Tag: Clinical-Nursing

NURS 6003 – Transition to graduate study Week 2 discussion Essay

Discussion – Week 2

COLLAPSE

Strategies for Addressing Questions

In Module 1, you began building a foundation for your success by considering a network-individuals and teams who can help you to clarify and execute on the vision. A network is most helpful when you are comfortable asking questions. Chances are other members of your network have experienced similar questions and may have helped guide others toward resolutions that can now be helpful.

In this Discussion, focus on the questions you are ready to ask as your journey begins. Keep in mind that sharing questions is often a great way to help others who have similar questions even if they do not realize it!

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To prepare:

Reflect on questions or concerns you might have as you begin the MSN program.

Consider the individuals, teams, and departments you previously considered in Module 1 as well as how they may provide support with addressing these questions and concerns. NURS 6003 – Transition to graduate study Week 2 discussion Essay

By Day 3 of Week 2

Post any questions or concerns that you are willing to share with the group. The Discussion board represents an opportunity to network with your course colleagues, and others may have the same questions or concerns.

By Day 6 of Week 2

Respond to at least two of your colleagues’ posts by offering a possible resolution to their questions/concerns with supporting documentation, if possible, or expanding on their thinking and providing an example as support.

Click on the Reply button below to reveal the textbox for entering your message. Then click on the Submit button to post your message. NURS 6003 – Transition to graduate study Week 2 discussion Essay

 

Transition to graduate study

Name

Institution

 

Transition to graduate study

Transitioning to graduate study is an opportunity for career development and advancement through improved education level, knowledge and skills. Although the transition is an opportunity, it also presents some unique challenges that could hinder me from completing the study program. The first concern is a lack of academic preparedness even with a bachelor’s degree that indicates qualification for the program. In fact, academic prepared is linked to previous tertiary experiences (identified as understanding of academic processes, experiences in field of expertise, previous qualifications, and involvement in scholarly activities prior to the enrolment) that has an influence on attrition and throughput rates. This concern should be addressed through having the minimum academic qualifications for joining the study program since they have a direct bearing on entry qualifications and academic performance. In addition, it should be addressed through more experience in the field of study prior to joining the study program. NURS 6003 – Transition to graduate study Week 2 discussion Essay. The assumption made is that persons with high academic preparedness will perform better than their counterparts with lower academic preparedness since they are influenced by prior academic success and learning experiences, and are more willing and motivated to engage of learning. Besides that, there is a link between academic preparedness and motivation since prior academic success and learning experience affect self-belief that in turn impacts willingness and motivation to engage in learning (Fitzgerald, 2015).

The second concern is the primary motivation for joining the graduate study program. This includes the eagerness to complete the study program, reason for pursuing the graduate study, meaning of the study, and confidence regarding the study program in terms of meeting career objectives. Confidence about the choice of graduate study program is a concern since it is typically based on personal interest rather than the pragmatic worth of the program as should be the case. In fact, it is not uncommon for individuals to be motivated by knowledge expansion, improving social status, self-actualization, and securing better compensation and employment. As such, the primary motivation for most individuals is educational and career aspirations, a concern since motivation is linked to goal commitment and perseverance, which are linked to the strength and nature of the desire to engage in learning activities within the limited timeframe. The concern can be addressed through ensuring that individuals join programs with pragmatic worth as a primary motivation and personal interest being a secondary motivation (Thomas et al., 2016). NURS 6003 – Transition to graduate study Week 2 discussion Essay

The final concern is the availability and utilization of university support services that include information communication services, academic writing center, mentors, school coaches, individual academic support, orientation program, and library services. The individual academic support is a one-on-one interaction with academics and supervisors who help in improving performance. The academic writing center helps in developing academic writing skills. Library services enable students to access academic material. The orientation program facilitates the integration of students into the academic culture of the university to help in minimizing transitional challenges. In essence, the university support services help in establishing a positive relationship between the university and students, helping in integrating the students into the university’s academic culture. Although the university support services facilitate smooth academic transition, the concern is that students do not typically use these services. This concern can be addressed through ensuring that the university provides maximum services that are easily available to the students, and ensuring that the students utilize these services (McCaffrey, 2016) NURS 6003 – Transition to graduate study Week 2 discussion Essay.

 

References

Fitzgerald, M. (2015).
Nurse practitioner certification examination and practice preparation
.  Philadelphia, PA: F.A. Davis Company.

McCaffrey, R. (2016).
Doctor of nursing practice: enhancing professional development
. Philadelphia, PA: F. A. Davis.

Thomas, P., Kern, D., Hughes, M. & Chen, B. (2016).
Curriculum development for medical education: a six-step approach
(3
rd
ed.). Baltimore, MD: John Hopkins University Press. NURS 6003 – Transition to graduate study Week 2 discussion Essay

Interest groups assignment- Emergency Nurses Association

Interest Groups: Emergency Nurses Association

Introduction

Emergency Nurses Association (ENA)

A national intradisciplinary specialty body for emergency nurses

ENA has members serving in federal advocacy groups

Advocates for patient safety

Interest groups assignment- Emergency Nurses Association

Advocates for excellence & professionality in emergency nursing practice

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Emergency Nurses Association Voice at Federal Level

ENA is an advocate on:

Regulatory & legislative matters that affect emergency patients

Regulatory & legislative matters affecting emergency nurses

ENA has a government relations team that:

Holds regular meetings with elected officials

Interest groups assignment- Emergency Nurses Association

Keeps tab on federal laws that affect emergency nurses & patients

Takes part in law-making process for policies and programs that affect emergency nurses & patients

Lobbies for solutions to emergency issues via the EN411 Action Network

Emergency Nurses Association Voice at National Level

ENA tracks emergency nursing and medical laws within all 50 states

ENA works with leaders at state level to:

Identify & advocate for law that support prevention of workplace violence and injury

Advocate for law addressing workforce matters like safe work environment, safe patient handling

Members of ENA participate in lawmaking process at state level

Interest groups assignment- Emergency Nurses Association

Guides development of polices regarding emergency healthcare

Key Obstacles

Lack of representatives in both local & federal governments

Lack adequate of policies to guide emergency nurses

Lack of adequate funds to support its programs/initiatives

Spending

In 2019, ENA managed to lobby for $87,500 for Emergency Nurses

In 2018 ENA spent $158,500 in lobbying

In 2018, ENA Foundation awarded:

Above$435,000 for scholarships, research & continuing education grants

50 conference scholarships to emergency nurses

Interest groups assignment- Emergency Nurses Association

89 educational scholarships to emergency nurses

Conclusion

ENA a leading and dominant influencer in regulatory & legislative issues that affect emergency nursing & healthcare

ENA ensures voices of emergency nurse are heard

ENA represents patients, nurses & the society through advocacy groups

References

Emergency Nurses Association. (2019). government relations. Retrieved from https://www.ena.org/#advocacy-policy Interest groups assignment- Emergency Nurses Association

Emergency Nurses Association (ENA). (2015b).
Mission statement.
Retrieved from
https://www.ena.org/about/Pages/Default.aspx

Laskowski-Jones L. (2016). The emergency nurse as a professional.
Reflections of Nursing Leadership
. 1(1).

