet

 

List the topic and include the citation for the systematic review you have selected from our approved list (optional: an additional scholarly source of support):

Topic: Interventions to improving professional adherence to guidelines for prevention of device related infections

Flodgren G, Conterno LO, Mayhew A, Omar O, Pereira CR, Shepperd S. Interventions to improve professional adherence to guidelines for prevention of device-related infections.
Cochrane Database of Systematic Reviews 2013
, Issue 3, Art., No.: CD006559. doi:10.1002/14651858.CD006559.pub2. Hospital-acquired infections PPT – ACE Star Model – NR451.

Hocevar, S. N., Lessa, F. C., Gallagher, L., Conover, C., Gorwitz, R., & Iwamoto, M                (2014).InfectionPrevention Practices in Neonatal Intensive Care Units Reporting to the National                Healthcare Safety Network. 
Infection Control and Hospital Epidemiology
, 
35
(9), 1126–1132.                http://doi.org/10.1086/677636

 

What is the nursing practice issue you have identified related to the topic you have chosen?

The practice issue that I have identified concerning my topic is whether or not the need for intense NICU infection bundles related to decreasing the incidence of ventilator-associated pneumonia, necrotizing fasciitis and CLABSI’s are recommended for the NICU population. The question I have chosen for this topic is as followed: Hospital-acquired infections PPT – ACE Star Model – NR451.

Will implementing new infection bundles versus not implementing new infection bundles significantly decrease acquired infections in NICU babies?

As a traveling Registered Nurse, I have had the pleasure to work at several different NICU’s around the United States. At the hospital that I am currently working at, a level four nicus in Tacoma, Washington, they have implemented some brand new NICU infection bundles that I have never seen before. The purpose of my capstone will be to see if the newly implanted NICU bundles have an effect on helping to decrease the incidence of infections in the NICU population. Hospital-acquired infections PPT – ACE Star Model – NR451.
 

Fully describe the scope of the practice issue:

The scope of the practice issue that I have found is that in keeping tabs on some of the past hospitals that I have traveled to, I have seen that they have an above average reported CLABSI, necrotizing fasciitis, and ventilator-associated pneumonia infections. At the hospital that I am currently working at, I have noticed that regarding those three infections, there has been an overall decrease in the amount of these infections among the NICU population. Hospital-acquired infections PPT – ACE Star Model – NR451. Education, demonstration, and evaluation of NICU nurses during their hands-on assessment of their patients is crucial in determining whether or not the policies on infection prevention and whether or not the strict use of new infection bundles. Babies in the neonatal intensive care unit often have immature immune systems. They are exposed to many different caregivers and may have multiple blood test, IV lines, and other invasive procedures. The incidence of CLABSI reported from NICUs is consistently among the highest reported when compared to other hospital locations. Due to this factor, it is important to figure out what is the best plan of action regarding decreasing infections in this population. I will also be using the Standardized Infection Ratio (SIR) to compare the rate of central line infection/VAP/Necrotizing fasciitis Rates with other hospitals. Hospital-acquired infections PPT – ACE Star Model – NR451. 

What is the practice area?

_x__ Clinical

_x__ Education

___ Administration

___ Other (List):

How was the practice issue identified?
(check all that apply)

_x__ Safety/risk management concerns

___ Unsatisfactory patient outcomes

_x__ Wide variations in practice

___ Significant financial concerns

 

 

___ Difference between hospital and community practice

__x_ Clinical practice issue is a concern

___ Procedure or process is a time waster

___ Clinical practice issue has no scientific base

__ Other: Hospital-acquired infections PPT – ACE Star Model – NR451.

Describe the rationale for your checked selections:

Safety Risk Management Concerns:

I chose safety and risk management because critically ill infants that are cared for in the neonatal intensive care units are among the most vulnerable patient population in the hospital. NICU babies are at an increased risk for adverse outcomes related to nosocomial infections and unplanned readmission to the hospital. Nosocomial infections can affect nearly 1 in 6 very low birth weight infants (VLBW), which can double the risk of mortality and lengthen the NICU stay. Invasive equipment, such as central lines and ventilators, are a familiar source of nosocomial infection. Hospital-acquired infections PPT – ACE Star Model – NR451.

Wide Variation in practice:

I chose this area because every NICU that I have worked at practices differently concerning the maintenance of CLABSI, ventilators, and feedings. I have even worked within the same hospital system, just in a separate location and saw a vast difference in how they did things compared to their partners up the road. For example, some hospitals require everybody in the room to wear a hat and mask when inserting a central line, whereas other hospitals only require the person entering the catheter of a central line to wear a hat and mask. Some hospitals are strict about suctioning an intubated baby before turning their head or repositioning, while some hospitals have no preference on which order this happens. Hospital-acquired infections PPT – ACE Star Model – NR451.  Some hospitals will clean an infant’s nasogastric/orogastric tube with alcohol before beginning a gavage feeding, while some hospitals don’t see it necessary.

Clinical practice issue is a concern:

I chose this because I believe that many hospitals are relaxed about their infection policies. I have worked in hospitals that are very strict about preventing infection in our NICU babies, and I have also worked in hospitals that hardly have a policy for infection written. Regardless of whether or not a NICU is a level IV or a level II, infection protocols should be followed consistently and concisely by all staff.

 

 

What evidence must be gathered?
(check all that apply)

_x__ Literature search

___ Guidelines

___ Expert Opinion

___ Patient Preferences

___ Clinical Expertise

___ Financial Analysis

___ Standards (Regulatory, professional, community)

___ Other

 

Describe the rationale for your checked selections:

Literature Search:

A reasonable basis of literature is fundamental regarding proving the significance of a clinical problem. A literature search is a 
systematic
, thorough search of all types of published literature to identify a magnitude of excellent quality references relevant to a specific topic and is a fundamental element of the methodology of any research project. A Literature search is necessary to research because it can help to draw information for making sound evidence-based guidelines. Hospital-acquired infections PPT – ACE Star Model – NR451.

Clinical Expertise:

Clinical expertise will need to be assessed to determine whether the newly implanted infection bundles are beneficial to our tiny patients. Evidence-based practice involves integrating the best evidence and clinical expertise.

Guidelines:

Guidelines from organizations such as the National Women’s Newborn Service, Centers for Disease Control and the World health organization should be evaluated to determine what infection procedures are recommended in the NICU setting. Hospital-acquired infections PPT – ACE Star Model – NR451.

 

 

 

Evidence Summary Worksheet

Directions
: Please type your answers directly into the worksheet.

 

Describe the practice problem in your own words with reference to the identified population, setting and magnitude of the problem in measurable terms:

The practice problem that I have identified is whether or not the implementation of new NCU infection bundles are beneficial to our tiny NICU patients. The practice problem identified by our assigned article
Interventions to improve professional adherence to guidelines for prevention of device-related infections
refers to the fact that healthcare associated infections (HAI’s) are detrimental to the well-being of our patients. Hospital-acquired infections PPT – ACE Star Model – NR451. When infection procedures, or bundles, are not strictly followed in the NICU this can lead to patients to the subjection of acquiring device-related infections. Nosocomial infections in the NICU are a significant cause of morbidity. Premature infants are especially vulnerable since they can undergo many invasive procedures and are often times dependent on invasive devices such as feeding tubes, central lines, and ventilators. The very mechanisms that sustain life can be a reservoir for bacterial invasion, especially in those with immature immune systems. The use of Aseptic and sterile technique should always be involved when handling invasive devices in the NICU. This has been found to decrease the incidence of infection in the NICU. It would be essential to measure this outcome within a six-month time span to determine the number of babies that fall victim to infections related to invasive devices within this time frame regarding the different policies and bundles used in a particular NICU.

