Tag: Clinical-Nursing

NURS 6541 Week 1 Discussion – Family Essay

Family

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

ORDER A PLAGIARISM-FREE PAPER HERE

Culture

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

Strategies to Assist Families with Making Health-Related Decisions

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

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

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

References

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

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

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

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

NURS-6531 Adv. Practice Care of Adults Midterm Exam

User

Course

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

Test

Midterm Exam

Status

Needs Grading

Attempt Score

0 out of 100 points

Time Elapsed

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

Results Displayed

All Answers, Submitted Answers, Correct Answers

Question 1

ORDER A PLAGIARISM-FREE PAPER HERE

0 out of 0 points

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

Selected Answer:

 

Yes

Answers:

 

Yes

No

Question 2

1 out of 1 points

The most common cancer found on the auricle is:

Selected Answer:

 

Basal cell carcinoma

Answers:

Actinic keratosis

 

Basal cell carcinoma

Squamous cell carcinoma

Acral-lentiginous melanoma

Question 3

0 out of 1 points

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

Selected Answer:

 

Anticholinergics

Answers:

Xanthines

 

Antihistimines

Steroids

Anticholinergics

Question 4

0 out of 1 points

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

Selected Answer:

 

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

Answers:

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

Order a topical hemorrhoid cream along with a stool softener.

 

Refer the patient for a barium enema and sigmoidoscopy.

Refer the patient for a surgical hemorrhoidectomy.

Question 5

0 out of 1 points

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

Selected Answer:

 

Underweight, pink skin, and increased respiratory rate

Answers:

 

Overweight, cyanosis, and normal or slightly increased respiratory rate

Underweight, pink skin, and increased respiratory rate

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

Normal weight, cyanosis, and greatly increased respiratory rate

Question 6

1 out of 1 points

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

Selected Answer:

 

CT scan

Answers:

CBC/diff

Erythrocyte sedimentation rate

Abdominal ultrasound

 

CT scan

Question 7

1 out of 1 points

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

Selected Answer:

 

Purulent drainage

Answers:

 

Purulent drainage

Tearing

Photophobia

A positive fluorescein stain

Question 8

1 out of 1 points

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

Selected Answer:

 

Gonococcal conjunctivitis

Answers:

Viral conjunctivitis

Common pink eye

 

Gonococcal conjunctivitis

Allergic conjunctivitis

Question 9

0 out of 1 points

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

Selected Answer:

 

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

Answers:

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

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

 

Herpes zoster and consider that this patient may be immunocompromised

A recurrence of chickenpox and treat the patient’s symptoms

Question 10

0 out of 1 points

Which type of lung cancer has the poorest prognosis?

Selected Answer:

 

Adenocarcinoma

Answers:

Adenocarcinoma

Epidermoid carcinoma

 

Small cell carcinoma

Large cell carcinoma

Question 11

1 out of 1 points

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

Selected Answer:

 

Chronic diarrhea

Answers:

Acute diarrhea

 

Chronic diarrhea

Irritable bowel

Functional bowel disease

Question 12

1 out of 1 points

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

Selected Answer:

 

Systemic lupus erythematosus

Answers:

An allergic reaction

Relapsing polychondritis

Lymphocytoma cutis

 

Systemic lupus erythematosus

Question 13

1 out of 1 points

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

Selected Answer:

 

Acute bronchitis

Answers:

Chronic sinusitis

 

Acute bronchitis

Bacterial pneumonia

Acute exacerbation of chronic bronchitis

Question 14

0 out of 1 points

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

Selected Answer:

 

Mild persistent

Answers:

Mild intermittent

Mild persistent

 

Moderate persistent

Question 15

0 out of 1 points

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

Selected Answer:

 

None of the above

Answers:

 

Penicillin V 500 milligrams PO every 8 hours for 10 days

Ampicillin 250 milligrams PO twice a day for 10 days

Clarithromycin 500 milligrams po daily for 7 days

None of the above

Question 16

0 out of 1 points

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

Selected Answer:

 

Arterial insufficiency

Answers:

Congestive heart failure

 

Varicose veins

Deep vein thrombosis

Arterial insufficiency

Question 17

1 out of 1 points

Which statement below is correct about pertussis?

Selected Answer:

 

It is also called whooping cough

Answers:

 

It is also called whooping cough

It begins with symptoms like strep throat

It lasts about 3 weeks

It occurs most commonly in toddlers and young children

Question 18

0 out of 1 points

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

Selected Answer:

 

Asthma

Answers:

 

Pneumonia

Asthma

Sinusitis

Pertussis

Question 19

1 out of 1 points

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

Selected Answer:

 

Diverticulitis

Answers:

Diverticulosis

Diverticula

 

Diverticulitis

Diverticulum

Question 20

1 out of 1 points

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

Selected Answer:

 

Herpes zoster

Answers:

Varicella

 

Herpes zoster

Syphilis

Rubella

Question 21

0 out of 1 points

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

Selected Answer:

 

Medications

Answers:

Alcohol

 

Gallstones

Medications

Pregnancy

Question 22

1 out of 1 points

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

Selected Answer:

 

Order an abdominal ultrasound

Answers:

Order abdominal x-rays

 

Order an abdominal ultrasound

Refer the patient to a surgeon for evaluation

Prescribe pain medication

Question 23

0 out of 1 points

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

Selected Answer:

 

stool that has been stored before testing

Answers:

ingestion of large amounts of vitamin C

 

a high dietary intake of rare cooked beef

a colonic neoplasm that is not bleeding

stool that has been stored before testing

Question 24

0 out of 1 points

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

Selected Answer:

 

Colonoscopy

Answers:

Colonoscopy

 

Small bowel follow-through

Barium enema

CT abdomen

Question 25

1 out of 1 points

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

Selected Answer:

 

Systolic heart failure

Answers:

Mitral regurgitation

 

Systolic heart failure

Cardiac myxoma

Diastolic heart failure

Question 26

1 out of 1 points

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

Selected Answer:

 

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

Answers:

 

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

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

Sputum and gram positive organisms

A complete blood count showing leukocytosis

Question 27

0 out of 1 points

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

Selected Answer:

 

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

Answers:

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

 

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

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

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

Question 28

1 out of 1 points

Expected spirometry readings when the patient has chronic emphysema include:

Selected Answer:

 

Increased total lung capacity (TLC)

Answers:

Decreased residual volume (RV)

Increased vital capacity (VC)

Increased forced expiratory volume (FEV-1)

 

Increased total lung capacity (TLC)

Question 29

1 out of 1 points

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

Selected Answer:

 

A and C

Answers:

Esophageal cancer

Chest pain

GERD

 

A and C

All of the above

Question 30

0 out of 1 points

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

Selected Answer:

 

Basal cell carcinoma

Answers:

Squamous cell carcinoma

 

Malignant melanoma

A common nevus

Basal cell carcinoma

Question 31

1 out of 1 points

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

Selected Answer:

 

Replace water-soluble vitamins

Answers:

Prevent intestinal obstruction

Provide adequate nutrition

Promote clearance of secretions

 

Replace water-soluble vitamins

Question 32

1 out of 1 points

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

Selected Answer:

 

B and C

Answers:

Scalp

Nails

Feet

 

B and C

All of the above

Question 33

1 out of 1 points

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

Selected Answer:

 

Topical steroid use

Answers:

 

Topical steroid use

Topical antibiotic use

A recent laceration

Cold climates

Question 34

0 out of 1 points

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

Selected Answer:

 

Order stool cultures.

Answers:

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

 

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

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

Order stool cultures.

Question 35

1 out of 1 points

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

Selected Answer:

 

Antihistamines

Answers:

Aspirin

NSAIDs

Opioids

 

Antihistamines

Question 36

0 out of 1 points

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

Selected Answer:

 

Peripheral edema

Answers:

Peripheral edema

 

Weight gain

Shortness of breath

Nocturnal dyspnea

Question 37

1 out of 1 points

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

Selected Answer:

 

Amoxicillin

Answers:

Ibuprofen

Erythromycin

 

Amoxicillin

Acetaminophen

Question 38

1 out of 1 points

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

Selected Answer:

 

“Is your leg pain relieved by rest?”

Answers:

“Are you wearing your usual shoes?”

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

 

“Is your leg pain relieved by rest?”

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

Question 39

0 out of 1 points

Which of the following statements about malignant melanomas is true?

Selected Answer:

 

They usually occur in older adult males

Answers:

They usually occur in older adult males

The patient has no family history of melanoma

They are common in blacks

 

The prognosis is directly related to the thickness of the lesion

Question 40

1 out of 1 points

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

Selected Answer:

 

Heart failure

Answers:

Asthma

Nocturnal allergies

Valvular disease

 

Heart failure

Question 41

0 out of 1 points

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

Selected Answer:

 

Doxycycline (Vibramycin)

Answers:

Erythromycin

 

Clarithromycin (Biaxin)

Doxycycline (Vibramycin)

Penicillin

Question 42

1 out of 1 points

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

Selected Answer:

 

Powders

Answers:

 

Powders

Gels

Creams

Lotion

Question 43

1 out of 1 points

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

Selected Answer:

 

Squamous cell carcinoma

Answers:

 

Squamous cell carcinoma

Basal cell carcinoma

Malignant melanoma

Acne vulgaris

Question 44

1 out of 1 points

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

Selected Answer:

 

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

Answers:

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

Assess the patient’s cranial nerves.