Oestberg, F. (2015). Policy and politics: Why nurses should get involved.
Nursing, 42
(12), 46–49.

Interest Groups- Emergency Nurses Association

Interest groups assignment- Emergency Nurses Association

SBAR template

Choose an experience from your nursing practice. Using the ”SBAR” template, explain the situation in detail, followed with background information. Then explain your immediate assessment and recommendations you have for the provider.

Include the following in the ”SBAR” template:

1.Be sure to include three or four evidence‐based references, not older than 5 years.

2.When giving your recommendation discuss how you would educate the client using evidence‐based research and guidelines. How would you deliver your recommendation in various learning environments? SBAR template

APA style is not required, but solid academic writing is expected.

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

 

SBAR

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Situation

 

 

 

 

 

 

 

Background

 

 

 

 

 

 

 

 

 

Assessment

 

 

 

 

 

 

 

 

 

 

Recommendation

SBAR template

 

 

 

 

 

 

 

 

 

 

 

References

 

 

 

 

 

 

 

 

 

 

NUR-643E-RS-SBAR

SBAR

As a nurse it is not uncommon to experience situations requiring the use of SBAR an abbreviation for situation, background, assessment and recommendation method SBAR template. An experience with the use of SBAR that standards out occurred during a night shift in the medical ward. In this case, I was attending to a patient who was admitted into hospital for treatment and observation. Her situation worsened during the course of the night and it was deemed necessary to call the attending physician. During the call, the first step was to explore the situation
(S)
in which I presented a brief and clear description of the situation. I reported that the patient was experiencing increasing shortness of breath and was complaining of chest pains. The second step was to report on the case background
(B)
in which I offer relevant and clear background information on the patient. I reported that the patient had back surgery three days ago. About three hours ago, he indicated shortness of breath and recklessness, complained of chest pain, blood pressure reading is 128 over 54, and pulse is 120. The third step was to report an assessment
(A)
that indicated a professional nursing conclusion of the case based on the situation and background information. I made the assessment and reported that the patient could be having a pulmonary embolism or cardiac event. The final step was to make a recommendation
(R)
on the case by stating what is required from the physician in a relevant and clear manner. SBAR template The recommendation made was that the physician should see the patient immediately, and that he should be started on oxygen to relieve the breathing difficulty. The case makes it clear that SBAR facilitates communication between medical personnel through offering accurate and timely reports about patients thereby preventing the precipitation of adverse events in clinical routine, and improving patient safety and care outcomes (Müller et al., 2018; Shahid & Thomas, 2018) SBAR template.

References

Müller, M., Jürgens, J., Redaèlli, M., Klinberg, K., Hautz, W. & Stock, S. (2018). Impact of the communication and patient hand-off tool SBAR on patient safety: a systematic review.
BMJ Open
, 8(8), e022202. doi: 10.1136/bmjopen-2018-022202

Shahid, S. & Thomas, S. (2018). Situation, background, assessment, recommendation (SBAR) communication tool for handoff in health care – a narrative review. Safety in Health, 4, 7. doi: 10.1186/s40886-018-0073-1 SBAR template

Otitis media with effusion soap note essay example

patient: DX: right otitis media with effusion

With this patient in mind, address the following in a SOAP Note:

Subjective: What details did the patient or parent provide regarding the personal and medical history? Include any discrepancies between the details provided by the child and details provided by the parent, as well as possible reasons for these discrepancies.

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Objective: What observations did you make during the physical assessment? Include pertinent positive and negative physical exam findings. Describe whether the patient presented with any growth and development or psychosocial issues. Otitis media with effusion soap note essay example.

Assessment: What were your differential diagnoses? Provide a minimum of three possible diagnoses. List them from highest priority to lowest priority. What was your primary diagnosis and why?

Plan: What was your plan for diagnostics and primary diagnosis? What was your plan for treatment and management? Include pharmacologic and non-pharmacologic treatments, alternative therapies, and follow-up parameters, as well as a rationale for this treatment and management plan.

Reflection notes: What was your “aha” moment? What would you do differently in a similar patient evaluation?

Primary Diagnosis of Otitis Media with Effusion Through the
SOAP
(Subjective, Objective, Assessment, Plan) Algorithm, Differential Diagnoses, Management, and Case Reflection

Patient Initials: _______                     Age: _______                         Gender: _______

SUBJECTIVE DATA:

Chief Complaint (CC):
There is some pain and fullness of the right ear as reported by the child  Otitis media with effusion soap note essay example. But the mother reports that the child is unable to hear well in close proximity and is lately having trouble breathing and sleeping.

History of Present Illness (HPI):
A 2
1/2
year-old Caucasian male child was brought by his mother to the clinic with the main complaint of having a feeling of fullness in the right ear and inability to hear properly with that side. The mother also reports that the child has been having trouble breathing while sleeping, often having to sleep with his mouth open. No fever is reported by the mother. The boy is still fed from a bottle, especially when the mother wants him to sleep. The boy feeds well and is achieving his milestones as required. Otitis media with effusion soap note essay example.

The inability to hear well started one week ago, occurs from distances of about one meter, one has to raise their voice for the child to hear and turn, and occurs all the time since start. The sleep disturbance started about three days ago, occurs at night, is associated with the inability to breathe well in sleep, and is relieved by opening the mouth and using it to breathe. For the child, the pain is in the head but he does not know when it started. It is not too much (he cannot exactly rate it), and occurs on and off while able to be relieved by drinking milk. The fullness as reported by the child is in the head, started “a long time ago,” comes on and off, is relieved by yawning, and is not “too bad.”

