Tag: Clinical-Nursing

Anemia of chronic disease pathophysiology case study essay

Case Study #1

Mr. X is a 34y/o Hispanic male who presented to the emergency room for a fatigue, dyspnea and chest pain which started yesterday morning. He has been experiencing some nausea, vomiting, and reports that he is needs dialysis. He was diagnosed with chronic kidney disease 4 years ago and HIV 5 years ago. He is currently taking antiretroviral therapy for his HIV infection and reports compliance. He was last seen at a free clinic for his HIV care 2 weeks ago and does not know his current CD4 count or viral load. He has been receiving hemodialysis for 8 months and no longer produces urine. He was last dialyzed 5 days ago. His past medical history is significant for HIV, Chronic Kidney disease stage 5, Anemia, hypertension, pneumonia, hyperlipidemia

Past surgical history is positive for only a permacath (central venous access for dialysis access) placement 8 months ago.

Physical exam:

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Vitals: 38.1-97-18-183/139

Normocephalic.

Alert & Oriented x3. Well developed.

Eyes: PERL. No nystagmus

Neck: Supple, no cervical lymphadenopathy

Cardiovascular: Normal Rate and rhythm. No murmur, gallops. 2+/4+ radial, brachial, dorsalis pedis pulses bilaterally. 2+ pitting edema of bilateral lower extremities.

Pulmonary: Dyspneic. Lungs are clear anemia of chronic disease pathophysiology case study essay.

Abdomen: Soft and nontender, active bowel sounds. No peritoneal signs.

Skin: warm, dry and pale.

Rectal exam: stool is brown, no rectal masses

Lab Result

Sodium 133 mEq/L

Potassium 6.0 mEq/L

Creatinine 19.95 mg/dL

BUN 114 mg/dL

CO2 14 mEq/L

Anion gap 26 mEq/L

WBC 10,000

Hematocrit 25.4%

Hemoglobin 8.4 g/dL

MCV 85 fL

Platelets 154,000

Serum Iron 70 mcg/dL

Total Iron Binding Capacity 150 mcg/dL

Ferritin 450 ng/ml

Glucose 124 mg/dL

Questions

1. The clinical scenario is most consistent with which type of anemia? You may simply list your answer below using a bullet point format. This does not have to be in a complete sentence anemia of chronic disease pathophysiology case study essay. A citation is not required.

2. What specific data in the clinical scenario supports your diagnosis? You may simply list your answers below using bullet point format. This does not have to be in a complete sentence. A citation is not required.

3. What is the most likely cause of this patient’s anemia? You may simply list your answer below using a bullet point format. This does not have to be in a complete sentence. A citation is not required.

4. Describe the key pathophysiologic concepts of the diagnosis in question 1. To answer this question completely, you must answer all of the sub-questions below using complete sentences. Each sub-question may be answered in 1-6 sentences. ***Citations are required for each answer to each question using APA format.

a. What is the electron transport chain and how is it altered by anemia?

b. Why is the ferritin level 450 ng/ml?

c. What effects does anemia/low blood volume have on the cardiovascular system?

d. What are the effects of tissue hypoxia on the cardiovascular system, pulmonary system and CNS?

e. How does chronic kidney disease cause anemia? anemia of chronic disease pathophysiology case study essay

5. For what actual or potential complications related to the diagnosis in question 1 does he need to be monitored? You may simply list your answer below using a bullet point format. This does not have to be in a complete sentence. A citation is not required.

References:

McCance 2018

 

Advanced Pathophysiology: Anemia of Chronic Disease

Student’s Name

Institution of Affiliation

Course Name

Date

 

Question 1

The clinical scenario described is most consistent with Anemia of chronic disease secondary to infection with HIV and Chronic Kidney Disease (CKD). Since this type of anemia is multifactorial, diagnosis is only based on the presence of a condition that causes chronic inflammation such as cancer, an infection, kidney disease or an autoimmune condition anemia of chronic disease pathophysiology case study essay.

Question 2

The diagnosis of anemia of chronic disease is supported by the following clinical data:

Iron levels below the borderline

A low hematocrit and hemoglobin level

High levels of ferritin- ferritin is only released when there’s the need to make RBCs and is stored in the liver. However, when the erythropoietin to make RBCs is produced in small amounts, the amount of ferritin used is also less thus, its levels automatically increase. anemia of chronic disease pathophysiology case study essay.

The total binding capacity of iron is low-Total binding capacity is an indirect way of measuring transferrin. In this patient case scenario, although iron is present, it is not readily available for use hence the low levels.