 

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

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

Question 45

1 out of 1 points

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

Selected Answer:

 

Ursodiol

Answers:

 

Ursodiol

  Ibuprofen

Prednisone

  Surgery is the only answer

Question 46

0 out of 1 points

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

Selected Answer:

 

Staphylococcus aureus

Answers:

Staphylococcus aureus

Group A beta hemolytic streptococcus

Haemophilus influenza

 

Pseudomonas aeruginosa

Question 47

0 out of 1 points

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

Selected Answer:

 

Painful diarrhea

Answers:

Painful diarrhea

Painful constipation

Cramping and abdominal pain

 

Weight loss

Question 48

1 out of 1 points

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

Selected Answer:

 

Any recent trauma

Answers:

 

Any recent trauma

Difficulty swallowing

  Stiffness in the right shoulder

Change in sleeping habits

Question 49

0 out of 1 points

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

Selected Answer:

 

ACE Inhibitor

Answers:

ACE Inhibitor

 

Beta Blocker

Calcium channel blocker

Diuretic

Question 50

1 out of 1 points

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

Selected Answer:

 

A, B, and C

Answers:

Gonococcal infection

Thrush

Leukoplakia

B only

 

A, B, and C

Question 51

0 out of 1 points

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

Selected Answer:

 

Rhus dermatitis

Answers:

Rhus dermatitis

 

Ophthalmic zoster

Chemosis

Optic neuritis

NURS-6531 Adv. Practice Care of Adults Midterm Exam

Question 52

0 out of 1 points

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

Selected Answer:

 

Serum cholesterol with HDL and LDL

Answers:

 

Serologic markers for hepatitis

Serum bilirubin

Serum cholesterol with HDL and LDL

A liver biopsy

Question 53

1 out of 1 points

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

Selected Answer:

 

Rhabdomyolysis

Answers:

A drug interaction

Hepatic dysfunction

Hypersensitivity to lovastatin

 

Rhabdomyolysis

Question 54

1 out of 1 points

Treatment of acute vertigo includes:

Selected Answer:

 

Bedrest and an antihistamine

Answers:

 

Bedrest and an antihistamine

Fluids and a decongestant

A sedative and decongestant

Rest and a low sodium diet

Question 55

1 out of 1 points

Treatment of H.pylori includes which of the following?

Selected Answer:

 

A, B, and C

Answers:

Proton pump inhibitor

Antibiotic therapy

Bismuth subsalicylate

A and B

 

A, B, and C

Question 56

1 out of 1 points

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

Selected Answer:

 

Retinal detachment

Answers:

Cataracts

Glaucoma

 

Retinal detachment

Iritis

Question 57

1 out of 1 points

In order to decrease deaths from lung cancer:

Selected Answer:

 

Patients should be counseled to quit smoking

Answers:

All smokers should be screened annually

All patients should be screened annually

Only high risk patients should be screened routinely

 

Patients should be counseled to quit smoking

Question 58

1 out of 1 points

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

Selected Answer:

 

Every 5 years

Answers:

 

Every 5 years

Every 2 years

 Every year

Whenever blood work is done

Question 59

1 out of 1 points

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

Selected Answer:

 

Mort has benign prostatic hyperplasia

Answers:

Mort is black

Mort also has congestive heart failure

 

Mort has benign prostatic hyperplasia

  Mort has frequent migraine headaches

Question 60

1 out of 1 points

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

Selected Answer:

 

Psoriasis

Answers:

Actinic keratosis

Eczema

 

Psoriasis

Seborrheic dermatitis

Question 61

1 out of 1 points

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

Selected Answer:

 

Add a thiazide diuretic to the Lisinopril 5mg daily

Answers:

Increase her Lisinopril to 20mg daily

 

Add a thiazide diuretic to the Lisinopril 5mg daily

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

Discontinue the Lisinopril and start a diuretic

Question 62

0 out of 1 points

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

Selected Answer:

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

Answers:

defer any further dental work until his valve replacement is completed

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

 

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

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

Question 63

0 out of 1 points

Appropriate therapy for peptic ulcer disease (PUD) is:

Selected Answer:

 

Dependent on cessation of NSAID use

Answers:

Primarily by eradication of infection

 

Based on etiology

Aimed at diminishing prostaglandin synthesis

Dependent on cessation of NSAID use

Question 64

1 out of 1 points

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

Selected Answer:

 

An ACE Inhibitor

Answers:

A calcium channel blocker

A beta blocker

 

An ACE Inhibitor

No hypertension medication

Question 65

1 out of 1 points

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

Selected Answer:

 

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

Answers:

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

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

 

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

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

Question 66

1 out of 1 points

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

Selected Answer:

 

Retinoblastoma

Answers:

Viral conjunctivitis

Glaucoma

Corneal abrasion

 

Retinoblastoma

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

0 out of 1 points

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

Selected Answer:

 

A labyrinthectomy

Answers:

Pharmacological therapy

A labyrinthectomy

 

A vestibular neurectomy

Wearing an earplug in the ear with the most hearing loss

Question 68

0 out of 1 points

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

Selected Answer:

 

Hyperhomocysteinemia

Answers:

Hyperhomocysteinemia

Smoking

Genetic factors

 

Alcohol ingestion

Question 69

1 out of 1 points

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

Selected Answer:

 

Allergic conjunctivitis

Answers:

 

Allergic conjunctivitis

Bacterial conjunctivitis

Gonococcal conjunctivitis

Viral conjunctivitis

Question 70

0 out of 1 points

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

Selected Answer:

 

A long-acting bronchodilator

Answers:

A long-acting bronchodilator

An inhaled corticosteroid and cromolyn

Theophylline and a short acting bronchodilator

 

A bronchodilator PRN and an inhaled corticosteroid

Question 71

0 out of 1 points

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

Selected Answer:

 

Β-hemolytic Streptococcus

Answers:

 

Group A Streptococcus

Staphlococcus areus

Β-hemolytic Streptococcus

Streptococcus pyogenes

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

0 out of 1 points

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

Selected Answer:

 

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

Answers:

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

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

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

 

Initiate a parenteral antibiotic and consider hospital admission

Question 73

1 out of 1 points

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

Selected Answer:

 

Iritis

Answers:

 

Iritis

Allergic conjunctivitis

Viral conjunctivitis

Bacterial conjunctivitis

Question 74

1 out of 1 points

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

Selected Answer:

 

100 mg/dL

Answers:

160 mg/dL

130 mg/dL

 

100 mg/dL

70 mg/dL

Question 75

1 out of 1 points

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

Selected Answer:

 

Investigation with endoscopy, manometry, and/or pH testing

Answers:

Referral for surgical intervention such as a partial or complete fundoplication

Dependent upon how sever the practitioner believes the condition

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

 

Investigation with endoscopy, manometry, and/or pH testing

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

0 out of 1 points

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

Selected Answer:

 

Under 3 years of age

Answers:

Under 3 years of age

Preschool children

 

6 to 12 years of age

Adolescents

Question 77

0 out of 1 points

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

Selected Answer:

 

A decongestant

Answers:

A bronchodilator

An antibiotic

A decongestant

 

A cool mist vaporizer

Question 78

0 out of 1 points

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

Selected Answer:

 

Epiglottitis

Answers:

 

Peritonsillar abscess

Thyroiditis

Mononucleosis

Epiglottitis

Question 79

1 out of 1 points

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

Selected Answer:

 

It is not effective during an acute asthma attack.

Answers:

 

It is not effective during an acute asthma attack.

It may take 2 to 3 days to begin working.

This drug works within 10 minutes.

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

Question 80

0 out of 1 points

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

Selected Answer:

 

Stool softeners

Answers:

 

Bulk-forming agents

Stool softeners

Laxatives

Osmotic agents

Question 81

1 out of 1 points

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

Selected Answer:

 

Apply a topical antibiotic and warm compresses.

Answers:

 

Apply a topical antibiotic and warm compresses.

Apply cool compresses and avoid touching the hordeolum.

Use an oral antibiotic and eye flushes.

Apply light palpation to facilitate drainage.

Question 82

1 out of 1 points

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

Selected Answer:

 

A decongestant nasal spray

Answers:

An antihistamine intranasal spray

 

A decongestant nasal spray

Ipratropium

Omalizumab

Question 83

1 out of 1 points

What is the Gold standard for the diagnosis of asthma?