There were no major discrepancies between what was reported by the parent and what the child reported, adjusting for the child’s age. Otitis media with effusion soap note essay example.

Medications:
For his allergy to the environmental factors stated above, the boy is on Zyrtec (cetrizine) syrup 5 mg once daily. However, he is only given the medication when he has a runny nose like at present.

Allergies:
The patient is allergic to airborne particulate matter such as pollen grains and dust. He usually gets a serious runny nose for a day or two on exposure to these allergens. He also at times develops these same symptoms when he is exposed to cigarette smoke Otitis media with effusion soap note essay example.

Past Medical History (PMH):
The child has a previous history of being treated as an outpatient for Acute Otitis media (AOM) about a month ago, and an admission for pneumonia when he was one year old. He has no significant history of childhood illnesses.

Past Surgical History (PSH):
There is no significant surgical history for the child.

Personal/Social History:
The child is able to feed normally unassisted and is meeting his developmental stages on time. He has no delayed milestones. He plays normally with other children, his siblings, and his parents.

Immunization History:
The boy received all the childhood immunization vaccines needed, including for pneumonia and influenza Otitis media with effusion soap note essay example.

Significant Family History:
There is a family history of allergy on the maternal grandmother, and asthma on the paternal grandmother. Both parents have no significant illnesses. The child was a normal pregnancy and delivery with a good Apgar score and an uneventful neonatal period.

Lifestyle:
The boy’s father is a smoker, although he never smokes in the house. However, the mother reports that the boy has a tendency of running outside to his father when he is smoking. Otitis media with effusion soap note essay example.

Review of Systems:

General:
The boy is normal size and weight for his age. There are no changes in weight since the last one was taken. There is no obvious weakness or fatigue as the child is playful like any other child his age. He also has no fever (T = 37.1°C). He has no obvious language or cognitive deficiencies.

HEENT:
The boy says his head is heavy and sometimes feels a headache. He says he can see well, but has some difficulty hearing speech using his right ear. He also says the mucus coming out of his nose is bothering him. He has no difficulty in swallowing solid food or drinks.

Respiratory:
Unremarkable. He has no pain in the chest, is not coughing, and is not laboring to breathe.

Gastrointestinal:
The mother reports normal bowel movements Otitis media with effusion soap note essay example.

Genitourinary:
The mother reports normal bladder activity.

Psychiatric:
There is no obvious cognitive or developmental anomaly from the child’s speech. He is meeting all his developmental goals as envisaged.

Allergic/Immunologic:
Confirmed sensitivity to particulate environmental allergens, from the mother.

OBJECTIVE DATA (Physical Exam, Imaging, & Laboratory Tests)

Vital signs:
The patient has a temperature of 37.1°C, a respiratory rate of 28 breaths per minute, and a heart rate of 90 beats per minute.  He weighs 13.6 kilograms at presentation, and the mother reports that he weighed 13.5 kg the last time he was seen at the child welfare clinic. His height is 85 centimetres. Using weight as 30 pounds and height as 33.5 inches, the calculated BMI for this boy is 18.8. This puts the BMI-for-age percentile for this boy at the 96
th
percentile, or obesity (CDC, 2019).

General:
The child is in good general condition, with normal posture and gait. He is active and playful for a child of his age. His body hygiene and grooming are satisfactory and not of a child from a low socio-economic background. There are no obvious neurological deficits and the child is oriented in space, time, place, and person. He has normal affect or emotions, mannerisms, and reactions for a child his age. No abnormal body odors and/ or breath are detectable.

HEENT:
The head is normal for body and age. The eyes are unremarkable. On examination of the throat, the adenoids appear enlarged. There is no pallor. However, the boy has a runny nose which the mother has to wipe from time to time. There are no polyps or inflammation of the nose. Pneumatic otoscopy and tympanometry (Zakrzewski & Lee, 2013) of the right ear reveals a retracted tympanic membrane with an air-filled interface visible. The fluid behind the membrane is yellowish, and there is prominence of the lateral processes. There is also no mobility of the tympanic membrane. Otitis media with effusion soap note essay example.

Neck:
There is no cervical lymphadenopathy.

Chest:
The rib cage looks symmetrical with no chest indrawing.

Lungs:
Auscultation reveals normal air entry. There no rhonchi, rales, or wheezing. A plain chest X-ray is done as a precaution, given the previous medical history of pneumonia.

Heart and Peripheral, Vascular (Cardiovascular):
There are normal heart sounds on auscultation. There is normal peripheral circulation with no pallor or blue discoloration. A full blood count (CBC) is to be done to rule out any infection (leucocytosis) and the differential diagnosis of acute otitis media or AOM (Higgins, 2018).

Abdomen:
Normal bowel sounds with no tenderness on palpation Otitis media with effusion soap note essay example.

Neurological:
No obvious neurological deficit. Common reflexes are normal.

ASSESSMENT:
Primary diagnosis
:
Otitis media with effusion (OME).
First differential diagnosis
: Acute otitis media (AOM).
Second differential diagnosis
: Myringitis.
Third differential diagnosis
: Cystic fibrosis (Higgins, 2018).

Physical examination is the mainstay of OME diagnosis. This involves the use of pneumatic otoscopy, tympanocentesis, and tympanometry (Higgins, 2018; Al-Juboori et al., 2014; Zakrzewski & Lee, 2013; Robb, & Williamson, 2012; American Academy of Pediatrics, 2004). Because of the claim of some pain by the child and the past medical history; acute otitis media (AOM) is the first likely differential diagnosis, and must be ruled out since it causes inflammation as opposed to OME (Higgins, 2018). Also, it is the most recent illness the child was treated for (just about a month ago), and may not have been completely controlled. It is followed by Myringitis, which is inflammation of the middle ear and the tympanic membrane. Lastly is the remote differential diagnosis of cystic fibrosis (Higgins, 2018). In this case, the thick secretions of cystic fibrosis would be responsible for the effusion and blockage of the Eustachian tube. Otitis media with effusion soap note essay example. Pneumonia which the child has suffered from in the past is ruled out by the chest X-ray and the absence of fever, meaning it is well controlled and was adequately treated.