Type the complete APA reference for the systematic review article you chose from the list provided. It must be relevant to the practice issue you described above. Include the APA reference for any additional
optional
supplemental scholarly source related to the review you wish to use.

Flodgren G, Conterno LO, Mayhew A, Omar O, Pereira CR, Shepperd S. Interventions to improve professional adherence to guidelines for prevention of device-related infections.
Cochrane Database of Systematic Reviews 2013
, Issue 3, Art., No.: CD006559. doi:10.1002/14651858.CD006559.pub2. Hospital-acquired infections PPT – ACE Star Model – NR451.

Hocevar, S. N., Lessa, F. C., Gallagher, L., Conover, C., Gorwitz, R., & Iwamoto, M                (2014).InfectionPrevention Practices in Neonatal Intensive Care Units Reporting to the National                Healthcare Safety Network. 
Infection Control and Hospital Epidemiology
, 
35
(9), 1126–1132.                http://doi.org/10.1086/677636

Identify the objectives of the article:

The objective of the study that I have chosen is to figure out quality improvement strategies to change clinical practice in improving the rate of device-related infections in the healthcare setting. The article looks at the care bundles developed by the HAI’s and suggests that bundling interventions an effective form of decreasing healthcare-associated infections. The report assesses the effectiveness of different interventions, with or without various combinations, to target healthcare professionals/healthcare organizations to improve professional adherence to infection control guidelines on device-related infection rates and also aims to measure adherence to these guidelines.

Provide a statement of the questions being addressed in the work and how these relate to your practice issue:

The matters discussed in the article deal with assessing the different interventions in targeting infection control regarding device-related infections. This is similar to my capstone question because I am seeking to establish whether or not the use of newly implanted infection bundles has a profound effect on decreasing the incidence of infections in the NICU brought on invasive devices such as central lines, feeding tubes, and ventilators. The article also talks about the breakdown of aseptic technique during insertion of invasive devices as well as the duration of the devices use. These areas are all critical factors in whether or not NICU bundles will be successful in decreasing the incidence of invasive device-related infections Hospital-acquired infections PPT – ACE Star Model – NR451.

Summarize (in your own words) the interventions the author(s) suggest improving patient outcomes.

Some of the interventions that the authors have found to be effective in preventing ventilator-associated pneumonia include elevating the head of the bed by 30 degrees; continuous suctioning when there is evidence of increased sections, not changing circuits on ventilators unless it is entirely indicative, oral care and hand hygiene. The article talked about daily sedation use, however, in the NICU we rarely use sedation unless the baby is high risk for pulling out their endotracheal tube. The questions being addressed in the article deal with assessing the different interventions in targeting infection control concerning device-related infections. This is similar to my capstone question because I am seeking to establish whether or not the use of newly implanted infection bundles has a profound effect on decreasing the incidence of infections in the NICU brought on invasive devices such as central lines, feeding tubes, and ventilators. The article also talks about the breakdown of aseptic technique during insertion of invasive devices as well as the duration of the devices use. These areas are all critical factors in whether or not NICU bundles will be successful in decreasing the incidence of invasive device-related infections. In regards to the prevention of CLASI infections, the article has found that timely dressing changes using aseptic techniques, daily audits of central line site, chlorhexidine on the skin with the preparation of insertion of a sterile catheter, and the use of sterile barriers during catheter insertion, such as a hat, and mask. Hospital-acquired infections PPT – ACE Star Model – NR451.

Summarize the main findings by the authors of your systematic review including the strength of evidence for each main outcome.  Consider the relevance to your project proposal for the Milestone 2 project paper
.
(If an
optional
supplemental source is also used, include a statement of relevance to it as well.)

The main findings of the studies showed that adherence to invasive device related bundles could help decrease the risk of nosocomial infections in this population. Many of these infection prevention practices are implemented in the newly recommended NICU bundles. The study found that there were beneficial effects regarding the use of these infection bundles up to three months, nine months, and twelve months after initiated. The study found a decrease in VAP rates between 5 and 23 cases per 1,000 ventilator days. The article highlights that for effective prevention of device-related hospital infections, it is vital to ensure that the clinical practice bundles/policies that are implemented have an evidence-based backing and target the critical risk factors for the specific indwelling medical devices in question. However, the study emphasizes that further research should be done to come to a definitive answer.

 

Outline evidence-based solutions that you will consider for your project
.

●       Whether or not suctioning an infant’s ET tube and oral secretions before repositioning decrease the incidence of VAP

●       Whether or not cleaning a nasogastric/orogastric feeding tube with alcohol for at least 15 seconds decreases the incidence of necrotizing fasciitis

●       Whether or not using a mask and hat is crucial for everybody to have one when PICC line placement has begun Hospital-acquired infections PPT – ACE Star Model – NR451.

●       Providing education and demonstration to NICU nurses and doctors to make sure infection bundles are properly being followed

●       Whether or not the use of aseptic/sterile technique is needed when handling invasive devices in the NICU

●       If changing ventilator circuit only when visibly soiled or malfunctioning is beneficial in decreasing the incidence of VAP

●       Minimizing days on ventilation

●       Use of frequent hand hygiene when handling invasive devices

●       Frequent caregiver education and demonstration of NICU bundles to ensure that bundles are being followed consistency and concisely Hospital-acquired infections PPT – ACE Star Model – NR451.

Discuss any limitations to the studies that you believe impacts your ability to utilize the research in our project.

The main limitation that I can see with my study is that a NICU may have a hospital policy/bundle in place, but it is not implemented effectively by all staff, including nurses and doctors. Even though there may be a strict and effective prevention of invasive device-related infections in place, studies may still show that the rate of NICU acquired infections are still steadily increasing. As there is no way to closely monitor every nurse, on every shift, at every assessment, this is the only barrier I can see that may skew the results of infections acquired in the NICU.

 

Design for Change Proposal

Hospital-acquired infections are a common cause of lengthened hospitalization, increased mortality, and increase in hospital costs. Inconsistent and inadequate hygiene practices are a leading cause of infection in the NICU. Major reservoirs for infection include ventilators, central lines, and feeding tubes. Different management approaches have been derived in various countries to reduce the rate of hospital-acquired infections Hospital-acquired infections PPT – ACE Star Model – NR451. The effects focus mainly on the roles of nurses in ensuring that the best practices in hygiene are utilized. Education focuses on hand hygiene and the use invasive device infection bundles in the NICU. Given that nurses are at the center stage when it comes to handling hygiene issues of patients in the NICU, nurses are upheld to the highest standard regarding ensuring that hospital-acquired infections are obsolete in the care setting. The use of evidence-based care is a reliable way that nurses can use to address this problem (Stevens, 2013).

Change Model Overview

The ACE Star Model is a tool used for understanding knowledge characteristics, nature and cycles as they are implemented in different aspects of evidence-based practice. The model presents a logical tool for organizing both new and old ideas for improving nursing care into an innovative framework that identifies issues of evidence-based practice approaches and processes. As such, the model can be construed as a simplified portrayal of the relationships that exist between the different knowledge transformation stages even as new knowledge is used to modify old data before it is applied into practice. The model includes common nursing processes and accentuates the application of distinctive features of evidence-based practice (Ellis, 2016). The five steps involved in the ACE star model include the implementation of knowledge development, evidence review, interpretation into practice recommendation, assimilation into practice, and evaluation (ANA, 2015). This design proposal places relevant previous research results within the context of evidence-based practice, allowing the model to serve as an organizer for evaluating and using evidence, and mainstreaming nursing practice into the use of evidence-based practice. Hospital-acquired infections PPT – ACE Star Model – NR451.