Selected Answer:

 

Spirometry

Answers:

Patient’s perception of clogged airways

Validated quality-of-life questionnaires

  Bronchoscopy

 

Spirometry

Question 84

0 out of 1 points

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

Selected Answer:

 

Methyldopa

Answers:

Methyldopa

 

Enalapril

Amlodipine

Hydrochlorothiazide

Question 85

1 out of 1 points

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

Selected Answer:

 

Candidiasis

Answers:

Herpes simplex

Aphthous ulcers

 

Candidiasis

Oral cancer

Question 86

1 out of 1 points

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

Selected Answer:

 

African-American ethnicity

Answers:

Household cigarette smoke

Group daycare attendance

Sibling history of acute otitis media

 

African-American ethnicity

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

1 out of 1 points

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

Selected Answer:

 

A chalazion

Answers:

 

A chalazion

Uveitis

Keratitis

A pterygium

Question 88

0 out of 1 points

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

Selected Answer:

 

You must initiate the plan of care for the patient

Answers:

You must initiate the plan of care for the patient

 

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

You must be employed as an independent contractor

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

Question 89

1 out of 1 points

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

Selected Answer:

 

Acute pharyngitis

Answers:

Asthma

Gastroesophageal reflux

 

Acute pharyngitis

Allergic rhinitis

Question 90

1 out of 1 points

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

Selected Answer:

 

Cigarette smoking

Answers:

Familial and genetic factors

 

Cigarette smoking

Air pollution

Occupational environment

Question 91

0 out of 1 points

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

Selected Answer:

 

Topical decongestants

Answers:

 

Antihistamines

Oral decongestants

Topical decongestants

Antipyretics

Question 92

0 out of 1 points

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

Selected Answer:

 

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

Answers:

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

Sodium restriction can cause serious adverse effects

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

 

Seventy-five of sodium intake is derived from processed foods

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

1 out of 1 points

Which of the following heart murmurs warrants the greatest concern?

Selected Answer:

 

Diastolic murmur

Answers:

Systolic murmur

Venous hum murmur

 

Diastolic murmur

Flow murmur

Question 94

1 out of 1 points

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

Selected Answer:

 

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

Answers:

Hordeolum; treat with a topical antibiotic and warm compress

Conjunctivitis; treat with topical antibiotic and warm compresses

 

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

Chalazion; refer to an ophthalmologist for incision and drainage

Question 95

1 out of 1 points

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

Selected Answer:

 

Inferior wall

Answers:

 

Inferior wall

Anterior wall

Apical wall

Lateral wall

Question 96

0 out of 1 points

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

Selected Answer:

 

Otitis media with effusion

Answers:

 

Acute otitis media (AOM)

Otitis media with effusion

Mucoid otitis media

Serous otitis media

Question 97

0 out of 1 points

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

Selected Answer:

 

incisional hernia

Answers:

inguinal hernia

 

epigastric hernia

umbilical hernia

incisional hernia

Question 98

1 out of 1 points

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

Selected Answer:

 

Omeprazole

Answers:

 

Omeprazole

Ranitidine

An antacid

None of the above

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

1 out of 1 points

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

Selected Answer:

 

Quit smoking

Answers:

 

Quit smoking

Maintain aggressive hypertension therapy

Stick to a low-fat, low-sodium diet

Continue with his exercise program

Question 100

1 out of 1 points

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

Selected Answer:

 

All of the above

Answers:

Recent myocardial infarction

Atrial fibrillation

Atherosclerosis

 

All of the above

Question 101

1 out of 1 points

Impetigo and folliculitis are usually successfully treated with:

Selected Answer:

 

Topical antibiotics

Answers:

Systemic antibiotics

 

Topical antibiotics

Topical steroid creams

Cleansing and debridement

NURS-6531 Adv. Practice Care of Adults Midterm Exam

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

Nurs 6541: Primary Care of Adolescents and Children

Week 2 Developmental Red Flags

ORDER A PLAGIARISM-FREE PAPER HERE

Initial Post

Case Study 3

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

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

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

 

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

History

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

 

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

Assessment/Intervention

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

References

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

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

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

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

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

Physician
. 2011 Sep 1;84(5):544-549.

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

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

NURS 6541 Week 1: Overview of Growth and Development

Week 1

Week 1: Overview of Growth and Development

When we work with parents in a spirit of true partnership, mothers, fathers, and other caregivers are more likely to invite and welcome providers’ support in evaluating needs, developing goals, and identifying effective ways to strengthen the family and provide care for children. —Child Welfare Information Gateway

ORDER A PLAGIARISM-FREE PAPER HERE

Primary care of pediatrics begins in infancy and progresses through adolescence. During these stages of growth and development, children depend upon their families and health care providers to meet their individual health needs. As an advanced practice nurse, you must assess the family unit as a whole in order to determine the needs of the patient and the family. It is essential to work closely with parents and caregivers to provide care to pediatric patients and maintain patients’ health and well-being.

 

This week you explore the impact of sociocultural influences on assessments of children and families. You also examine strategies for assisting families in making health-related decisions for children at different stages of growth and development.

 

Note: Throughout this course, the term parent will be used to represent a pediatric patient’s caregiver, which may include a parent, stepparent, foster parent, guardian, and so on.

Learning Objectives

By the end of this week, students will:

Analyze the impact of sociocultural influences on assessments of children and families

Analyze strategies to assist families in making health-related decisions for children at different stages of growth and development

Understand and apply key terms, principles, and concepts related to growth and development

Analyze personal strengths and weaknesses in working with children

Analyze theories in pediatric nursing practice

Apply theories in pediatric nursing practice

Required Readings

Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., Blosser, C. G., & Garzon, D. L. (Eds.). (2017). Pediatric primary care (6th ed.). St. Louis, Missouri: Elsevier.

Chapter 2, “Child and Family Health Assessment” (pp. 10–32)

This chapter explores components of the child and family health assessment and provides guidelines for obtaining adequate information during family health assessments.

 

 

Chapter 3, “Cultural Perspectives for Pediatric Primary Care” (pp. 33-44)

This chapter outlines characteristics of culture and presents guidelines for providing culturally competent care to pediatric patients. It also examines components of specific cultural groups, including immigrant and refugee populations.

Chapter 4, “Developmental Management in Pediatric Primary Care” (pp. 46-60)

This chapter covers developmental principles, theories, and assessments of pediatric patients. It also identifies strategies for managing child development through both child-centered and family-centered care.

Chapter 9, “Introduction to Functional Health Patterns and Health Promotion” (pp. 141-157)

This chapter examines factors that impact children’s health. It focuses on health perception, health management, and strategies for providing family-centered care.

Chapter 14, “Sleep and Rest” (pp. 273-284)

This chapter describes normal sleep patterns and identifies indicators of sleep problems in children and adolescents. It also presents strategies for treating pediatric patients with sleep problems.

Chapter 17, “Role Relationships” (pp. 311-338)

This chapter explores the dynamics and challenges of family relationships. It also describes circumstances that can cause disequilibrium in family units.

 

Hagan, J. F., Jr., Shaw, J. S., Duncan, P. M. (Eds.). (2017). Bright futures: Guidelines for health supervision of infants, children, and adolescents (4th ed.). Elk Grove Village, IL: American Academy of Pediatrics.

“Promoting Family Support” (pp. 41-64)

This chapter explores the composition of the family and family roles, focusing on the family’s growth and development in addition to the child’s growth and development. It also examines aspects of family and child assessments, including forming an effective partnership with families and promoting family support from infancy through adolescence.

“Promoting Healthy Weight” (pp. 151-166)

This chapter describes the prevalence and trends of overweight and obesity in the United States. It also presents strategies for screening, assessing, treating, and preventing obesity in pediatric patients from infancy through adolescence.

“Promoting Healthy Nutrition” (pp. 167-192)

This chapter examines the impact of environment and culture on patient behaviors related to food and nutrition. It also explores essential components of nutrition for children from preconception through adolescence.

“Promoting Physical Activity” (pp. 193-203)

This chapter describes physical activity as a growing problem. It also identifies strategies for promoting physical activity, including age-appropriate activities for infants, children, and adolescents.

“Promoting Safety and Injury Prevention” (pp. 235-256)

This chapter explores two categories of issues relating to safety and injury prevention and examines strategies for promoting safety among infants, children, and adolescents.

National Association of Pediatric Nurse Practitioners. (2008). NAPNAP position statement on age parameters for pediatric nurse practitioner practice. Journal of Pediatric Health Care, 22(3), e1–e2.

This article identifies age parameters for the pediatric patient population and outlines roles of health care providers caring for this patient population.

S. Department of Health and Human Services. (2012). Healthy people 2020 topics and objectives. Retrieved from
http://www.healthypeople.gov/2020/topicsobjectives2020/default.aspx

This website provides evidence-based resources for a range of health topics including adolescent health, early and middle childhood, family planning, nutrition and weight status, and physical activity.

Required Media

Laureate Education (Producer). (2013b). Course welcome. Retrieved from https://class.waldenu.edu

Note: The approximate length of this media piece is 4 minutes.

In this video program, Dr. Dawn Garzon discusses the importance of primary care for adolescents and children.

Clinical Resources

Document: Practicum Journal Template (Word document)

Document: Nurse Practitioner (NP) Student Clinical Orientation (PowerPoint file)

Document: Practicum Manual (PDF)

Optional Resources

Agency for Healthcare Research and Quality. (2012). Guidelines and recommendations. Retrieved from http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/index.html

 

Discussion: Child and Family Assessments

When caring for pediatric patients, you do not just assess and treat the patient but rather the entire family unit. This often poses challenges for advanced practice nurses because of the dynamics of the various types of family units (i.e., two traditional parents, a single parent, same-sex parents, divorced parents, stepparents, adoptive families, foster families, military families, grandparents as the primary caregiver, etc.). Care strategies that might work for a two-parent family, for instance, might not work for a single-parent family or a foster family. Additionally, family units also present with differences in backgrounds, cultures, and religions. All of these factors have the potential to impact the care of patients and their families, making it essential for you to tailor your assessments and care plans to meet the individual needs of families.