PLAN

Treatment Plan:
The goals of treatment for OME are three – to reduce or stop the effusion causing conductive hearing loss, to return hearing to normal, and to prevent recurrence (Zakrzewski & Lee, 2013). The use of antibiotics, decongestants, antihistamines, and steroids is not recommended because the evidence does not support their efficacy in treating OME (Zakrzewski & Lee, 2013; American Academy of Pediatrics, 2004). The recommended evidence-based treatment modalities are autoinflation, watchful waiting (doing nothing), and surgery (Higgins, 2018; Al-Juboori et al., 2014; Zakrzewski & Lee, 2013; Robb, & Williamson, 2012; American Academy of Pediatrics, 2004). Autoinflation involves opening up the Eustachian tube by increasing the intranasal pressure. Surgery involves adenotonsillectomy and/ or myringotomy; and is only resorted to if the OME fails to resolve itself through watchful waiting or observation for 3 months (Higgins, 2018; Al-Juboori et al., 2014; Robb, & Williamson, 2012). Otitis media with effusion soap note essay example. Other alternative treatments like homeopathy have been shown to be ineffective (Robb, & Williamson, 2012).

Health Promotion:
The child should not be exposed to cigarette smoke as this triggers the allergic reaction blocking the Eustachian tube. He should also be kept far from dust and other particles. Moreover, the child should not be fed with his bottle while lying on his back. This is because research shows that this is an important cause of OME when milk enters the Eustachian tube causing inflammation and blockage (Higgins, 2018).

Disease Prevention:
The American Academy of Pediatrics recommends that the child who has had OME be put under surveillance, with re-examination at intervals of at least 3 months (American Academy of Pediatrics, 2004).

REFLECTION:
The lesson learnt from this experience is that you can actually manage some conditions (like OME) by just observing and doing nothing, based on solid evidence. And the ‘ah-ha’ moment came with the differentiation between AOM and OME, with the former causing inflammation and fever and not the latter. Otitis media with effusion soap note essay example.

________________________

Preceptor Signature and Date

(Signature is REQUIRED for this assignment).

 

References

Al-Juboori, A.N., Al-Aqeedee, A.A., & Saeed, H.D. (2014). Otitis media with effusion in children: A follow up study in West Baghdad, Iraq.
Journal of Communication Disorders, Deaf Studies & Hearing Aids
, 2(4), 1-5. Doi: 10.4172/2375-4427.1000122

American Academy of Pediatrics (2004). Clinical Practice Guidelines: Otitis media with effusion.
Pediatrics
, 113(5), 1412-1429,
https://www.google.co.ke/url?sa=t&source=web&rct=j&url=http://www.antibioticos.mscbs.gob.es/PDF/AAP_otitis_media_with_effusion.pdf&ved=2ahUKEwidpJiJ8LvkAhXxyYUKHfc8DzoQFjAQegQIBxAB&usg=AOvVaw1N-oE5C7AiXC3ICjPDM0sh&cshid=1567762186200

Centres for Disease Control and Prevention [CDC] (2019).
Child and teen BMI calculator
. Retrieved 6 September 2019 from
https://www.cdc.gov/healthyweight/bmi/calculator.html

Higgins, T.S. (2018).
Otitis media with effusion
. Retrieved 6 September 2019 from
https://emedicine.medscape.com/article/858990-overview

Robb, P.J. & Williamson, I. (2012). Otitis media with effusion in children: Current management.
Paediatrics and Child Health
, 22(1), 9-12. Doi: 10.1016/j.paed.2011.03.002

Zakrzewski, L. & Lee, D.T. (2013). An algorithmic approach to otitis media with effusion.
The Journal of Family Medicine
, 62(12), 700-706,
https://www.mdedge.com/familymedicine/article/79105/pediatrics/algorithmic-approach-otitis-media-effusion
 Otitis media with effusion soap note essay example

Complete a 250‐word NUR 643E Health Assesment Topic Reflection 2 reflection of what you have learned during this topic. Include the following in your reflection:

1.Think about an experience you’ve encountered when viewing or completing the particular assessment.

2.Discuss difficulties that could potentially arise or specific questions related to completing this type of assessment.

3.Include illustrative examples of potential strategies used to overcome the difficulties encountered when completing (the particular) assessment. NUR 643E Health Assesment Topic Reflection 2

4.Describe how the Christian worldview and compassion for all plays a role in this type of assessment.

APA style is not required, but solid academic writing is expected.

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

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Health assessment topic reflection

The health assessment topic was informative with regards to identifying one facet of nurses’ function. It introduced the concept of health assessment as the first step in identifying the health care needs of a patient. Health assessment makes use of physical examination to develop an understanding of what patients need from the medical perspective and how nurses and other medical personnel can meet that need. In addition, the topic distinguished health assessment from diagnostic tests that are conducted when a specific disease/condition is suspected following the presentation of known symptoms and/or signs. Besides that, the topic identified that there are four types of health assessment NUR 643E Health Assesment Topic Reflection 2. The first type is initial assessment conducted to determine the nature of the health problem reported by the patient. The second type is focused assessment that exposes and treats the health problem. The third type is time-lapsed assessment that is conducted to assess the problem as the patient’s condition is stabilized and the treatment proceeds. The fourth type is emergency assessment that seeks to rapidly identify the root cause of the health problem along with assessing the patient’s circulation, breathing and airway (Finkelman, 2016) NUR 643E Health Assesment Topic Reflection 2.

Although health assessment improves the speed of nursing intervention through presenting a targeted for nursing care, there are concerns about accuracy and comprehensiveness. This is especially of concern when it is considered that nurses have different experience, knowledge, and skill levels so that there are no guarantees that two different nurses will always present the same health assessment results for a patient. This variation on assessment outcomes based on individual nurses has implications for the care approach selected. This concern is best addressed through having standards, protocols and policies targeted at ensuring that the most accurate assessment results are presented based on the current available verified evidence. NUR 643E Health Assesment Topic Reflection 2. Besides that, health assessment should be accompanied by diagnostic tests to gain an accurate understanding of the health issues affecting the patient. Overall, health assessment is an opportunity for nurses to offer compassionate care that is in line with the Christian perspective through empathizing with the suffering and pain of patients, and presenting an early treatment plan that relieves the pain and suffering even as other assessments proceed for more comprehensive care (Cherry & Jacob, 2016).