Define the Scope of the EBP

The scope of the issue at hand is to determine if implementing new infection bundles versus not implementing new infection bundles decrease acquired infections in NICU babies. Flodgren et al. (2013) are succinct in noting that mortality rate linked with infection vary from 5% in well-managed facilities to 35% in poorly management facilities. Only about 50% of NICUs were found to implement strict NICU infection bundles (Flodgren et al., 2013). Hocevar conducted a study in North America that determined that meta-analysis revealed a statistically significant reduction in VAP, CLABSI, and necrotizing enterocolitis when following strict newly developed infection bundles. The study found the rate of infection decreased by 60% in the first year with this implementation. Hocevar et al. (2014) are more proactive in exploring the problem by noting that the differences observed for infection rates can be attributed to variations links within nursing practices. Following this awareness, the project proposes that applying new nursing management strategies in the NICU that include prioritizing hygiene and the use of consistent invasive line bundles will reduce the acquired infections in NICU babies Hospital-acquired infections PPT – ACE Star Model – NR451.

The short-term objective is to improve prioritization of hygiene and safety and incorporate strict NICU bundles in nursing policies applied in NICU.

Three long-term objectives have been identified to include improving nurses’ service delivery, improving NICU patients’ outcomes, and reducing incidences of NICU acquired infections.

The project milestones include identifying the study sample from the population of interest, assigning the sample into control and treatment groups, subjecting the treatment group to new nursing policies that prioritize infection bundles and safety, collecting statistics on acquired infections in NICU for the study sample, conducting a ratio analysis on the statistics, and presenting results that establish the effect of the new nursing policies in comparison to the old nursing policies.

Stakeholders

A team should be inclusive of a team manager, several NICU nurses, a clinical nurse coach, neonatologist, dietician to aid in necrotizing enterocolitis bundles, and one facility administrator that will be in charge of implementing change. Hospital-acquired infections PPT – ACE Star Model – NR451.

Determine Responsibility of Team Members

The team manager (researcher) will identify goals associated with change before ensuring that these goals are met by allocating each member of the team a set of tangible and achievable tasks and responsibilities. Additionally, the team manager is responsible for collecting and presenting the outcomes of the change to the other stakeholders who include medical personnel employed in NICU. The facility administrator will be the leverage for support for change. The three NICU nurses will work under the supervision of a charge nurse to monitor whether infection bundles are being implemented consistently and concisely among all members of the team. A clinical nurse coach would be utilized in educating staff members on infection-related research data and implementation of infection bundles. The dietician will be a resource in decreasing necrotizing enterocolitis by recommending adequate feedings for infants at risk. Hospital-acquired infections PPT – ACE Star Model – NR451.

Evidence

An evaluation of available literature identified three journal articles as the supporting material that highlighted the need for change by calling for the implementation of new nursing policies that prioritize NICU infection bundles. The reports all agreed that while facility-acquired infections are an occurrence in the NICU, due mainly in part to babies’ deficient immunity and an environment that collects many pathogens from different sources, eliminating all possibilities of infections is a preferable outcome Hospital-acquired infections PPT – ACE Star Model – NR451. The reports mentioned that some diseases could have been avoided if medical personnel prioritized hygiene and safety and utilized strict infection bundles. The three journal articles are in agreement that most of the facility-acquired infections noted in NICU can be minimized through a change in nursing practice and policy. The two journal articles are Flodgren et al. (2013) and Hocevar et al. (2014).

Summarize the Evidence

Flodgren et al. (2013) report that facility associated infections are a source of concern in any medical facility. That is because they are linked with mortality that varies between 5% and 35%. These statistics imply that about 1 out of 3 babies in the NICU who get hospital-acquired infections are expected to die from this. In the 50% of hospitals found to utilize strict NICU infection bundles, the incidence of CLASI, VAP, and necrotizing enterocolitis decreased by 60%. The article goes on to note that infections are linked to the use of invasive medical devices and the inability to adhere and implement newly developed infection bundles to prevent disease (Flodgren et al., 2013). The incidence of VAP significantly reduced from 67.8% to 36.4% after the implementation of prevention bundles (Seham et al., 2014). This same meta-analysis showed that necrotizing enterocolitis bundles decreased the incidence of this disorder from 39% to 13% in a three-year time frame (Seham et al., 2014). Frequent manipulation of invasive line devices is found to be the leading cause contributing to infections. Hocevar et al. (2014) makes a similar assessment but adds that the heterogeneity linked with the different NICU activities may be to blame for the situation. Activity heterogeneity places a strain on nursing personnel and inhibits their capacity to follow the set nursing policies. There is a need to emphasize hygiene and safety in NICU nursing practices as a possible strategy for reducing the incidence of facility-acquired infection (Hocevar et al., 2014). As a result, it is projected that implementing new infection bundles decreases acquired infections in NICU babies. Hospital-acquired infections PPT – ACE Star Model – NR451.

Develop Recommendations for Change Based on Evidence

By the current substantiation from the three-primary journal article, it turns out that implementing new infection bundles that prioritize hygiene and safety will present with a better solution for decreasing the incidence of facility-acquired infections in NICU babies. Including these measures in nursing policies would increase medical care efficiency in the NICU by reducing the occurrence and frequency of preventable errors.

Translation

Action Plan

The action plan will point out NICU inter-professional team members who will directly implement change. NICU nursing personnel will be informed of the project intentions and will need to apply implementation of newly developed infection bundles. The results from the control group (using standard nursing practices) will be acquired from past NICU performance, whereby the outcomes of past and present NICU results will be paralleled to ascertain how the change affected hospital-acquired infections. This will be based on the awareness that if the nursing practice changes present positive outcomes, then the difference in care will be justified. The change program will be implemented for a year after which the findings will be correlated for before and after the nursing practice changes, following which the results will be offered, and concluding commendations made for NICU action. Hospital-acquired infections PPT – ACE Star Model – NR451.

Process, Outcomes Evaluation and Reporting

The anticipated conclusion of the change made will be to decrease the incidence and frequency of facility-associated infection in NICU babies. This will be evaluated by correlating the facility-associated infection rates before and after implementation of the proposal. These actions will illustrate whether the adherence to infection bundles leads to a decrease in infection prevalence. The results will be conveyed to the stakeholders (who include the NICU personnel, administrators, nurse manager, and clinical nurse coach) using charts and figures that depict the effects of changing nursing practices on facility-associated infection rates within NICU. Hospital-acquired infections PPT – ACE Star Model – NR451.

Identify Next Steps

Following the program completion and publication of the results, the clinical nurse coach will suggest to the stakeholders whether or not the program outcomes be implemented into the NICU. If implementing NICU bundles produces a beneficial result, then it will be suggested that it be incorporated as part of customary nursing practice. The project should then be utilized within the facility. Should the data provide negative results, then the status quo will be conserved while highlighting that change is not warranted. Hospital-acquired infections PPT – ACE Star Model – NR451. Also, a recommendation will be made that other facilities should adopt the implementation of invasive line infection bundles in their NICU.

Disseminate Findings

The outcomes of the project will be circulated through distribution in medical publications such as journals. Dissemination using this strategy will guarantee that medical practitioners and other stakeholders can easily access the results. This is based on the assumption that the outcomes will be informative and reliable enough to implement these evidence-based findings into NICU.