 

Note:Throughout this course, the term parent will be used to represent a pediatric patient’s caregiver, which may include a parent, stepparent, foster parent, guardian, and so on.

To prepare:

 

Review this week’s media presentation, as well as

“Child and Family Health Assessment,”

“Cultural Perspectives for Pediatric Primary Care,” and

“Developmental Management in Pediatric Primary Care” in the Burns et al. text.

Consider how a provider’s personal definition of family and family roles might impact the assessment of a child and the child’s family. NURS 6541 Week 1: Overview of Growth and Development

Reflect on how the culture of the provider and/or the patient may further influence the assessment.

Think about three strategies that a provider can use to assist families with making health-related decisions for children at different stages of growth and development.

Consider how these strategies might change when assessing patients at different stages of growth and development and with different family backgrounds.

By Day 3

Post an explanation of how a provider’s personal definition of family and family roles might impact the assessment of a child and his or her family.

Then, explain how culture (both the culture of the provider and that of the child and his or her family) may further influence the assessment. NURS 6541 Week 1: Overview of Growth and Development

Finally, explain at least three strategies that the provider can use to assist families with making health-related decisions for children at different stages of growth and development.

Also, explain how these strategies might change when assessing patients at different stages of growth and development and with different family backgrounds.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days who suggested different strategies than you did.

Based on your personal and/or professional experiences, expand on your colleagues’ postings by providing additional insights or different perspectives. NURS 6541 Week 1: Overview of Growth and Development

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings.

Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post.

Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit! NURS 6541 Week 1: Overview of Growth and Development

Quiz: Week 1

This Quiz covers the content you have explored throughout the week. The Quiz may include the following topics:

Growth and development

Wellness recommendations for nutrition, sleep, injury prevention, and immunizations

By Day 7

You have 30 minutes to complete the Quiz. You may only attempt this Quiz once.

This quiz is a test of your knowledge in preparation for your certification exam.

No outside resources including books, notes, websites, or any other type of resource are to be used to complete this quiz.

You are expected to comply with Walden University’s Code of Conduct.

 

Assignment: Practicum – Journal Entry

As a future advanced practice nurse, it is important that you are able to connect your didactic experience to your Practicum experience. By applying the concepts, you study in the classroom to clinical settings, you better prepare yourself for your future professional career. Each week, you complete an assignment that prompts you to reflect on your Practicum experiences and relate them to the material presented in the classroom. NURS 6541 Week 1: Overview of Growth and Development

To prepare for this course’s Practicum experience, address the following in your Practicum journal:

Explain what most excites and/or concerns you about pediatric clinical experiences.

Include a description of your strengths and weaknesses in terms of working with children and how these strengths and weaknesses might impact your Practicum experience.

Select and explain a nursing theory to guide your practice with pediatric patients.

Based on your strengths, weaknesses, and theory of nursing practice, develop goals and objectives for the Practicum experience in this course.

Be sure to consider the NAPNAP Position Statement on Age Parameters for Pediatric Nurse Practitioner Practice from this week’s Learning Resources. NURS 6541 Week 1: Overview of Growth and Development

Create a timeline of Practicum activities based on your Practicum requirements.

By day 7 of Week 4

This Assignment is due.

You will submit this Week 1 Journal Entry along with the Week 2 and Week 4 Journal Entries, and the Week 3 SOAP Note.

Time Logs

You are required to keep a log of the time you spend related to your practicum experience and enter every patient you see each day.

You can access your time log from the Welcome Page in your Meditrek account.

You will track time individually for each patient you work with.

Please make sure to continuously input your hours throughout the term.

Logs are reviewed by your instructors in weeks 3, 7 and 11. NURS 6541 Week 1: Overview of Growth and Development

Week in Review

This week you examined the multiple challenges associated with pediatric care assessments and the various care strategies that should be tailored to meet the needs of diverse family units.

Next week you will examine growth development in infants, toddlers, and preschoolers, identify developmental red flags and specific assessment and management tools used for this age group.

 

Looking Ahead Week 1

So that you have key information available to you off-line, it is highly recommended that you print this Looking Ahead for your reference. NURS 6541 Week 1: Overview of Growth and Development

 

Week 3

In Week 3, you connect your classroom experience to your Practicum experience as you complete your first SOAP Note.

Review the Week 3 Learning Resources for guidance on writing SOAP Notes and contact the Instructor with any questions.

You submit the Week 3 SOAP Note and your Practicum Time Log in Week 4.

Week 4

In Week 4, you develop a protocol for the diagnosis, management, and follow-up care for a growth and development or psychosocial issue.

Prior to beginning this Assignment, the course Instructor must approve the issue you select. E-mail the course Instructor with your selection by Day 7 of Week 2.

Review the Week 4 Assignment section for additional guidance.

Contact the course Instructor with any questions.

Week 7

In Week 7, you complete your second SOAP Note.

Be sure to review the Instructor’s feedback on your first SOAP Note submission to improve the quality of your second submission.

Also, you develop a protocol for the diagnosis, management, and follow-up care for a disorder that is common among pediatric patients. NURS 6541 Week 1: Overview of Growth and Development

Prior to beginning this Assignment, the course Instructor must approve the disorder you select.

E-mail the course Instructor with your selection by Day 7 of Week 5. Review the Week 7 Assignment 1 section for additional guidance.

Contact the course Instructor with any questions.

 

Week 10

In Week 10, you complete your final SOAP Note.

Be sure to review the Instructor’s feedback on your first two SOAP Note submissions to improve the quality of your final submission.

You submit the Week 10 SOAP Note and your Practicum Time Log in Week 10.

 

Note: Throughout this course, the term parent will be used to represent a pediatric patient’s caregiver, which may include a parent, stepparent, foster parent, guardian, and so on. NURS 6541 Week 1: Overview of Growth and Development

Abnormal Uterine Bleeding Essay

Abnormal Uterine Bleeding

Society for Reproductive Endocrinology and Infertility (SREI, 2012) described abnormal uterine bleeding as bleeding that differs in quality and quantity from normal menstrual bleeding, such as women spotting or bleeding between the women’s menstrual periods; bleeding after sex; bleeding heavier or last more days than normal; and bleeding post menopause. According to SREI (2012), factors that can cause abnormal bleeding include structural abnormalities of the reproductive system, such as uterine polyps, fibroids, and adenomyosis. Furthermore, SREI (2012) explained that vaginal, uterine or cervical lesions, miscarriage, ectopic pregnancy, endometritis, adhesions in the endometrium, and use of an intrauterine device (IUD) can also cause abnormal bleeding. Johns Hopkins Medicine (2016) specified that early recognition of abnormal bleeding, and seeing a health care provider immediately for appropriate diagnosis and treatment increase the chance of successful treatment. Therefore, the author will focus on a single patient comprehensive evaluation, which includes the patient’s personal/health history; physical examination; laboratory/diagnostic tests; diagnosis; treatment/management plan; education strategies; and follow-up care. Comment by DeAllen B Millender: Good introduction. Abnormal Uterine Bleeding Essay

General Patient Information

ORDER A PLAGIARISM-FREE PAPER HERE

Age
: 41-year-old

Race/Ethnicity
: Hispanic American

Partner Status
: Married Comment by DeAllen B Millender: This information is not in APA format.

Current Health Status

Chief Complaint:
 “I have heavy, prolonged menstrual bleeding with severe cramping for the past one year”.

History of Present Illness (HPI)
: RG is a 41-year-old Hispanic American female who presented to the clinic with complaint of heavy prolonged menstrual bleeding with severe cramping for the past one year. Patient reported sharp pelvic pain during menstruation, bleeding between periods, pain with intercourse, blood clots during periods. Abdominal pain/pressure and bloating. Abnormal Uterine Bleeding Essay. Patient suggested that these symptoms started after her second caesarean section surgery one year ago. Patient also reported that she takes over-the counter medication, such as ibuprofen to relieve the pain. she also suggested that she uses heating pad on her abdomen/pelvic for pain relief, and she stated that she soaks in a warm sitz bath to ease pelvic pain and cramping. Patient also reported fatigue and weakness. Patient further stated that she decided to see an obstetrician and gynecologist (OB/GYN) because the heavy prolonged bleeding with severe menstrual cramp interfere with her regular activities. Patient denied nausea, vomiting, diarrhea, fever, and chills.

Timing/Onset: 
Patient said one year ago.

Location
: The location of the problem as stated by the patient is pelvic/uterus/vaginal.

Duration
: 5 to7 days during periods for the past one year.

Quality/Characteristic
: Patient reported heavy prolonged menstrual pain; severe, sharp lower abdominal/pelvic cramping/pain, and blood clots during periods.

Aggravating Factors
: Monthly periods as stated by the patient.

Relieving/Alleviating Factors
: Patient stated that ibuprofen pain medication, heating pad, and/or warm sitz bath help the pain/cramping.