References

Cherry, B. & Jacob, S. (2016).
Contemporary nursing: issues, trends, & management
. Amsterdam: Elsevier Health Sciences.

Finkelman, A. (2016).
Leadership and management for nurses: core competencies for quality care
(3
rd
ed.). London: Pearson Education NUR 643E Health Assesment Topic Reflection 2.

Bronchiolitis in children case study

HPI: A 14-month-old Native American boy brought in by his mom due to cough, low grade fever and runny nose for the past 2 days. This morning, the mother noted that her son was breathing quickly and “it sounds like he has rice cereal popping in his throat.” Mom is worried because her son seems to have a lot of “bouts of colds”. Per mom, his oral intake is decreased. He didn’t want to eat this morning.

PE: Smiling, alert Native American boy.

VS: Temp of 99.9, pulse 112, respiratory rate is 58, Pulse ox 96%

HEENT: There is moderate, thick, clear rhinorrhea and postnasal drip.

CV: His capillary refill is less than 3 seconds

PULM: lung sounds are diminished in the bases, he has pronounced intercostal and subcostal retractions, expiratory wheezes are heard in all lung fields. Bronchiolitis in children case study.

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Diagnosis is bronchiolitis

To prepare:

Review “Respiratory Disorders,” “Cardiovascular Disorders,” and “Genetic Disorders” in the Burns et al. text.

Review and select one of the six provided case studies. Analyze the patient information.

Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.

Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or non-pharmacologic treatments.

Consider strategies for educating patients and families on the treatment and management of the respiratory disorder.

Post an analysis of your assigned case by using the following:

What additional questions will you ask?

Has the case addressed the LOCATES mnemonic? If not, what else do you need to ask? What additional history will you need? (Think FMH, allergies, meds, and so forth that might be pertinent in arriving to your differential diagnoses) Bronchiolitis in children case study

What additional examinations or diagnostic tests, if any will you conduct?

What are your differential diagnoses? What historical and physical exam

features support your rationales? Provide at least 3 differentials.

What is your most likely diagnosis and why?

How will you treat this child?

Provide medication treatment and symptomatic care.

Provide correct medication dosage. Use the knowledge you learned from this week’s and previous weeks’ readings as well as what you have learned from pharmacology to help you with this area.

Patient Education, Health Promotion & Anticipatory guidance:

Explain strategies for educating parents on their child’s disorder and reducing any concerns/fears presented in the case study.

Include any socio-cultural barriers that might impact the treatment and management plans.

Health Promotion:

What immunizations should this child have had?

Based on the child’s age, when is the next well visit?

At the next well visit, what are the next set of immunizations?

What additional anticipatory guidance should be provided today?

 

Week 5 Discussion

Name

Institution

The case study selected is about the 14-month-old Native American boy with runny nose, low grade fever and cough. The additional questions that I would ask the patients mother are listed below.

Does the patient have any known allergies? If yes, how does it affect the baby’s breathing?

Do you have a personal or family history of asthma, bronchitis, emphysema, tuberculosis, lung cancer, cystic fibrosis, or any other lung disease?

Does the patient cough throughout the day or at certain specific periods?

The case has nit addresses the LOCATES mnemonic. For instance, the allergies of the patient have not been identified. Thus I would ask the patients mother of the allergies of the baby. I will also ask the mother whether there are any alleviating factors that have been applied to reduce the patient’s symptoms including medications which are not mentioned in the case. Moreover, I will ask about the time when the symptoms occur considering their pattern, frequency and the duration they last. I will also ask about the circumstances or environment under which the symptoms occur and ask the mother to rate the client’s symptoms using a scale of 1 to 10. Bronchiolitis in children case study

Additional examinations or diagnostic tests for the patient would include a pulse oximeter test to measure the oxygen levels in the blood. Notably, a mucus sample test is conducted to test for viruses from nose swab samples. Blood test can also be conducted to check the child’s white blood cell count and oxygen levels which indicate the presence and absence of infections. Differential diagnosis is also important in determining the exact infection ailing the child. In this case, bronchiolitis, pneumonia and asthma are the possible differential diagnoses. Bronchiolitis is characterized by fast breathing, difficulties in eating wheezing, sounds heard in the lungs, cough, sunken ribs during inhalation, runny nose and low grade fever (Meissner, 2016). Bronchiolitis in children case study. On the other hand, pneumonia symptoms include cough, fever and sweating and loss of appetite while asthma is manifested through shortness of breath, wheezing, coughing and chest tightness. From the above differentials, bronchiolitis symptoms match most of the diagnostic criteria symptoms and the child suffers from this condition.

Treatment

The treatment of bronchiolitis in children is influenced by the age and general wellness. This patient can be treated using 1.875 ml of the Ibuprofen Infant Drops (50 mg/1.25 ml), the recommended dosage for children between the age of 12 to 23 months (Osvald & Clarke, 2016). This will help in reducing the fever and increase the comfortability of the patient. The intake of fluids will also help in alleviating the symptoms. However, antibiotics are ineffective since most cases are caused by viruses. A bulb syringe and saline nose drops can also be used to clear nasal congestion. Home care of symptoms involves keeping the child upright, drinking plenty of fluids, keeping the air moist and provision of a smoke free environment (Tomar & Yadav, 2019) Bronchiolitis in children case study.

Patient Education, Health Promotion & Anticipatory guidance:

one of the strategy that can be used in educating the parents of the child to eliminate fear is through individual communication whereby the nurse will explain the concepts of the disease, symptoms, remedies and risks as well as prevention noting that bronchiolitis can get away on its own without treatment and hence no need for worry. Creation of public awareness through the media and health fairs and programs will impart the parents with necessary knowledge regarding the infection. The socio-cultural barriers that might impact the treatment include the linguistic diversity, emotional reactions, mistrust of the healthcare system, religious beliefs and traditions of the Native American community. Bronchiolitis in children case study.