Conclusion

Infections related to invasive device usage in NICU babies is an epidemic. For this reason, infections diminish patient confidence in medical practice while harming patients through avoidable risks. The issue is best approached by reviewing nursing practice to prioritize hygiene and implementation of strict adherence to NICU bundles. Based on the information provided, it has been suggested that nursing policies for handling NICU activities should focus on the cleanliness and adherence to invasive devices bundles, adequate hygiene practices, and safety. Decreasing the incidence of infection begins it ensuring proper policies are followed when handling ventilators, central lines and feeding tubes. If the program outcomes backs the reviewed publications, then publishing the program outcomes will make them accessible to concerned stakeholders while reducing the incidence of hospital-acquired infection in the NICU. Hospital-acquired infections PPT – ACE Star Model – NR451.

 

References

American Nurses Association. (2015). 
Nursing: Scope and standards of practice 
(3rd ed.). Silver  Spring, MD: Author.

Ellis, P. (2016).
Evidence-based Practice in Nursing
(3
rd
ed.). London: Learning Matter/SAGE Publications Ltd.

Flodgren, G., Conterno, L. O., Mayhew, A., Omar, O., Pereira, C. & Shepperd, S. (2013). Interventions to improve professional adherence to guidelines for prevention of device-related infections.
Cochrane Database of Systematic Reviews
, 2013 Issue 3, Art., No.: CD006559. doi:10.1002/14651858.CD006559.pub2. Hospital-acquired infections PPT – ACE Star Model – NR451.

Hocevar, S. N., Lessa, F. C., Gallagher, L., Conover, C., Gorwitz, R. & Iwamoto, M. (2014). Infection Prevention Practices in Neonatal Intensive Care Units Reporting to the National Healthcare Safety Network.
Infection Control and Hospital Epidemiology
, 35(9), 1126-1132.
http://doi.org/10.1086/677636

Seham, F.A, Hanan, S.S., Safaa, H.S., Wafaa, F.E., Mona, M.E., Ahmed, G.S., Mohamed, A.A., (2014).Reducing ventilator-associated pneumonia in neonatal intensive care units using “VAP prevention Bundle”: a cohort study. Cochrane Database of Systematic Reviews, 2014 Issue 6, Art., No: CD006892. https://doi.org/10.1186/s12879-015-1062-1 Hospital-acquired infections PPT – ACE Star Model – NR451.

Stevens, K. R. (2013). The impact of evidence-based practice in nursing and the next big  ideas. 
Online Journal of Issues in Nursing, 18
(2), manuscript 4.           doi:10.3912/OJIN.Vol18No02Man04. Retrieved from
https://search-proquest
          com.chamberlainuniversity.idm.oclc.org/docview/1449497144?OpenUrlRefId=I            fo:xri/sd:wcdiscovery&accountid=147674

Hospital-acquired infections PPT

Interventions to improving professional adherence to guidelines for prevention of device related infections

Presented by

Introduction

This study builds on the assertion that Hospital-acquired infections are:

v a common cause of lengthened hospitalization,

vincreased mortality,

vand increase in hospital costs.

Improper hygiene practices are a leading cause of infection in the NICU.

This study intends to enact evidence-based care as a reliable way that nurses can use to address this problem Hospital-acquired infections PPT – ACE Star Model – NR451.

Description of the Ace Star change model for this project.

lIts a simplified portrayal of the relationships between the different knowledge transformation stages. It includes :

a.common nursing processes.

b.application evidence-based practice

lThis design proposal places relevant previous research results within the context of evidence-based practice.

Practice Issue

Is there any need for applying NICU bundles to reduce infections.

Question chosen compares implementing versus not implementing new infection bundles.

Comparison determines if there is any change.

Scope of the problem

To determine if implementing new infection bundles decrease infections.

mortality rate linked with infection vary in different facilities.

study in North America that revealed  reduction in :

üVAP

ü,CLABSI,

ü necrotizing enterocolitis

¡
The reduction came after following strict newly developed infection bundles..

l The differences observed for infection rates can be attributed to variations links within nursing practices. Hospital-acquired infections PPT – ACE Star Model – NR451.

l

Scope of the problem (CONT..)

The project proposes that applying new nursing management strategies in the NICU will reduce infections

The strategies should include :

üprioritizing hygiene

üuse of consistent invasive line bundles

The project has

v   short term objectives

v    Long term objectives

Team/stakeholders

The team will be inclusive of :

1.a team manager,

several NICU nurses,

3.a clinical nurse coach,

4.neonatologist

5.Dietician

one facility administrator .

Evidence supporting need for change—from literature

An evaluation of available literature identified three journal articles as the supporting material that highlighted the need for change

Prevalence of infection in medical facilities (Flodgren et al., 2013)

Efficacy of applying prevention bundles in reducing infections (Seham et al., 2014).

Correlation of heightened cases of infection and manipulation of invasive line devices (Hocevar et al., 2014)

Evidence supporting need for change—from literature (continued..)

Prevalence of infection in medical facilities
(
Flodgren et al., 2013
)

Ømortality associated with infections varies between 5% and 35%.

Ø1 out of 3 babies in the NICU get infected Hospital-acquired infections PPT – ACE Star Model – NR451.

Ø50% of hospitals enacting strict NICU infection bundles post a 60% decrease

Evidence supporting need for change—from literature (continued..)

Efficacy of applying prevention bundles in reducing infections (Seham et al., 2014
).

ØImplementation of bundles significantly reduced VAP from 67.8% to 36.4%

Ønecrotizing entero-colitis bundles decreased the incidence from 39% to 13%

Evidence supporting need for change—from literature (continued..)

Correlation of heightened cases of infection and manipulation of invasive line devices (Hocevar et al., 2014)

The report highlights:

heterogeneity of different NICU activities highlighted as probable cause

proposes hygiene and safety in NICU nursing practices as strategy.

Infection buddle’s could reduce infections in NICU babies

Notable points from literature

Øfacility-acquired infections are an occurrence in the NICU.

ØElimination of infection is  possible

ØMeasures taken should entail prioritization of measures deemed as likely to instigate infection

Action Plan

Plan entails:

ØPointing out team members who will implement change

ØNICU nursing personell to be informed of the project intentions

ØNurses will be required to implement the new bundles Hospital-acquired infections PPT – ACE Star Model – NR451

ØResults acquired wil be used to determine if there is any change in affected hospitals

ØIt will be based on the awareness If nursing practice changes present positive outcomes

Timeline for the plan

The changes will be implemented for a year then the results shall be compared

Emphasis will be on observation of nursing practices:

prior to enactment of bundle

after enactment of bundle

The nurse’s role and responsibility in the pilot program

For the pilot program :

Nurses will monitor if the infection bundles are thoroughly implemented.

The change nurse will be incharge of the nurses

The clinical coach nurse will educate team members about the findings and how they should be implemented Hospital-acquired infections PPT – ACE Star Model – NR451

Procedure (what steps are to be taken to complete this change process, from start to finish?)

After completion, the clinical nurse coach will advise the stakeholders on implementation including the need for

The changes shall be incorporated into nursing practice

The changes shall be utilized within the facility

Other facilities shall be advised to adopt the findings.