Severity
: The severity of the pain/cramping on a pain scale is 10/10 reported by the patient.

Treatments/Therapies
: Patient stated that she had not undergone any treatment for the reported problems.

Last Menstrual Period
: The last menstrual period reported by patient was 7/5/2016.

Sexual Activity Status
: Patient reported being sexually active. Abnormal Uterine Bleeding Essay

Barrier Prevention
: Patient stated she uses natural barrier methods.

Sexual Preference: 
Patient sexual preference is monogamous/heterogeneous relationship.

Satisfaction with Sexual Activity
: Patient reported that she is sexually satisfied with her partner.

Contraception Method
: Patient denied using any contraception method.

Patient History

Past medical History (PMH):
 Anemia and C-section. Patient was delivered full term through vaginal delivery without complications. The birth weight was 8 pounds 10 oz.

Psychological/Mental Health: 
Patient denied depression, mood swings, anxiety, or mental health problem.

Medications:
 RG reported that she takes over the counter Motrin 200-400 mg orally every 4-6 hours as needed for pain and cramping.

Allergies:
 Patient reported no known allergies (NKA).

Past Surgical/Hospitalization History
: Patient reported history of C-section twice, and she was hospitalized for 3 days post the C-sections.

Preventive Screening
: Patient reported that she had flu shot on 11/20/2015; last mammogram was 2/12/2015 and mammogram was normal; Pap smear was on 2/20/2015, which was also normal; patient also reported that she was up to date with her childhood immunization, but denied pneumococcal vaccination.

Family History:
 Both father and mother have history of diabetes mellitus type 2 and hypertension. Both parents are still living, and two siblings are still living and well.

Gynecological History
: Patient is multipara with 2 pregnancy resulting in two viable offsprings. Patient had her first child at the age of 33 years. Menarche at age 13; periods last between 5 to 7 days. Patient reported heavy prolonged menstrual bleeding with severe cramping; sharp pelvic pain during menstruation; and bleeding between periods for the past one year. Denied vaginal discharge or sexually transmitted infection/disease.

Obstetric History
: Gravida 2, Para 2, term 2, preterm 0, spontaneous abortion 0, and living 2 (G2T2P2A0L2). Gravida 1: Delivered at 39 weeks by C-section on 4/20/08 male; Gravida 2: Delivered at 40 weeks by C-section on 2/18/15 female. Patient denied therapeutic abortion (TAB) or spontaneous abortion (SAB); Patient denied preterm or low birth weight baby with no delivery complications. Patient also denied having sexual transmitted disease.

Personal/Social History
: Patient is married with 2 children, and lives at home with the husband. Patient is a college graduate; works outside the house as a nurse at a nearby hospital. Patient’s husband works for a computer company. Patient family is a middle income family. Also, patient denied any physical or psychological abuse. Patient denied being exposed to any environmental or occupational health hazards. Patient also denied alcohol consumption, tobacco, or recreational drug use. Patient denied participating in any exercise or physical activity because she is tired after work, and prefers to rest. Patient reported that she eats healthy; she eats low fat, low carbohydrate meals, and she eats fruits and vegetable at least 3 to 4 times a week. Patient stated

that she sleeps well at night, and she usually goes to bed at 9 pm and wakes up at 6 am. Patient drinks a cup of coffee occasional, especially when she is at work to be awake.

Review of System (ROS)

General: 
RG admitted fatigue and weakness; denied fever /chills; and no weight loss.

Head and Neck: 
Patient denied headache or dizziness. Patient also denied lumps, neck injury, pain/tenderness or jugular vein distention.

Chest
: Patient denied chest pain, cough or shortness of breath.

Heart: 
RG denied irregular heartbeats, heart attack, or heart murmur.

Breasts:
 Patient denied nipple discharge, tenderness or swelling.

Gastrointestinal
: Patient admitted lower abdominal pain, pressure, and bloating; denied constipation, nausea, vomiting, and diarrhea.

Genitourinary
: RG denied urinary tract infection, urinary frequency or burning on urination.

Genital
: Patient admitted heavy prolonged menstrual bleeding with severe cramping for one year. Patient admitted sharp pelvic pain during menstruation, bleeding between periods, pain with intercourse, and blood clots during periods. Patient denied vaginal discharge.

Musculoskeletal:
 RG denied varicosities or extremities problem.

Psychiatric: 
RG
 
denied depression, anxiety, or any psychiatric problems.

Neurological:
 Patient admitted fatigue and weakness; denied confusion, seizures, or tingling.

Hematologic:
 Patient admitted history of anemia; denied blood transfusion or easily bruise or bleeding.

Physical Examination

General exam
: Patient appeared well developed and pleasant with good hygiene. Patient also appeared pale and weak. Vital signs: Blood pressure 118/76, heart rate 80, respiration 18,

temperature 98.8, pulse ox 100% on room air. Weight 78.2 kg, height 67 inches, and body mass index (BMI) 27.

HEENT
: The head is normaceplalic, atraumatic. The pupils are equal, round, and reactive to light and accommodation. Extraocular movements are intact. Tympanic membrane is gray bilaterally. Oral mucosa is dry. Oropharynx is clear. Abnormal Uterine Bleeding Essay Nares are patient, no nasal or septal deviation noted. No pharyngeal erythema.

Neck
: Noted to be supple without jugular vein distention (JVD), thyromegaly or lymphadenopathy.

Lungs
: Noted to be clear to auscultation throughout the lobes; no wheezes or rhonchi noted.

Cardiovascular
: Regular rate and rhythm on auscultation, S1 S2 present without murmurs. Palpable pulses noted without peripheral edema.

Gastrointestinal
: Bowel sounds are active in all quadrant. Abdomen is soft and tender on palpation.

Breast
: The size of the breasts, areolas, and nipples are round and symmetrical with no discoloration, rash, lesions, dimpling, or retraction bilaterally; no masses, lumps, or tenderness noted on palpation bilaterally; and axillary lymph nodes non-palpable.

Pelvic Examination:

Vulva:
 The hair distribution is normal; no lesion noted.

Vagina
: Vaginal walls are pink, and pubic hair is shaven; no lesions, masses, inflammation or discharge noted.

Cervix
: Intact cervix with closed os.

Uterus
: Enlarged, asymmetrical, soft, boggy and tender.

Laboratory and Diagnostic Tests

Laboratory Test and Results
: Pregnancy test: Result is negative. Hemoglobin and Hematocrit (H/H): Result showed H/H 8.7/26.7, which is positive for anemia.

Diagnostic:

Transvaginal ultrasonography of the uterus: Revealed uterine enlargement measuring 12 cm with no leiomyomata; uterine wall thickening; cystic anechoic spaces in the myometrium; heterogeneous echo texture; obscured endometrial/myometrial border; sub endometrial echogenic linear striations; and thickening of the transition zone measuring 12.8 millimeter. The transvaginal sonography is used to rule out possible uterine tumor (Sakhel & Abuhamad, 2012).

Magnetic Resonance Imaging (MRI): MRI is ordered to obtain a high resolution image of the uterus as well as verifying/confirming the suspected diagnosis. The MRI result revealed that the junctional zone of the uterus is thickened and measures 12.8 millimeter. Also, MRI revealed an ill-defined ovoid and diffuse region of thickening with striated appearance (Sakhel & Abuhamad, 2012). Abnormal Uterine Bleeding Essay

Differential Diagnoses

The differential diagnoses of the patient clinical presentation as described by Schuiling and Likis (2013) include: Adenomyosis, uterine fibroids and endometrial hyperplasia. However, the primary diagnosis for the patient is Adenomyosis Abnormal Uterine Bleeding Essay.

Adenomyosis: 
Schuiling and Likis (2013) described adenomyosis as a benign, common condition that involves the movement of endometrial tissue into the uterine muscles. The definitive cause of the adenomyosis is unknown, but the condition is common among women with elevated levels of estrogen; the condition usually ceases post menopause when estrogen levels are reduced. Risk factors explained by Taran, Stewart, and Brucker (2013) include multiparity; previous uterine surgery, such as C-section, dilatation/curettage, or fibroids

removal surgery; and women at reproductive age, especially between the age of 40s or 50s. furthermore, Taran et al. (2013) specified that the clinical presentation entails chronic pelvic pain, prolonged menstrual cramps, heavy menstrual bleeding, spotting between periods, abdominal tenderness, painful intercourse, longer periods than normal, blood clots during periods. Taran et al. (2013) also explained that finding during physical examination include enlarged, tender, soft and boggy uterus. According to Taran et al. (2013) diagnosis is made based on sonographic or MRI results, and treatment is not recommended for women with mild form of adenomyosis, except when the symptoms interfere with daily activities. Taran et al. (2013) further explained that treatment options include anti-inflammatory medications; hormonal treatments; endometrial ablation; uterine artery embolization, MRI-guided focused ultrasound surged or hysterectomy, which is the definitive treatment for adenomyosis.

Adenomyosis is selected as the primary diagnosis because the aforementioned patient’s clinical presentation, physical examination findings, and diagnostic tests results are synonymous with adenomyosis aforementioned associated signs and symptoms; risk factors; physical examination findings; and diagnostic test results.