Health Promotion:

Immunizations assist in the prevention of diseases. Airborne infections spread faster especially in children due to their underdeveloped immune systems and thus vaccines help protect them. In this case, there is no vaccine currently available for bronchiolitis. However, annual flu shots are recommended for the patient. Palivizumab should also have been given to the patient to protect the lungs from infection by respiratory syncytial virus (RSV) (Blanco et al., 2019). This is injected intramuscularly every month for five months prior to the RSV season. During winter, passive immunization of the child is crucial every month. Before receiving the immunizations, the child will be expected to meet particular criteria to prevent adverse health impacts. Influenza vaccination is also recommended for the patient once in every 12 months Bronchiolitis in children case study. The patient will be expected to visit the hospital after two weeks for wellness checkup and monitoring. This is because; the infection often goes away after 13 days without active treatment. Another visit will take place after three weeks or in the event that the symptoms worsen during treatment.

The additional anticipatory guidance that should be provided today includes the prevention strategies that can be employed to prevent the occurrence of the infection in the future. These include immunization and the frequency, avoidance of respiratory disease patients, hand hygiene and homecare. This includes monitoring and fever management as well as when to visit the doctor Bronchiolitis in children case study. The parent will also be educated on respiratory disorders common in children to prevent fear in such cases.

 

References

Blanco, J. C., Pletneva, L. M., McGinnes-Cullen, L., Otoa, R. O., Patel, M. C., Fernando, L. R., … & Morrison, T. G. (2018). Efficacy of a respiratory syncytial virus vaccine candidate in a maternal immunization model. 
Nature communications
, 
9
(1), 1904 Bronchiolitis in children case study.

Meissner, H. C. (2016). Viral bronchiolitis in children. 
New England Journal of Medicine
, 
374
(1), 62-72.

Osvald, E. C., & Clarke, J. R. (2016). NICE clinical guideline: bronchiolitis in children. 
Archives of Disease in Childhood-Education and Practice
, 
101
(1), 46-48.

Tomar, P., & Yadav, N. K. (2019). PARENTERAL SMOKING AN IMPORTANT RISK FACTOR FOR BRONCHIOLITIS IN CHILDREN. 
Indian Journal of Applied Research
, 
9
(2). Bronchiolitis in children case study

Complete a 250‐word NUR 643E Health Assessment Topic Reflection 1 of what you learned during this topic. Include the following in your reflection:

1.Think about an experience you’ve encountered when viewing or completing the particular assessment.

2.Discuss difficulties that could potentially arise or specific questions related to completing this type of assessment.

3.Include illustrative examples of potential strategies used to overcome the difficulties encountered when completing (the particular) assessment. NUR 643E Health Assessment Topic Reflection 1

4.Describe how the Christian worldview and compassion for all plays a role in this type of assessment.

APA style is not required, but solid academic writing is expected.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. NUR 643E Health Assessment Topic Reflection 1

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Response

Physical examination and history taking for the head and neck are essential functions of medical personnel, but they can be particularly challenging. In fact, this is usually the first activity that medical personnel undertake upon coming into first contact with the patient since these regions have a concentration of nerves that could be overlooked if the client presents with a seemingly non-related issue. NUR 643E Health Assessment Topic Reflection 1. As part of providing compassionate care that is in line with the Christian worldview, conducting physical examination of the head and neck is considered a priority to ensure that potentially debilitating conditions are not overlooked. Conducted when the patient is in a seated position, the physical examination of the head and neck can be length although varied dependent on the patient’s presenting history and complaint (Kauffman, 2014). There are five activities that are typically conducted when conducting physical examinations to include examinations of the head, ears, eyes, neck, and nose and throat. Perhaps the most challenging aspect of the examinations is checking the ears, particularly auditory acuity tests involving the use of tuning fork instruments. The challenge is in the use and interpretation of the test results when hearing loss is suspected. Firstly, Weber (lateralization) test that checks for asymmetric, normal and bilateral hearing. It is subjective since the client is required to indicate sound loudness for the vibrating tuning fork as compared for the two ears. NUR 643E Health Assessment Topic Reflection 1. The subjective nature of the test makes it difficult to interpret the results. Secondly, Rinne test that checks for conductive hearing loss. It checks for bone and air conduction by placing a vibrating tuning fork on the ear’s mastoid process. The challenge is in the subjective nature of the test since the patient must indicate when he or she stopes hearing the tone from the vibrating tuning fork. The identified difficulties noted in the subjective nature of the two tests can be addressed through experience in using the tests, making the nurse more skilled in noting the typically overlooked subtle differences that have implications for test findings and interpretations (Bickley & Szilagyi, 2013; Kauffman, 2014). NUR 643E Health Assessment Topic Reflection 1.

References

Bickley, L. & Szilagyi, P. (2013).
Bates’ guide to physical examination and history-taking
(11
th
ed.). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Kauffman, M. (2014).
History and physical examination: a common sense approach
. Burlington, MA: Jones & Bartlett Learning. NUR 643E Health Assessment Topic Reflection 1.

Health Organization Evaluation Essay

Research a health care organization or network that spans several states with in the United States (United Healthcare, Vanguard, Banner Health, etc.). Assess the readiness of the health care organization or network you chose in regard to meeting the health care needs of citizens in the next decade.

Prepare a 1,000-1,250 word paper that presents your assessment and proposes a strategic plan to ensure readiness. Include the following:

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Describe the health care organization or network Health Organization Evaluation Essay.

Describe the organization’s overall readiness based on your findings.

Prepare a strategic plan to address issues pertaining to network growth, nurse staffing, resource management, and patient satisfaction.

Identify any current or potential issues within the organizational culture and discuss how these issues may affect aspects of the strategic plan. Health Organization Evaluation Essay.

Propose a theory or model that could be used to support implementation of the strategic plan for this organization. Explain why this theory or model is best.

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

Health Organization Evaluation

Introduction

Banner Health is a not-for-profit health system headquartered in Phoenix, Arizona.  Recognized and regarded as a top health system in United States, Banner Health operates twenty-eight hospitals and numerous specialized facilities in Wyoming, Nebraska, Nevada, Colorado, Arizona, and California. The paper assesses the readiness of Banner Health in regard to meeting the health care needs of citizens in the next decade Health Organization Evaluation Essay.

A description of Banner Health

Banner Health is a health system in the United States that provides a range of services, entailing family clinics, home care, a nursing registry, medical equipment services, and family clinics.  Apart from emergency and basic medical services, the organization’s hospitals also offer specialized services such as organ transplants, heat car, multiple-birth deliveries, behavioral health services, and rehabilitation services. Health Organization Evaluation Essay. According to Plunkett (2017), the major programs of Banner Health include critical care, cancer, heart care, medical education, emergency medicine, medical imaging, neurosciences, pediatrics, surgery, rehabilitation, and obstetrics.