Forms that will be used (if applicable)

The key strategies for this case include

ØIncorporating the findings into procedures

ØEducating staff

ØJournals

ØRecommendations

Resources available to the staff

–Facility equipment’s

–Journals

–internet

References

Thank you for listening

Hospital-acquired infections PPT – ACE Star Model – NR451

Hospital-acquired infections PPT

Social Movements Example Essay

Week 5Social Movements Assignment A grassroots way to facilitate change in society is through a social movement. Often these movements are created after an injustice to change the way a society thinks and acts towards a sect of people. Your assignment this week focuses on using social psychology concepts to explain the development of a social movement and the change in society that has occurred from the social movement.Some examples of social movements you may want to research are:Black Lives MatterBlue Lives MatterPro-ChoiceDefend ScienceLGBTQHuman RightsEnvironmentAnimal RightsAnti-BullyingYour assignment for this week is to find two articles that discuss one social movement. To help guide your analysis, complete the following steps: – Summarize each article, focusing on main ideas and primary examples (2-4 Paragraphs)- Discuss the relationship between the articles and key terms and ideas in social psychology (2-3 Paragraphs) – Describe social change that has come about from the movement and utilize social psychology ideas to support your recommendation (1-2 paragraphs) – Provide APA citations for both articles and additional references. Grading:50 points – summarizes two articles related to a specific social movement.20 points – discusses the issues the topics of the articles in relation to social psychology terminology15 points – conclusion using social psychology ideals on changes that have come about due to the social movement discussed15 points – for orderly presentation in subsections, freedom from spelling and grammar errors, and use of APA style citations and reference page. Social Movements Example Essay.

Social Movements Assignment

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A grassroots way to facilitate change in society is through a social movement. Often these movements are created after an injustice to change the way a society thinks and acts towards a sect of people.  Your assignment this week focuses on using social psychology concepts to explain the development of a social movement and the change in society that has occurred from the social movement.

 

Some examples of social movements you may want to research are:

Black Lives Matter                  Blue Lives Matter                   Pro-Choice

Defend Science                       LGBTQ                                     Human Rights

Environment                           Animal Rights                          Anti-Bullying

 

 

Your assignment for this week is to find two articles that discuss one social movement. To help guide your analysis, complete the following steps:

 

– Summarize each article, focusing on main ideas and primary examples (2-4 Paragraphs)

– Discuss the relationship between the articles and key terms and ideas in social psychology (2-3 Paragraphs) Social Movements Example Essay.

– Describe social change that has come about from the movement and utilize social psychology ideas to support your recommendation (1-2 paragraphs)

– Provide APA citations for both articles and additional references.

 

 

 

Grading:

50 points – summarizes two articles related to a specific social movement.

20 points – discusses the issues the topics of the articles in relation to social psychology terminology

15 points – conclusion using social psychology ideals on changes that have come about due to the social movement discussed Social Movements Example Essay.

15 points – for orderly presentation in subsections, freedom from spelling and grammar errors, and use of APA style citations and reference page.

 

Expectation

Points Possible

Summaries

Summaries are included for two articles and provide specific details about main arguments, key claims, and examples.

50

Social Psychology Terminology and Use

The analysis includes a strong use of social psychology terminology and thoughtful applies concepts to current events.

20

Conclusion

Conclusion includes recommendations for social change and provides a specific plan of action to support a culture of change.

15 Social Movements Example Essay

APA Format and Style

Paper uses APA format and utilizes style and grammar to promote clarity.

15

Social Movements

Article 1:
Waggoner, C. (2013). Cyber Bullying: The public school response.
Administrative Issues Journal
3(3), 43-46. Retrieved from http://dc.swosu.edu/cgi/viewcontent.cgi?article=1221&context=aij

Waggoner (2013) explores the concept of cyberbullying and what constitutes consent. In this case, the article notes that any form of repeated ridicule, mistreatment or harassment through online communication platforms should be construed as cyberbullying irrespective of whether there is an element of consent from the victim. In fact, the author notes that unlike physical bullying, cyberbullying has more serious consequences since the victim can be targeted at any time of the day and place irrespective of physical distance. Based on the pervasive nature of cyberbullying that turns the issue of consent irrelevant, the article advances a plea that a more effective solution is necessary to curb cyberbullying (Waggoner, 2013).

Article 2:
Guan, N. C., Kanagasundram, S., Ann, Y. H., Hui, T. L. & Mun, T. K. (2016). Cyber bullying – a new social menace.
ASEAN Journal of Psychiatry
, 17(1), 104-115. Retrieved from http://www.aseanjournalofpsychiatry.org/index.php/aseanjournalofpsychiatry/article/viewFile/362/239

Guan et al. (2016) mentions that cyberbullying is distinctive in its use of online platforms as tools. In fact, the article mentions that advances in communication technology have facilitated cyberbullying. Additionally, the authors affirm that its prevalence ranges from 30% to 55% with equal opportunities for both boys and girls to be either victims or perpetrators although victims are typically younger while perpetrators are older Social Movements Example Essay. Based on the high prevalence rate for cyberbullying, the article recommends that action be taken as a priority to curb the practice.

Conclusion

Based on information presented in the two articles, there is need for cyberbullying to be addressed as a priority. Following that, there is a need for more focus on improving awareness about the issue, offering help to both victims and perpetrators, and engaging local community members to develop localized solutions. For cyber bullying to be effectively addressed, there is a need to understand that it is distinct from traditional bullying with the focus being on increasing awareness, offering help and engaging community members. Additionally, access to online platforms should be supervised and limited so that there is limited interaction between victims and perpetrators and opportunities for cyberbullying are limited Social Movements Example Essay.

References

Guan, N. C., Kanagasundram, S., Ann, Y. H., Hui, T. L. & Mun, T. K. (2016). Cyber bullying – a new social menace.
ASEAN Journal of Psychiatry
, 17(1), 104-115. Retrieved from http://www.aseanjournalofpsychiatry.org/index.php/aseanjournalofpsychiatry/article/viewFile/362/239

Waggoner, C. (2013). Cyber Bullying: The public school response.
Administrative Issues Journal
3(3), 43-46. Retrieved from http://dc.swosu.edu/cgi/viewcontent.cgi?article=1221&context=aij Social Movements Example Essay

Health policy values essay example

Details:

Write a paper of 750-1,000 words examining your personal values and beliefs. Include the following:

Describe your personal values and spiritual beliefs.

Using the elements of cost, quality, and social issues to frame your description, differentiate your beliefs and opinions about health care policy. Give examples of relevant ethical principles, supported by your values.

Analyze how factors such as your upbringing, spiritual or religious beliefs/doctrine, personal and professional experiences, and political ideology affect your current perspective on health care policy. Health policy values essay example.

Examine any inconsistencies you discovered relative to the alignment of your personal values and beliefs with those concerning health policy. Discuss what insights this has given you.

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References

Shams, L., Akbari Sari, A., & Yazdani, S. (2016). Values in Health Policy – A Concept Analysis. 
International Journal of Health Policy and Management
, 
5
(11), 623–630.
http://doi.org/10.15171/ijhpm.2016.102

 

Retrieved from

http://www.independentnurse.co.uk/professional-article/relating-your-values-morals-and-ethics-to nursing-practice/64200
Retrieved from

Save Link
Nursing Code of Ethics wInterpretive Statements

Assignment
Health policy values essay example

View Rubric

 

20.0 %Examine any inconsistencies you discovered relative to the alignment of your personal values and beliefs with those concerning health policy. Discuss what insights this has given you.

Does not address inconsistencies discovered relative to the alignment of personal values and beliefs with those concerning health policy. Does not discuss insights.

Identifies inconsistencies discovered relative to the alignment of personal values and beliefs with those concerning health policy. Does not discuss insights.Health policy values essay example

Discusses inconsistencies discovered relative to the alignment of personal values and beliefs with those concerning health policy. Does not discuss insights.

Discusses inconsistencies discovered relative to the alignment of personal values and beliefs with those concerning health policy. Partially discusses insights. Some inconsistencies present.

Comprehensively examines inconsistencies discovered relative to the alignment of personal values and beliefs with those concerning health policy. Fully discusses insights. Clear examples and details given. No inconsistencies.

5.0 %Paragraph Development and Transitions Style

Paragraphs and transitions consistently lack unity and coherence. No apparent connections between paragraphs. Transitions are inappropriate to purpose and scope. Organization is disjointed.