Uterine Fibroids: 
Women’s Health (WH, 2015) described uterine fibroid to be muscular tumors that develop in the uterine wall, which can also be referred to as leiomyoma or myoma. Uterine fibroids are usually non-cancerous, and can be single or multiple tumors in the uterus. According to WH (2015), women risk for developing uterine fibroid are increased by age, such as women in their 30s and 40s until menopause when the fibroids commonly shrink. Other risk factors include family history, ethnic origin, obesity and eating habits. Symptoms of fibroids as explained by WH (2015) involve lower back pain; pain during sex; heavy bleeding; painful menses, enlarged lower abdominal, frequent urination; and lower abdominal/pelvic feeling of fullness. Physical examination shows reveal painless, firm, irregular pelvic mass. According to WH (2015), diagnosis is done using transvaginal ultrasound, MRI, hysteroslpingography, hysteroscopy, and endometrial biopsy. Fibroid is not selected as the primary diagnosis because there is no visualization of the fibroid during pelvic examination or on sonography test. Moreover, severe pain is noted during pelvic exam. Furthermore, sonographic result is more consistent with adenomyosis rather than fibroids.

Endometrial Hyperplasia: 
Cancer Research of United Kingdom (CRUK, 2014) described endometrial hyperplasia as thickening of the covering of the uterus due to excessive growth of the cells that covers the uterus, and endometrial hyperplasia can lead to womb cancer. Risk factors according to CRUK (2014) include- age over 35 years; white race; nulliparity; older age at menopause; obesity; cigarette smoking; family history of ovarian, colon, or uterine cancer; early menarche; and history of diabetes, polycystic ovary syndrome, thyroid disease and gallbladder disease. The CRUK (2014), explained that the condition is caused by imbalance of to the estrogen and progesterone. According to CRUK (2014), signs and symptoms of endometrial hyperplasia includes abnormal, prolonged, heavy periods; bleeding between periods; shorter than 21 days’ menstrual cycles; and bleeding after menopause. Also, diagnosis is established by vaginal ultrasound scan, dilatation and curettage, or hysteroscopy.

23rd 
ed
. Philadelphia, PA: 
Lippincott Williams
 &.
Wilkins
; 2014presentation, physical findings during examination; and diagnostic results are not synonymous with the signs and symptoms; physical examination finding, risk factors and diagnostic

results associated with endometrial hyperplasia (American College of Obstetricians and Gynecologist, 2016).

Management Plan

Diagnosis: 
The only definitive
 
diagnosis of adenomyosis is established after uterus is examined post hysterectomy. However, clinical findings that helped in the diagnosis of the patient includes enlarged, asymmetrical, soft, boggy and tender uterus during pelvic examination and aforementioned sonographic and MRI findings, which synonymous with the diagnosis of adenomyosis (Sakhel & Abuhamad, 2012).

Treatment: 
Treatment was considered based on the patient clinical presentations, and collaborative agreement with the patient, the author, and the preceptor for total hysterectomy after explanation of the treatment options to the patient. Patient selected hysterectomy because patient does not want to have another child. According to Schuiling and Likis (2013) explanations, patient was advised to continue with the over-the counter anti-inflammatory drug: Motrin 200-400 mg orally every 4-6 hours as needed for pain and cramping until hysterectomy is performed. Also, Ferrous sulfate 325 mg orally three times a day for anemia was prescribed. Patient was educated to take the medication on an empty stomach one hour before meal or 2 hours after meal for optimum absorption.

Patient Education: 
Patient was educated on the risk factors for adenomyosis, the causes, symptoms, diagnosis, and treatment options. Patient was educated that most women with adenomyosis does not have any symptoms, but adenomyosis is usually found after the tissue obtained from the uterus has been biopsied after pelvic surgery. Patient was also informed that the C-section she had twice during child birth may have put her at risk for adenomyosis. Patient was informed that the symptoms of adenomyosis goes away after menopause or after hysterectomy. Patient was educated that all options of treatment must be tried before hysterectomy, but patient opted for hysterectomy without trying all options of treatment. furthermore, patient was educated to continue the home remedy, such as continuation of the use of the heating pad, warm soak bath, and continuing with the over the counter Motrin to alleviate the pain associate with the condition. Finally, patient was educated on the psychological and emotional effects of adenomyosis and hysterectomy surgery because some women grieve on the loss of their womb, which may put them into depression as a result of that; the patient has to be completely sure that she really wants to do the surgery at her age now or wait and do the surgery in the future (University of Maryland Medical Center, 2016).

Follow Up Care
: In consideration of the Schuiling and Likis (2013) discussion, patient was schedule to follow-up in 6 weeks for follow-up on the patient’s anemia and surgical work up labs, such as complete blood count, complete metabolic panel, prothrombin time and international normalized ratio(PT/INR). Also, an electrocardiogram (EKG) and chest x-ray was ordered to rule out any cardiac problem that would complicate the hysterectomy surgery. The patient’s H/H came up to 11.5/38.9 and all the other laboratory and diagnostic result was normal. The Total hysterectomy surgery was performed on 7/27/2016. Surgery was successful, and patient was schedule to follow up in six eek post-surgery.

Conclusion Comment by DeAllen B Millender: Level 1 headings are centered, in bold print, and in ‘Title Case’ (Chapter 3, 3.03, pp. 62-63; see Table 3.1 and Figure 2.1) Abnormal Uterine Bleeding Essay.

The author selected a patient at the author’s clinical site, and obtained a complete health history following the patient care from the beginning of the clinical up to 9 weeks of clinical. The author also used the patient health information and clinical presentation to come up with a diagnosis of adenomyosis. The author developed an appropriate treatment plan with the patient in collaboration with the author’s preceptor incorporating the author’s classroom knowledge with the author’s chosen nursing theorist. Finally, the patient was educated on the condition and follow up care.

References

American College of Obstetricians and Gynecologist. (2016). Endometrial Comment by DeAllen B Millender: Paper and poster titles presented at meetings that are not a part of a symposium should be in italics (Chapter 7, 7.04, p. 206). Abnormal Uterine Bleeding Essay

Hyperplasia. Retrieved from http://www.acog.org/Patients/

FAQs/Endometrial-Hyperplasia

Cancer Research of United Kingdom. (2014). Endometrial hyperplasia. Retrieved from http://www.cancerresearchuk.org/about-cancer/cancers-in-general/cancer-questions/endometrial-hyperplasia

John Hopkins Medicine. (2016). Recognizing gynecologic problems. Retrieved from http://www.hopkinsmedicine.org/healthlibrary/

conditions/adult/gynecological_health/recognizing_gynecologic_ problems_85,P00584/

Sakhel, k., & Abuhamad, A. (2012). Sonography of adenomyosis. 
Journal of Ultrasound in Medicine, 31
(12), 805-808.

Schuiling, K. D., & Likis, F. E. (2013). 
Women’s gynecologic health
 (2rd ed.). Burlington, MA: Jones and Bartlett Publishers.

Society for Reporoductive Endocrinology and Infertility. (2012). Abnormal uterine bleeding. Retrieved from http://www.socrei.org/BOOKLET_abnormal_uteine_bleeding/

Taran, F. A., Stewart, E. A., & Brucker, S. (2013). Adenomyosis: Epidemiology, risk factors, clinical phenotype and surgical and interventional alternative to hysterectomy. 
Geburtshilfe Frauenheilkunde, 73
(9), 924-931. Abnormal Uterine Bleeding Essay

University of Maryland Medical Center. (2016). Adenomyosis. Retrieved from

http://umm.edu/health/medical/ency/articles/adenomyosis

Women’s Health. (2015). Uterine fibroids fact sheet. Retrieved from

http://www.womenshealth.gov/publications/our-publications/fact-sheet/uterine-fibroids.html#c

Abnormal Uterine Bleeding Essay

STEMI heart attack essay

A STEMI is a classic heart attack which happens on complete blockage of the coronary artery, preventing blood supply to a huge portion of the heart muscles. The classical symptom of a STEMI is crushing pain at the center of the chest which may radiate to the jaw, the neck or left arm, accompanied by shortness of breath, dizziness, anxiety, and restlessness (Dalal et al., 2014). Also known as an ST-segment elevation myocardial infarction, its diagnosis can be confirmed via an EKG which is essential for all patients at high risk.  The management of a STEMI is by administering aspirin followed by immediate revascularization. Clinical evidence suggests that the earlier a patient undergoes revascularization, the higher the chances of good health outcomes. When immediately identified on EKG and a STEMI protocol implemented, a patient can undergo catheterization for possible stenting or an emergency PTCA on time (Dalal et al., 2014).

ORDER A CUSTOM-WRITTEN, PLAGIARISM-FREE PAPER HERE

Reference

Dalal, J. J., Alexander, T., Banerjee, P. S., Dayasagar, V., Iyengar, S. S., Kerkar, P. G., & Mullasari, A. (2014). 2013 consensus statement for early reperfusion and pharmaco-invasive approach in patients presenting with chest pain diagnosed as STEMI (ST-elevation myocardial infarction) in an Indian setting.
Journal of the Association of Physicians of India
,
62
, 13. STEMI heart attack essay

 

Please write 1 paragraph for each of the following (total 3 paragraphs) and each paragraph shall be no less than 3 sentences and no more than 6 sentences.