As a leading not for profit organization in the United States, Banner Health is committed to its mission of making people access health care easily so that their lives can be better. The organization exists to offer health care services to communities, instead of generating profits. Thus, every dollar that Banner Health earns is reinvested into new physician services, hospital beds and technologies, maintenance of existing facilities and equipment, and paying salaries to employees (Plunkett, 2017).

Organization’s overall readiness

Banner Health is rapidly moving to the adoption of value-based reimbursement models in the readiness to meet the health care needs of citizens in the next decade. These models reward value rather than volume and by moving a considerable percentage of financial and clinical risks from the payers to the providers, they can assist lessen costs considerably, increase efficiency and lead to improvements in care quality. These programs are focused at cost, quality, tactics of population health management, efficiencies as well as member engagement. According to National Academies of Sciences, Engineering, and Medicine (2018), health systems are endeavoring to shift from volume to value since the patient is the most important. Health Organization Evaluation Essay.  For organizations, such as Banner Health, the issue of value is propelled by the requirement to minimize costs of health care while making improvements in health outcomes along with pursuing continuing quality improvement.

The cost of care offered both outside and inside of the hospital setting is rapidly growing and nowadays accounts for a considerable portion of Medicare expenses. Thus, health care systems are mandated to figure out ways of delivering timely, effective, reliable, safe and consistent care Health Organization Evaluation Essay. As National Academies of Sciences, Engineering, and Medicine (2018) indicate, for an organization like Banner Health that is focused on population health, the focus is to change the transactional organizational structure   framework and mentality of getting paid more for doing more to an understanding that the organization have responsibility of total care of their patients.  An approach that Banner Health to enhance cultural change from volume to value is the creation of several Imaginarium which act as sites for innovation testing of novel ideas on ways of delivering services to meet the needs of consumer Health Organization Evaluation Essay.

 

A strategic plan to address issues pertaining to network growth, nurse staffing, resource management, and patient satisfaction

Banner Health has a strategic planning process that includes strategic growth, patient satisfaction, nurse staffing, and resource management. As health care needs are increasing, it is the goal of Banner Health to create new facilities in responding to the current and future health care needs of Americans.  The plan of the organization is to construct comprehensive medical centers and offer convenient care that is accessible to patients and families. Different regions are growing fast and Banner health wants to ensure that its health plan members and patients can easily access care when they require it.

In regard to nurse staffing, Banner Health has adopted a staffing approach intended to boost the efficient delivery of health care. Health Organization Evaluation Essay. Banner Health’s management recognizes that the nursing staff is critical in the operation of the organization and improved patient outcomes. Nurses are viewed as the backbone of exceptional patient care, and Banner Health acknowledged their priceless role in offering the best possible and safest care to all patients, all the time. As such, it is striving to maintain a healthy patient to nurse ratio to prevent burnout amongst the nursing staff and adverse effects among patients.

To promote patient satisfaction, the organization is employing to offer patients powerful and new schemes for sharing their experiences Health Organization Evaluation Essay. The organization has employed telemedicine to enable interactions between patients and physicians. These technologies promote patient satisfaction through leveraging strategies of interpersonal communication rather than simply depending on technology to promote efficiency. Banner Health’s resource management is connected to the provision of care that is cost-effective. The organization is convinced that health care transformation, including enhanced services and better services for reduced costs will hugely happen via management plans of population health that improves the management and use of resources in clinics and hospitals.

Potential issues within organizational culture and how they might affect aspects of the strategic plan

As one of the biggest not for profit organization in the United States, Banner Health holds the belief the organization’s strength and its capability to deliver on its mission of making people to access health care easily lies with the organization’s leaders. This organizational culture makes most staff to be excluded from the process of thinking and decision making thus limiting the implementation of a strategic plan.  As Kiptoo and Mwirigi (2014) state,  the organizational culture impacts the strategy that the organization chooses and organization has particular beliefs and values that all staff is required to observe Health Organization Evaluation Essay. The culture influences daily operations of the organization and might influence what is unacceptable or acceptable in the company depending on the operating environment of the organization. This implies that if Banner Health is implementing a strategic plan, it is crucial the organization brings everyone on board so that all employees can be part of the process.  An organizational culture greatly contributes to the implementation of the strategic plan and failure to involve all staff members can lead to an unpromising outcome. Health Organization Evaluation Essay.

A model that could be used to support the implementation of the strategic plan for Banner Health

The goal-based strategic planning model is the best model that could be used to support implementation of the strategic plan for Banner Health.  This model is the best because it focuses on major challenges and opportunities facing the organization. The planning team will begin by revisiting the core values, mission and vision of the organization and then evaluate every aspect of the organization’s weaknesses and strengths. As Perrin, K (2014) alleges, goal-based strategic planning entails beginning with a mission statement or goal of the organization and then develop an action plan so as to meet the goals.  Through use of the goal-based strategic planning model t Banner Health will be able to identify its goals along with strategies to attain the goals and action plans to attain the goal, entailing those responsible for their execution and the resources that are needed.

Conclusion

Banner Health has made necessary changes into its strategy, so as to remain one of the biggest health systems in United States and provide quality and cost-effective care in the next decades. The organization has shifted from performance-based reimbursement to value-based reimbursement to minimize costs of health care while making improvements in health outcomes. By making continuous improvements in network growth, nurse staffing, patients’ satisfaction, and resource management, the organization has endeavored to be a front-runner in the United States healthcare industry Health Organization Evaluation Essay.

References

Kiptoo, K., & Mwirigi, F.  (2014). Factors That Influence Effective Strategic Planning Process in Organizations.
IOSR Journal of Business and Management
, 16(6): 188-195.

National Academies of Sciences, Engineering, and Medicine.  (2017).
Models and Strategies To Integrate Palliative Care Principles into Care for People with Serious Illness: Proceedings of a Workshop
. Washington DC:  National Academies Press Health Organization Evaluation Essay.

Perrin, K.
Principles of Research and Evaluation for Health Care Programs
. Burlington, MA: Jones & Bartlett Publishers.