Some paragraphs and transitions may lack logical progression of ideas, unity, coherence, and/or cohesiveness. Some degree of organization is evident.

Paragraphs are generally competent, but ideas may show some inconsistency in organization and/or in their relationships to each other. Health policy values essay example

A logical progression of ideas between paragraphs is apparent. Paragraphs exhibit a unity, coherence, and cohesiveness. Topic sentences and concluding remarks are used as appropriate to purpose, discipline, and scope.

There is a sophisticated construction of paragraphs and transitions. Ideas universally progress and relate to each other. The writer has been careful to use paragraph and transition construction to guide the reader. Paragraph structure is seamless. Individually and collectively, paragraphs are coherent and cohesive ? they ?sparkle.?

10.0 %Organization and Effectiveness

Health policy values essay example

5.0 %Mechanics of Writing (includes spelling, punctuation, and grammar)

Surface errors are pervasive enough that they impede communication of meaning.

Frequent and repetitive mechanical errors that distract the reader.

Some mechanical errors or typos are present, but are not overly distracting to the reader.

Prose is largely free of mechanical errors, although a few may be present.

Writer is clearly in control of standard, written American English.

5.0 %Language Use and Audience Awareness (includes sentence construction, word choice, etc.)

Inappropriate word choice and/or sentence construction, lack of variety in language use. Writer appears to be unaware of audience. Use of ?primer prose? indicates writer either does not apply figures of speech or uses them inappropriately.

Some distracting inconsistencies in language choice (register), sentence structure, and/or word choice are present. Sentence structure may be occasionally ineffective or inappropriate. The writer exhibits some lack of control in using figures of speech appropriately.

Sentence structure is correct and occasionally varies. Language is appropriate to the targeted audience for the most part.

Health policy values essay example

The writer is clearly aware of audience; uses a variety of sentence structures and appropriate vocabulary for the target audience, and uses figures of speech to communicate clearly.

The writer uses a variety of sentence constructions, figures of speech, and word choice in unique and creative ways that are appropriate to purpose, discipline, and scope.

15.0 %Format

 

10.0 %Evaluating and Documenting Sources (includes use of appropriate style, correct citation format in-text and in reference section

Plagiarism; rarely follows any documentation format correctly; uses non-credible sources. No References section.

Uses documentation, but frequent formatting/citation errors are present; some sources have questionable credibility. Reference section is not correctly cited.

Sources used are credible and documented appropriately to the discipline; formatting and citation is usually correct, but some lack of control is apparent. Reference section is correctly cited.

Documentation is appropriate and formatting/citations are correct, although a few errors/typos may be present; most sources are authoritative. Reference section is correctly cited.

There are virtually no errors in documentation format or citation; all sources are authoritative. Reference section is correctly cited and at least 3 references are used

3.0 %Title page

No title page.

None

Title page is incomplete or inaccurate.

Title page has minor errors.

Title page is complete.

2.0 %Page constraint

Information presented does not meet minimum assigned length of 750 words.

None

Information presented exceeds 1000 words.

None

Information is presented within word limit constraints of 1000 words.

Personal Values and Beliefs

Values are revered guides that define one’s behaviors and actions during the daily interaction. Defining values Pickles, de Lacey and King (2017) highlight them as composite of a definite set of principles which an individual or a community perceive to be the perfect guidelines for living. Consequently, values are integral to each individual considering their fundamental role in shaping our personalities and the underlying decisions we make in our daily lives. An individual’s set of values shape t

Values are mostly influenced by family and the society an individual grows up in. Beliefs, on the other hand, are the claims which an individual in a given community regard as the core truth (McSherry et al., 2017). Further, Pickles, de Lacey and King (2017) assert that while values and beliefs are correlated presumably, beliefs are majorly influenced by religion. Having grown up in the religious family and a society which has a high regard for human dignity and equality played a major role in influencing the values I adopted. Notably, instigated by the environment in grew up in, I am an ardent believer in equality and fair treatment of everyone regardless of their gender, age, sexual orientation and religious background. Moreover, my family had heightened emphasis on selflessness, peace, and forgiveness, coupled with good listening skills and not being judgmental the virtues nurtured in me high relevance to this values.

However, the values and beliefs would be of minimal impact to the society and the human race, in general, were it not for my communities reverence for friendship. In this regard, I have always strived to ensure that my social skills are excellent including when dealing with strangers. Consequently, these values have engraved in me a mission of bringing positive change in this chaotic world a mission I consider as my personal obligation. In this regard, I’m of the opinion that in all my dealings emphasis should be on instigating positive impact on others. Health policy values essay example.

Personal values are deemed to have an impact on my practice. Notably, in a world is largely dominated by capitalism the quality of goods, services and their accrued outlays are determined by the amount of money one pays (Grace, 2017). Consequently, this ideology is also applied while drafting most healthcare policies. In my country, the healthcare policies adopt a third party system meaning an insurance company caters for a patient’s medical cost thus citizens who can’t afford an insurance cover are deemed to have limitations while accessing healthcare services. In this regard, this system has a slight difference with one of my personal value which is equal accordance of services regardless of an individual’s financial status. Moreover, while social factors are likely to affect proper service delivery in the healthcare sector in some communities, my values cannot entertain such practices. For instance, in some cultures, men are viewed as a superior gender to women, a factor which highly contradict my personal value of equality and fairness without any considerations to someone’s gender.

However, my personal value of fairness and equality is perfectly harmonious with the nursing practice ethical principle of ‘Justice’ which requires justice to be the core of all practices including new and experimental medical procedures (Grace, 2017). In this case, medicine should be distributed equally while putting into consideration the scarcity of resources, completion or any resultant conflict Health policy values essay example. As such, this is in line with my belief that no one should be given preference due to social status or any other related factor during the practice. Furthermore, underlining my values and beliefs is the goal of making a positive impact on the human race. As such this goal perfectly aligns with the ethical principle of beneficence which stipulates that all health care provided must be intended for good (Pickles, de Lacey & King, 2017).

Besides our upbringing, religion and politics also play role in shaping up our personality and character. Having been brought up in a highly religious family and in a country where democracy was highly regarded has had a huge contribution to my personal professional view of the healthcare policy. My caring and strict disciplinarian parents ensured that they instilled values and beliefs in me that made me gladly offer a helping hand to others. Mainly, they insisted that I should always give first considerations to the elderly, children and the less fortunate while offering any sort of help. Interestingly, after following my lifelong dream of joining the healthcare field, I realized that most of these values have been incorporated in healthcare policies. This is evident in the country through the Obama care act whose main aim is to provide quality healthcare to all at low cost. In this regard, my morale and passion are greatly boosted since the less privileged are highly considered. Additionally, my affiance as a nurse is further boosted by the future aspirations of the global health policy which strongly implies on equal and quality healthcare to all nations of the globe above any concern of specific nations, this brings hope for a better future to poor nations as they will have access to world-class healthcare. Health policy values essay example.

After a thorough and critical review of my personal values and beliefs, I’ve noted that the quality of healthcare is determined by many factors thus uniformity and equality cannot be the same or achieved overnight. Moreover, most policies have strived to provide quality healthcare to all despite all the determining factors. However, as a professional, financial status or social status should not limit the care or attention given to patients. Regardless of the various limitations, a medical professional should always strive to make every patient feel special and valued.

References

Grace, P. J., (Eds.). (2017). Nursing ethics and professional responsibility in advanced practice. Jones & Bartlett Learning.