Please provide proper citation with page numbers of the material you are referencing.

1. Discuss one of the following: STEMI, Non-

STEMI; congestive heart failure; murmurs;

ventricular tachycardia; asystole

2. What is a safe treatment plan for a
patient

with Atrial Fibrillation?

3. What is a safe
treatment plan
to reduce a

patient’s bilateral lower extremities pitting

edema? STEMI heart attack essay

For this Head-to-Toe Assessment Sample essay assignment, perform a complete head-to-toe assessment on one of your chosen participants. Your analysis should include the following:

BUY A PLAGIARISM-FREE PAPER HERE

Topical headings to delineate systems.

For any system for which you do not have equipment, explain how you would do the assessment.

Detailed review of each system with normal and abnormal findings, along with normal laboratory findings for client age.

An analysis of age-specific risk reduction, health screen, and immunizations.

Your expectation of normal findings and what might indicate abnormal findings in your review of systems.

The differential diagnosis (disease) associated with possible abnormal findings. Head-to-Toe Assessment Sample essay.

A plan of care (including nursing diagnosis, interventions, evaluation).

Client and age-appropriate evidenced based practice strategies for health promotion.

Pharmacological treatments that can be used to address health issues for this client.

Provide your answers in a 6- to 7-page Microsoft Word Head-to-Toe Assessment Sample essay document.

Support your responses with examples.

On a separate references page, cite all sources using APA format.

Use this
 
APA Citation Helper
 
as a convenient reference for properly citing resources.

This handout will provide you the details of
 
formatting your essay using APA style
.

You may create your essay in this
 
APA-formatted template
. Head-to-Toe Assessment Sample essay

Policy Brief Part 2 – Cost disparity in healthcare delivery essay

Policy Brief Part 2

Name

Institution

 

Introduction

Policy briefs communicate the healthcare issues and solutions to the government. This paper acts as a continuation of the policy brief that sought to resolve the problem of healthcare costs which is a disparity in healthcare delivery.  The alternatives recommended for the healthcare cost include the presentation of data to the consumer.  This intends to promote transparency and sharing of the information needed by the consumer in a personalized and user-friendly manner which assists in increasing accountability of financial resources in the healthcare system and also in reduction of costs. Another alternative resolution identified is the creation of regulatory reforms that promote healthcare transparency. This involves the creation of databases to allow the comparison of prices, for particular procedures and health plans.

BUY A PLAGIARISM-FREE PAPER HERE

Global Factors Associated

The presentation of medical data is associated will increasing transparency in the hospital billing. This is associated with the global economic factors in that the management of healthcare costs in the US will set an example to the global environment. The overall costs of healthcare will go down thus enhancing global accessibility of medical services as well as promote prevention. National health status affects the global stability of disease management. Citizens of outside countries seek medical attention from the US health facilities and thus they benefit from the lowered costs related to accountability and transparency (Rushefsky & Patel, 2016). The presentation of medical information also helps the global population to demand for similar initiatives to help reduce the economic burden of healthcare. Policy Brief Part 2 – Cost disparity in healthcare delivery essay.

Creation of regulatory reforms is associated with the global political factors. Change in policies is an initiative of the government in collaboration with the healthcare sector. As such, the American system sets a global example in developing policies that reduce the cost of care that could be applied by international organizations such as the World Health Organization (WHO) which promote the global healthcare access. Different states are able to advocate for reforms associated with insurance premiums, conduct comparisons and create effective regulations that promote the wellbeing of the people through reduced costs.

Final Recommendation

The continued increase of healthcare costs has become a global concern not only in the United States but also in the global setting. The final recommendation is to implement the proposed resolutions in order to resolve the cost of healthcare issue. The two alternatives enhance transparency and accountability in the health sector as well as encourage effective regulations through reforms that reduce healthcare wastage, exploitation and cost. Policy Brief Part 2 – Cost disparity in healthcare delivery essay. However, legislations tend to be more effective and universal and therefore, the creation of regulatory reforms that promote healthcare transparency is the best possible recommendation for resolution of this issue.

Implementation Plan

The policy should be implemented. The implementation plan will consist of the initiation, planning, implementation and closure phase. It will begin with the determination of the structure of the organization, promotion and project monitoring. Next, the review and refining of the action plan will take place followed by preparation for implementation. Consequently, a preparation for evaluation using models and methods will be done. This step will determine whether the goals of the policy have been met. Based on the evaluation results the next step in the implementation plan will be to make the mid-course corrections. This follows the development of a communication plan for the implementation and ends with the dissemination of information.

Communication Strategy

Communication plans for policy implementation are significant in organizing the reporting of the process and progress of the project to the community. The frequency of communication, format, leadership and the involvement of the partners and the community is considered during the development of a communication strategy. For the communication of the policy reforms media outlets will be the most effective channel of reaching the community. This will involve televisions, radio and social media platforms that are easily accessible to most of the country’s population (Bekker, 2007). The central message of communication is the management of hospital costs through policy reforms and legislation.

The target audience for the reforms includes the hospitals, insurance payers, providers, billers consumers, the government, health organizations and officials and the general population. The hospitals are the biggest stakeholder in the implementation of the policy reforms and their involvement in the reforms is notable too. The providers include nurses and pharmacists who write the medical records and note the services provided. Accuracy in recording is essential in effecting the proposed resolutions. Billers generate bills for the patients and payers and thus eliminating of errors in their work is a strategy of accountability and transparency in the hospital. Consequently, insurance providers are involved in the reforms as they provide data regarding their premiums to allow comparison by the community which is the core consumers. The support organizations involved in the implementation of policies include the World Health Organization, the non-governmental health related agencies and the health advocacy groups. Policy Brief Part 2 – Cost disparity in healthcare delivery essay.

Information dissemination involves the generation and effective spread of research evidence among policy makers. Dissemination will involve the publishing of policy briefs in the public platforms easily accessible to all citizens. A presentation in the national health meetings and conferences of healthcare professionals as well as the local community groups will be done. Moreover, program materials such as guides, flyers, DVDs and pamphlets will be distributed and also, social media publications will enable information sharing across a large population. A press release is an essential tool of information dissemination for the policy reforms too.

Evaluation Plan

Evaluation helps in monitoring the progress of the reforms. As such, they facilitate the revision and improvement of action plans for implementation of changes. The evaluation will begin with the definition of outcomes. In this case, the outcomes will be based on the feedback and numeric form. The outcomes will be the anticipated changes which will be reduced cost of healthcare. Moreover, transparency and accountability through information sharing to the public will be an essential outcome Policy Brief Part 2 – Cost disparity in healthcare delivery essay. The plan to evaluate the outcomes will result in changes in indicators, strategies and objectives. The plan will focus on the measurable and observable results of the process.

Notably, the evaluation plan will involve the quantitative approach. This will be characterized by observation of measurable outcomes including the cost of implementing the reforms, the cost saved for hospital services and the patient feedback regarding the changes. Monitoring of the cost will be done using the monitoring and updating systems. These systems assist in monitoring and sharing data and results and they include community-balanced scorecards, Web-based dashboards, software and databases among others. The systems are customized to capture the costs and analyze according to time in order to generate quantitative data results on the cost changes.  The National Association of City and County Health Officials, Agency for Healthcare Research and Quality, the government and the healthcare laws provide standards that must be met by policy reforms in healthcare (
Agency for Healthcare Research and Quality
, 2019).

Accreditation standards by the above entities ensure ethical practice. This helps prevent ethical conflicts associated with the autonomy of the patients which ensures that they are involved in decision making regarding their treatment plans. Reduction of hospital costs through policy reforms upholds beneficence (Wirt, 2012). However, the confidentiality of medical records is affected by the presentation of information to the public as well as sharing of databases for transparency. In this case, coding of information to prevent the exposure of personal client information will be done to retain the privacy of the sensitive health information. This will resolve the ethical conflict and ensure accountability and transparency. Finally, the results will be reported through a press conference, social media and streaming media as well as presentation in healthcare conferences and meetings as well as the local community meetings Policy Brief Part 2 – Cost disparity in healthcare delivery essay.

Conclusion

Policy briefs are essential in imposing changes in the healthcare sector through communication. Change in policies allows the implementation of best possible evidence based approaches towards improving the health sector. The increase in health costs has caused health disparities related to economic status which has discouraged the access to medical services. Therefore, implementing reforms that seek to improve accountability and transparency as well as inform the population on the pries of insurance premiums and average costs for services promotes positive changes related to reduction of prices, discourage exploitation of consumers and occurrence of billing errors and also create awareness to the public on the costs. Policy reforms are emphasized by legislations and hence are universal. Policy Brief Part 2 – Cost disparity in healthcare delivery essay.

 

 

References

Agency for Healthcare Research and Quality. (2019). 2016 National Healthcare Quality and Disparities Report. Retrieved from
https://www.ahrq.gov/research/findings/nhqrdr/nhqdr16/index.html
on Saturday 31,2019

Bekker, M. (2007). The politics of healthy policies: redesigning health impact assessment to integrate health in public policy. Eburon Uitgeverij BV.