Plunkett, J., (2017). 
Plunkett’s Health Care Industry Almanac 2018: Health Care Industry Market Research, Statistics, Trends and Leading Companies
. Houston, Texas: Plunkett Research, Ltd. Health Organization Evaluation Essay.

Diabetes/Endocrine-Advanced Pharm Nursing

Many patients, especially newly diagnosed patients, are prescribed medications that do not fit into the scheme of the ADA / AACE guidelines / best evidence based practices – for instance, starting on Januvia (sitagliptin) or Jardiance (empagliflozin) or Byetta (exenatide) as initial monotherapy. You know you’ve seen it happen.

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In this discussion, please talk about how patients get put on these medications and why/how they should be transitioned to more evidence based treatments.

Is it ok to start a patient on a drug (particularly an oral drug) other than metformin as an initial drug? Please cite possible circumstances where this could be reasonable. Diabetes/Endocrine-Advanced Pharm Nursing

What anti-diabetic medications have compelling evidence for use in select populations and is this benefit a ”class” effect?

(eg. SGLT2Is – Patients with type 2 diabetes and a high risk of cardiovascular disease had reduced risk of a cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke relative to those randomized to receive placebo)

How can patients and practitioners be convinced to change their behavior and opt for more evidence based approach to therapy? Diabetes/Endocrine-Advanced Pharm Nursing

In a 500-word teen suicide contemporary issue essay paper, discuss how teen suicide is a contemporary issue in todays teens. Include the following in your submission:

Describe the contemporary issue and explain what external stressors are associated with this issue.

1.Outline assessment strategies to screen for this issue and external stressors during an assessment for an adolescent patient. Describe what additional assessment questions you would need to ask and define the ethical parameters regarding what you can and cannot share with the parent or guardian. Teen suicide contemporary issue essay.

2.Discuss support options for adolescents encountering external stressors. Include specific support options for the contemporary issue you presented.

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

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This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion Teen suicide contemporary issue essay.

 

Assessing Suicide Ideation and External Stressors in Today’s Teens and Exploring the Available Support Options

Introduction

Suicide among teens is one of the contemporary mental health issues that are facing society today. In fact, according to Jameson et al. (2018) it is (together with homicide and accidents) one of the “leading causes of age-specific mortality” in teens 15 to 19 years old (p. 26) Teen suicide contemporary issue essay. There is a multiplicity of factors that drive teens to want to commit suicide. These are the external stressors operating within the teens’ socio-economic environment (Cincinnati Children’s Hospital Medical Centre, 2019). This essay briefly looks at how to assess for this issue, the environmental stress factors causing it, and support measures that are available.

Assessment Strategies and External Stressors for Teen Suicide

Suicidal ideation is not something that the clinician can see and recognize just by looking at a teenager. Therefore, in order to discover these teenagers with these suicidal ideas some sort of screening has to be in place. Currently, there are several screening tools available to the psychiatric-mental health nurse practitioner (PMHNP) for this task. Some of the most prominent and commonly used of these tools are the Suicidal Ideation Questionnaire, Suicide Behaviors Questionnaire, Columbia Suicide Severity Rating Scale, and the Patient Health Questionnaire (PHQ-9) amongst others (Conn et al., 2017). These screening tools are normally comprehensive enough to ascertain whether the patient is at significant risk of suicide or not. However, there are also other additional supplemental questions that the PMHNP can ask to solidify the findings. These aim at finding out suicidal tendencies – both current and past. Some of these questions are like: “Have you attempted to end your life before? Did you halt the attempt yourself or someone stopped you? Do you currently have any plan for committing suicide? Teen suicide contemporary issue essay. Have you ever attempted to utilise the method you intend to use now before? What do you think will be the result of your actions?” and so on (Conn et al., 2017). After the findings of these screening measures are obtained, there are some ethical parameters that govern disclosure of the information to the parents as these are usually mostly minors. Some of these bioethical principles are beneficence, nonmaleficence, and justice (Encyclopedia.com, 2016). Beneficence dictates that whatever we disclose to the teen’s parents must bring only good, while nonmaleficence says that the disclosure should not bring the teen any ‘harm’ (like being denied some favors by the parent). If the disclosure will help in preventing the teen from committing suicide (harm), it will also fall under nonmaleficence. Lastly, the principle of justice requires that the teen be treated fairly and be assisted to find inner peace.

Some of the external stress factors that may lead the teen to feel like committing suicide are the day-to-day socio-economic situations and tests in life. These include peer push to conform, pressure by parents to do well in school, dysfunction in the family like domestic violence or divorce, fiscal challenges at home, sexual abuse or molestation (like bullying) amongst others (Cincinnati Children’s Hospital Medical Centre, 2019). Teen suicide contemporary issue essay.

Support Alternatives Available for Teen Suicidal Ideation and Planning

           
There are several support avenues available for teens that suffer from suicidal ideation and planning. These include hotlines that one can call if they suspect a teen of being suicidal, or are suicidal themselves. A counsellor is normally on the other end to offer support. Others are group psychotherapy with teens with a similar problem. In group psychotherapy, the therapeutic factor of universality (knowing that they are not alone with the problem) is important. Then there are also resources for educating the family on how to cope (Conn et al., 2017). However, specific measures for teen suicide include existential counselling and Dialectical Behavior Training or DBT (Corey, 2017).

References

Cincinnati Children’s Hospital Medical Centre (2019).
Common pressures that can cause stress in teens
. Retrieved 4 September 2019 from
https://www.cincinnatichildrens.org/service/s/surviving-teens/stressors

Conn, B.M., Sherer, S. & Yohan, T. (2017).
Suicide risk and assessment among adolescents and young adults
.  Retrieved 4 September 2019 from Teen suicide contemporary issue essay

Corey, G. (2017).
Theory and practice of counselling and psychotherapy, 10
th
ed
. Boston, MA: Cengage Learning.

Encyclopedia.com (2016).
Principlism
. Retrieved from
https://www.encyclopedia.com/science/encyclopedias-almanacs-transcripts-and-maps/principlism

Jameson, J.L., Fauci, A.S., Kasper, D.L., Hauser, S.L., Longo, D.L., & Loscalzo, J. (Eds) (2018).
Harrison’s principles of internal medicine, 20
th
ed
. New York, NY: McGraw-Hill Education. Teen suicide contemporary issue essay