McSherry, W., Bloomfield, S., Thompson, R., Nixon, V. A., Birch, C., Griffiths, N., … & Boughey, A. J. (2017). A cross-sectional analysis of the factors that shape adult nursing students’ values, attitudes, and perceptions of compassionate care.
Journal of Research in Nursing,
22(1-2), 25-39.

Pickles, D., de Lacey, S., & King, L. (2017). The conflict between nursing student’s personal beliefs and professional nursing values.
Nursing Ethics
, 46 Health policy values essay example.

Chronic asthma and acute asthma exacerbation essay example

To Prepare

Review “Asthma” in Chapter 27 of the Huether and McCance text. Identify the pathophysiological mechanisms of chronic asthma and acute asthma exacerbation. Consider how these disorders are similar and different.

Select a patient factor different from the one you selected in this week’s Discussion: genetics, gender, ethnicity, age, or behavior. Think about how the factor you selected might impact the pathophysiology of both disorders. Reflect on how you would diagnose and prescribe treatment of these disorders for a patient based on the factor you selected. chronic asthma and acute asthma exacerbation essay example.

Review the “Mind maps—Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease (GERD)” media in the Week 2 Learning Resources. Use the examples in the media as a guide to construct two mind maps—one for chronic asthma and one for acute asthma exacerbation. Consider the epidemiology and clinical presentation of both chronic asthma and acute asthma exacerbation chronic asthma and acute asthma exacerbation essay example.

To Complete

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Write a 3-page paper that addresses the following:

Describe the pathophysiological mechanisms of chronic asthma and acute asthma exacerbation. Be sure to explain the changes in the arterial blood gas patterns during an exacerbation. chronic asthma and acute asthma exacerbation essay example.

Explain how the factor you selected might impact the pathophysiology of both disorders. Describe how you would diagnose and prescribe treatment for a patient based on the factor you selected.

Construct two mind maps—one for chronic asthma and one for acute asthma exacerbation. Include the epidemiology, pathophysiology, and clinical presentation, as well as the diagnosis and treatment you explained in your chronic asthma and acute asthma exacerbation essay example paper.

Pathophysiology of Asthma

Asthma is “an inflammatory disease of the airways that causes airway hyper responsiveness, mucosal edema, and mucus overproduction, production characterized by coughing, wheezing and dyspnea.” The pathophysiology of asthma is characterized by three major components: airway inflammation, airway hyperresponsiveness, and airway obstruction. Asthma may present in acute from or in chronic manifestation (Mims, 2015). This paper will discuss the pathophysiology of both acute and chronic asthma, and discuss the effect of genetic factors in the pathophysiology, diagnosis and the treatment of the condition, presented as mind maps for the two forms of asthma.

Pathophysiology

Acute asthma begins when the patient is exposed to environmental allergies, cold, or exercise. The cells that are involved in the inflammatory response include; mast cells, activated T lymphocytes, eosinophil, epithelial cells, endothelial cells, goblet cell. Th1 lymphocytes produce interleukin-2 cytokines and interferon alpha. Th2 lymphocytes, when activated, produce interleukin-5, IL-6, IL-9and 13. Fibroblast, endothelial cells, and cell-derived mediators produce structural changes that include; hypertrophy and hyperplasia of the smooth muscles surrounding the airways, formation of new blood vessel along the airways and growth of the airway epithelium (Agarwal, Dhooria, Aggarwal, Maturu, Sehgal, Muthu, & Jindal, 2015). chronic asthma and acute asthma exacerbation essay example.

In addition, in acute asthma, the pathophysiological progress is characterized by; bronchial smooth muscle constriction causing bronchospasm, increased mucus secretion by the goblet cells, and airway edema. Smooth muscle spasms are mediated by the immunoglobulin E dependent response, increased mucus hypersecretion is triggered by exposure to allergens. These changes reduce the airway diameter, reducing the rate of airway inhalation and the rate of exhalation as well.  Consequently, the neurological response causes an increase in the rate of breathing, thus increasing the work of breathing (Becker & Abrams, 2017).

On the other hand, chronic asthma is characterized by structural changes that occur weeks after the inflammatory response has begun. The structural changes involved are an increase in the size and the number of the smooth muscle cells surrounding the airway through hypertrophy and hyperplasia, respectively. Additionally, fibrosis in the sub epithelial area along the length of the airway (Horak, Doberer, Eber, Horak, Pohl, Riedler & Studnicka, 2016).

The progressive airway constriction and results in uneven airway distribution. As a compensatory mechanism, the bronchi hyperventilate, causing the corresponding hyperinflation of the lung alveoli, therefore preventing further stages of hypoxia. The increase in the partial pressure of carbon dioxide is prevented by hypoventilation of the airway. Additionally, hypercarbia is prevented by the ready diffusion in of the carbon dioxide gas from the pulmonary capillaries through the capillary and alveoli membrane into the alveolar space and therefore exhaled. However, due to the interference in the ability of the airways to ventilate sufficiently, there is a resultant mismatch in the perfusion ventilation ratio. chronic asthma and acute asthma exacerbation essay example. Vasoconstriction of the blood vessels in the pulmonary vascular bed prevents the further and worsening imbalance between the ventilation and the perfusion (Szefler, Holguin, & Wechsler, 2017).

The progression of pathophysiological events and changes occurring in both acute asthma and chronic asthma forms cause disturbances to the arterial carbon dioxide levels. In the acute form, the body responds to the increased airway obstruction by alveolar hyperventilation.  The hyperventilation causes the excessive exhalation of carbon dioxide from the blood circulation. The result is reduced amount of carbonic acid, in relation to the constant amount of bicarbonate in the circulation, therefore causing respiratory alkalosis during which the blood PH increases above 7.45 and the partial pressure of carbon dioxide falls below 38mmHg. The response by increasing the excretion of bicarbonate ions and hydrogen ion retention. In the chronic manifestation of asthma, due to irreversible structural changes in the airway, the airway obstruction leads to retention of carbon dioxide chronic asthma and acute asthma exacerbation essay example. Therefore the amount of carbonic acid is higher relative to the number of bicarbonate amounts in the blood circulation to levels above 42mmHg and the pH falls below 7.35, therefore causing respiratory acidosis. The body responds to the respiratory acidosis by increasing the excretion of the hydrogen ions and retention of bicarbonate ions in the kidney (Mims, 2015). chronic asthma and acute asthma exacerbation essay example.

Role of Genetics

The presence of the gene that codes for the platelet activating factor is associated with susceptibility to asthma. Additionally, the genetically determined response to asthma is dictated by environmental exposure. Certain medical disorders, specifically; hepatitis A and Mycobacterium tuberculosis are associated with an increase in the inflammatory response to allergens prompting asthmatic responses. In addition, minimized use of antibiotics and earlier exposure to the environmental exposures lead to increased production of Th2 lymphocytes. Subsequently, the relatively increased Th2 lymphocyte production precludes the production and secretion of immunoglobulin E. Immunoglobulin E causes increased response to the allergens leading asthmatic response in susceptible individuals. chronic asthma and acute asthma exacerbation essay example. Based on these factors, the diagnosis of the patient can be done through detailed history taking concerning the history antibiotics use, history of mycobacterium infection or history of asthma in the family. Additionally, the blood analysis of blood for the presence of increased levels of inflammatory mediators can be a diagnostic criterion. Based on the effect of genetics on the pathophysiology of asthma, the occurrence of asthma is managed by preventing exposure to the susceptible individuals based on the family history of asthma. Advising patients to reduce the use of antibiotic medication helps in improving immune response to asthma (Zhu, Yan, Zhai, Yang, & Li, 2017) chronic asthma and acute asthma exacerbation essay example.