Rushefsky, M. E., & Patel, K. (2016). 
Politics, Power and Policy Making: Case of Health Care Reform in the 1990s: Case of Health Care Reform in the 1990s
. Routledge.

Wirt. S. (2012). Association of rehabilitation nurses health policy tool kit. Retrieved from
https://rehabnurse.org/uploads/membership/hptoolkit12_full.pdf
on Saturday 31,2019 Policy Brief Part 2 – Cost disparity in healthcare delivery essay

Ethical Memoir

Compose a 2-page paper that describes a particular moral-ethical dilemma that you encountered and what the outcome of that dilemma was. Did you solve the dilemma? If so, how? If not, what were the repercussions or consequences? What would you do differently if faced with the same problem today? What is the importance of good ethics? Why should we be concerned about our actions? Use the learning and reading for this week as a basis for this paper. Regard the questions as prompts, not an ordering of your responses. Regard the questions as prompts, not an ordering of your responses. This is not a Q&A essay, but rather a graceful reflection regarding a difficult ethical dilemma you faced Ethical Memoir.

Capstone Research Summary table

3 -1

To begin, work through the reference list that was created in the ”Section B: Problem Description” assignment in Topic 2. Appraise each resource using the ”Rapid Critical Appraisal Checklists,” available in the textbook appendix. The specific checklist you use will be determined by the type of evidence within the resource.

Then, develop a research table to organize and summarize the research studies. Using a summary table allows you to be more concise in your narrative description. Only research studies used to support your intervention are summarized in this table. Refer to the ”Evaluation Table Template,” available in the textbook appendix. Use the ”Evaluation Table Template” as an adaptable template.

Problem Statement: Reduction of Fall Rates for Post-Operative Patients Capstone Research Summary table.

BUY A PLAGIARISM-FREE PAPER HERE

TEXT BOOK

Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing and

healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Walters Kluwer.

These are the references used in assignment 2

Everhart D, Schumacher, J.R., Duncan R.P., Hall A.G., Neff, D.F., & Shorr, R.I. (2014). Determinants of hospital fall rate trajectory groups: A longitudinal assessment of nurse staffing and organizational characteristics. Health Care Management Review. 39(4), 352–360.

Kobayashi, K., Kei, A., Yuko, I., Yusuke, S., Nagao, Y., & Shiro, I. (2018). Characteristics of falls in orthopedic patients during hospitalization. Nagoya Journal of Medical Science. 80(3), 341–349.

Luzia, M., Victor, G., & Lucena, F. (2014). Nursing diagnosis risk for falls: Prevalence and clinical profile of hospitalized patients. Revista. Latino-Americano. Enfermagem. 22(2), 262–268.

Mata, L., Cissa, A., Gabrielle, P., & Moraes, T. (2017). Factors associated with the risk of fall in adults in the postoperative period: a cross-sectional study. Revista Latino-Americano Enfermagem. 25(2904). Capstone Research Summary table

Shida, D., Wakamatsu, K., Tanaka, Y., Yoshimura, A., Kawaguchi, M., Miyamoto, S. (2015). The postoperative patient-reported quality of recovery in colorectal cancer patients under enhanced recovery after surgery using QoR-40. BioMed central Cancer. 15(799), 1–6.

Vitor, A., Moura, L., Fernandes, L., Botarelli, F.R., Araújo, J., & Vitorino, I. (2015). Risk for falls in patients in the postoperative period. Cogitare Enferm. 20(1), 29–37.

 

 

Summary Table

Name

Institution

Date

 

 

Summary Table

Author (Year)

Title

Aim

Design

Sample, number of participants

Level of evidence

Findings

Everhart et al (2014)

Determinants of hospital fall rate trajectory groups: A longitudinal assessment of nurse staffing and organizational characteristics

To establish if hospitals can be classified into fall rate trajectory groups & to determine the characteristics of the nurses and healthcare organizations allied to hospital fall rate trajectory groups.

4-month longitudinal study

Capstone Research Summary table

1,529 hospitals

 

U.S. acute care general hospitals taking part in the National Database for Nursing Quality Indicators

Level 4

Magnet hospitals lower rates of falls

Hospitals did not change their fall performance over time

There is a relationship between nurse staffing and the rate of falls

Kobayashi et al (2018)

Characteristics of falls in orthopedic patients during hospitalization

 

To establish characteristics over five years of cases of fall in orthopedic patient

Prospective study

Prospective analysis of 212,617 inpatients

Assessment of fall risk,

Level 2

Fall rate is high in orthopedic patients, irrespective of a low risk management score. Therefore, it is important to ensure frequent assessments at short intervals and fall risk assessments for hospitalized orthopedic patients

Luzia et al (2014)

Nursing Diagnosis Risk for falls: prevalence and clinical profile of hospitalized patients

 

To determine the incidence of diagnosis of falls in the adult patients admitted within surgical and clinical wards in order to classify the clinical profile and identify the risk factors associated with risk for falls

Capstone Research Summary table

A cross-sectional study

174 patients

University hospital in Brazil, with 795 beds

 

Data collection was done using on-line hospital records and computerized nursing care prescriptions system and statistical analysis was done

Level 5

The risk for falls of the inpatients in surgical and clinical wards was found to be low in the researched organizations. The patients at higher risk of falls included older adults, men, surgical patients, and patients with cardiovascular diseases and neurological disorders. The risk factors for diagnosis of risk for falls included impaired mobility, increased age, neurological changes, and vulnerability associated with impaired health and medical procedures

Mata et al (2017)

Factors associated with the risk of fall in adults in the postoperative period: a cross-sectional study

To examine factors linked with the risk of fall in patients undergoing surgical procedures

A quantitate cross-sectional study

Hospital in state of Minas Gerais, Brazil

257 adult inpatients

Data collection done using sociodemographic and clinical questionnaire, the Morse Fall Scale, and the Quality of Recovery Score

Descriptive statistical analysis and multinomial logistic regression used to perform data analysis

Level 5

Factors associated with the risk of fall in adults in the postoperative hospital stay include age, surgical recovery, diabetes, cancer, and systemic arterial hypertension

Shida et al (2015)

The postoperative patient-reported quality of recovery in colorectal cancer patients under enhanced recovery after surgery using QoR-40

To examine if early discharge from the hospital after surgery is compatible with a better outcome from according to the perspective of the patients

A cross-sectional study

Tokyo Bokutoh Metropolitan in Hospital Tokyo Bokutoh Metropolitan Hospital

Data collected using QoR-40, a recovery-specific and patient-rated questionnaire

Level 5

Surgical procedures affect the quality of life of patients and this included mobility. Therefore, patients should not be discharged early after surgery to lower the risk associated with early hospital discharge post-operative

 

Vitor et al (2015)

Risk for falls in patients in the postoperative period

To determine and identify the factors associated with a diagnosis of risk for falls & the major risk factors in patients recovering after surgical procedures with a university hospital

A descriptive cross-sectional study, using a quantitative approach

Capstone Research Summary table

Public tertiary teaching hospital located in the municipality of Natal/ Rio Grande do Norte, Brazil

Sample included patients in the postoperative period, admitted within the clinical surgical units of the hospital.

Sample size: 80 patients.

Level 5

Risk for falls ND found in 69 patients (86.25% of the sample)

There is a significant relationship between the surgical procedure (postoperative condition) and the elevated susceptibility of the person the risk of falls. The risk for falls during the postoperative period was attributable to syncope, weakness, and loss of balance

Anemia is a predisposing factor for falls

Narcotic and/or opioid medications used during hospitalization can be attributed to the increased risk for falls

 

 

 

 

References

Everhart D, Schumacher, J.R., Duncan R.P., Hall A.G., Neff, D.F., & Shorr, R.I. (2014). Determinants of hospital fall rate trajectory groups: A longitudinal assessment of nurse staffing and organizational characteristics.
Health Care Management Review
. 39(4), 352–360.

Kobayashi, K., Kei, A., Yuko, I., Yusuke, S., Nagao, Y., & Shiro, I. (2018). Characteristics of falls in orthopedic patients during hospitalization.
Nagoya Journal of Medical Science
. 80(3), 341–349. Capstone Research Summary table

Luzia, M., Victor, G., & Lucena, F. (2014). Nursing diagnosis risk for falls: Prevalence and clinical profile of hospitalized patients. Revista. Latino-Americano.
Enfermagem
. 22(2), 262–268.

Mata, L., Cissa, A., Gabrielle, P., & Moraes, T. (2017). Factors associated with the risk of fall in adults in the postoperative period: a cross-sectional study.
Revista Latino-Americano Enfermagem.
25(2904).

Shida, D., Wakamatsu, K., Tanaka, Y., Yoshimura, A., Kawaguchi, M., Miyamoto, S. (2015).

The postoperative patient-reported quality of recovery in colorectal cancer patients under enhanced recovery after surgery using QoR-40.
BioMed central Cancer
. 15(799), 1–6.

Vitor, A., Moura, L., Fernandes, L., Botarelli, F.R., Araújo, J., & Vitorino, I. (2015). Risk

for falls in patients in the postoperative period.
Cogitare Enferm
. 20(1), 29–37 Capstone Research Summary table.