Mind Map; Acute Asthma

Mind Map; Chronic Asthma

 

References

Agarwal, R., Dhooria, S., Aggarwal, A. N., Maturu, V. N., Sehgal, I. S., Muthu, V., … & Jindal, S. K. (2015). Guidelines for diagnosis and management of bronchial asthma: Joint ICS/NCCP (I) recommendations.
Lung India: official organ of Indian Chest Society
,
32
(Suppl 1), S3.

Becker, A. B., & Abrams, E. M. (2017). Asthma guidelines: the Global Initiative for Asthma in relation to national guidelines.
Current opinion in allergy and clinical immunology
,
17
(2), 99-103.

Horak, F., Doberer, D., Eber, E., Horak, E., Pohl, W., Riedler, J., … & Studnicka, M. (2016). Diagnosis and management of asthma–Statement on the 2015 GINA Guidelines.
Wiener Klinische Wochenschrift
,
128
(15-16), 541-554. chronic asthma and acute asthma exacerbation essay example.

Mims, J. W. (2015). Asthma: definitions and pathophysiology. In
International forum of allergy & rhinology
(Vol. 5, No. S1).

Szefler, S. J., Holguin, F., & Wechsler, M. E. (Eds.). (2017).
Personalizing Asthma Management for the Clinician
. Elsevier Health Sciences.

Zhu, Y., Yan, X., Zhai, C., Yang, L., & Li, M. (2017). Association between risk of asthma and gene polymorphisms in CHI3L1 and CHIA: a systematic meta-analysis.
BMC pulmonary medicine
,
17
(1), 193. chronic asthma and acute asthma exacerbation essay example.

Respiratory Alterations Essay Example

To Prepare

Review the three scenarios, as well as Chapter 27 and Chapter 28 in the Huether and McCance text.

Select one of the scenarios and consider the respiratory disorder and underlying alteration associated with the type of cough described.

Identify the pathophysiology of the alteration that you associated with the cough. Respiratory Alterations Essay Example.

Select two of the following factors: genetics, gender, ethnicity, age, or behavior. Reflect on how the factors you selected might impact the disorder.

Consider the following three scenarios:

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Scenario 1:

Ms. Teel brings in her 7-month-old infant for evaluation. She is afraid that the baby might have respiratory syncytial virus (RSV) because she seems to be coughing a lot, and Ms. Teel heard that RSV is a common condition for infants. A detailed patient history reveals that the infant has been coughing consistently for several months. It’s never seemed all that bad. Ms. Teel thought it was just a normal thing, but then she read about RSV. Closer evaluation indicates that the infant coughs mostly at night; and, in fact, most nights the baby coughs to some extent. Additionally, Ms. Teel confirms that the infant seems to cough more when she cries. Physical examination reveals an apparently healthy age- and weight-appropriate, 7-month-old infant with breath sounds that are clear to auscultation. The infant’s medical history is significant only for eczema that was actually quite bad a few months back. Otherwise, the only remarkable history is an allergic reaction to amoxicillin that she experienced 3 months ago when she had an ear infection. Respiratory Alterations Essay Example.

Scenario 2:

Kevin is a 6-year-old boy who is brought in for evaluation by his parents. The parents are concerned that he has a really deep cough that he just can’t seem to get over. The history reveals that he was in his usual state of good health until approximately 1 week ago when he developed a profound cough. His parents say that it is deep and sounds like he is barking. He coughs so hard that sometimes he actually vomits. The cough is productive for mucus, but there is no blood in it. Kevin has had a low-grade temperature but nothing really high. His parents do not have a thermometer and don’t know for sure how high it got. Respiratory Alterations Essay Example. His past medical history is negative. He has never had childhood asthma or RSV. His mother says that they moved around a lot in his first 2 years and she is not sure that his immunizations are up to date. She does not have a current vaccination record.

Scenario 3:

Maria is a 36-year-old who presents for evaluation of a cough. She is normally a healthy young lady with no significant medical history. She takes no medications and does not smoke. She reports that she was in her usual state of good health until approximately 3 weeks ago when she developed a “really bad cold.” The cold is characterized by a profound, deep, mucus-producing cough. She denies any rhinorrhea or rhinitis—the primary problem is the cough. She develops these coughing fits that are prolonged, very deep, and productive of a lot of green sputum. She hasn’t had any fever but does have a scratchy throat. Maria has tried over-the-counter cough medicines but has not had much relief. The cough keeps her awake at night and sometimes gets so bad that she gags and dry heaves. Respiratory Alterations Essay Example.

Post a description of the disorder and underlying respiratory alteration associated with the type of cough in your selected scenario. Then, explain the pathophysiology of the respiratory alteration. Finally, explain how the factors you selected might impact the disorder.

Respiratory alteration

Scenario 3

Post a description of the disorder and underlying respiratory alteration associated with the type of cough in your selected scenario.

Maria is likely suffering from acute bronchitis. That is because her cough has been present form more than five days and is accompanied by purulent sputum. In fact, the consistency, amount and color of the sputum shows that her condition is progressing even as though she has been using over the counter medication (Porth, 2011) Respiratory Alterations Essay Example. Considering the fact that the cough has existed for close to a month and yet she does not smoke and has treated the cough with over the counter medication, it is prudent to suggest that she is likely suffering from a viral infection to the lungs. Acute bronchitis will typically first present as a cough that is accompanied by a scratchy feeling and limited sputum being produced. Overtime, the sputum becomes purulent even as the cough turns productive (Marieb & Hoehn, 2012).

Then, explain the pathophysiology of the respiratory alteration.

The symptoms reported for the condition are caused by the bronchial walls being inflamed. This results in the bronchus experiencing edema even as more mucus is produced. The consequence is infection of the lower respiratory tract that is marked by a productive cough. Although the infection of the lower respiratory tract may not persist for long, and could clear up within days even as the bronchial walls are repaired over the next several weeks (Gielen et al., 2015). Even as the repair continues, the cough perseveres. Patient with acute bronchitis will cough for more than two weeks with some exceeding a month, acting as an indication that the bronchial walls are still being repaired although the acute infection was already cleared (Copstead-Kirkhorn & Banasik, 2014).

Finally, explain how the factors you selected might impact the disorder.

The selected factor is genetics. Ghosh et al. (2013) reports that genetics could have an impact on acute bronchitis by moderating susceptibility. This is seen in the case of EPHX1 low activity diplotype gene where the presence of histidines at exons 3 and 4 increase susceptibility to particulate matter greater than 2.5 micrometers in size, polycyclic aromatic hydrocarbons, and second hand tobacco smoke (Ghosh et al., 2013). In this respect, genetics is a factor that impacts acute bronchitis as a disorder. Respiratory Alterations Essay Example.

References

Copstead-Kirkhorn, L. & Banasik, J. (2014).
Pathophysiology
(5
th
ed.). Amsterdam: Elsevier Health Sciences.

Ghosh, R., Topinka, J., Joad, J., Dostal, M., Sram, R. & Hertz-Picciotto, I. (2013). Air pollutants, genes and early childhood acute bronchitis.
Mutation Research
, 749(1-2), 80-86. doi: 10.1016/j.mrfmmm.2013.04.001 Respiratory Alterations Essay Example

Gielen, S., Backer, G., Piepoli, M. & Wood, D. (2015).
The esc textbook of preventive cardiology: clinical practice
. Oxford: Oxford University Press.

Marieb, E. & Hoehn, K. (2012).
Human anatomy and physiology
. San Francisco, CA: Benjamin-Cummings Publishing Company.

Porth, C. (2011).
Essentials of pathophysiology: concepts of altered health states
. Philadelphia, PA: Lippincott Williams & Wilkins. Respiratory Alterations Essay Example.