A normal mean corpuscular volume which indicates that the Red Blood cells are of average size and normal

Question 3

The most likely cause for this patient’s anemia is a reduction in erythropoietin due to Chronic Kidney Disease. Diminished renal function influences a reduction in erythropoietin secretion which is vital for the production of erythrocytes. Besides, it is indicated that the patient no longer produces urine and this can result in the gradual accumulation of uremic toxins which shorten the lifespan of RBCs.

Question 4

What is the electron transport chain and how is it altered by anemia?

The electron transport chain is the step by step process of oxidation and reduction that facilitates the ATP process within a mitochondrion. It occurs in three major steps namely: glycolysis, Krebs cycle and electron transport. The process aims at promoting a concentration gradient through a surplus buildup of hydrogen ions between the membrane interspaces and the mitochondria matrix (McCance, 2019).  In the process, FADH and NADH transfer electrons to molecular oxygen influencing the release of hydrogen ions. Oxygen is a key requirement for this process to take place. Therefore, if not present, ATP cannot be formed. When anemia exists, low hemoglobin levels reduce the oxygen-carrying capacity and this generally reduces the electron transport chain anemia of chronic disease pathophysiology case study essay.

b. Why is the ferritin level 450 ng/ml?

Ferritin is a blood cell protein which contains and stores iron inside cells.  Ferritin is used in the formation of red blood cells. However, when the kidneys produce limited amounts of erythropoietin as it is in this patient case scenario, fewer amounts of ferritin are utilized. This leads to gradual accumulation within plasma hence the high levels (McCance, 2019).

What
effects does anemia/low blood volume have on the cardiovascular system?

Low blood volume creates a concentration gradient between intravascular space and the interstitial compartment. Blood becomes less viscous and fluid moves from the interstitial spaces to intravascular space. As a result, the heart rate and stroke volume increase leading to dilatation of the cardiac muscles, insufficiency of valves and heart murmurs (Zadrazil & Horak, 2015).  The most likely outcome is that of high-output heart failure/anemic heart failure.

What are the effects of tissue hypoxia on the cardiovascular system, pulmonary system, and CNS?

           
When tissue hypoxia sets in, blood vessels dilate causing a reduction in vascular resistance. This can lead to cardiac failure since both the heart rate and stroke volume increase in response. To ensure adequate oxygen supply to vital organs and tissues, the respiratory rate increases leading to dyspnea (Zadrazil & Horak, 2015). When there is diminished oxygen supply to the brain, lethargy and dizziness sets in.

e. How does chronic kidney disease cause anemia?

The major cause of anemia among patients with CKD (Chronic Kidney Disease) is limited erythropoietin production. Erythropoietin is a hormone that facilitates how red blood cells mature and differentiate. When there’s reduced erythropoietin production, the production of red blood cells also reduces which influences low hemoglobin levels and subsequent anemia (Zadrazil & Horak, 2015). Other factors that have proven to cause anemia in CKD include reduced iron levels available for erythropoiesis, inflammation and high levels of hepcidin which accounts for impaired absorption of dietary iron. Lastly, the gradual accumulation of uremic toxins due to impaired renal function shortens the half-life of red blood cells which ultimately causes anemia.

Question 5

CNS complications-delirium, dizziness and syncope

Cardiovascular complications- Anemic heart failure, Anasarca, Hypertension, Heart murmurs, and angina

Musculoskeletal complications- paresthesia as a result of poor perfusion to muscles and tissues

 

References

McCance, K.L. (2019). Cellular biology. In K.L. McCance & S.E. Huether (Eds).
Pathophysiology: The biologic basis for disease in adults and children
(pp 28). St. Louis, MO: Mosby Elsevier.

Zadrazil, J., & Horak, P. (2015). Pathophysiology of anemia in chronic kidney diseases: A review. 
Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub
, 
159
(2), 197-202 anemia of chronic disease pathophysiology case study essay.

NSG 6020 Week 1 Discussion HISTORY collection

Discussion Question 1

Based on your performance and the expert feedback in your 
HISTORY
 collection, describe two missed questions and your understanding of why they were important to collect for this case history. Use specific references from your text to explain.

This week’s case study was quite insightful for me.  There were definitely several questions that I regretfully missed the opportunity to ask my patient.  One question I should have asked Rachael was “Do you have any swollen lymph nodes?” Breast cancer can spread to lymph nodes, so her lymph nodes might be affected. “Malignant cells from a breast cancer may spread directly to the infraclavicular nodes or into the internal mammary chain of lymph nodes within the chest” (Bates, Szilagyi, & Hoffman, 2017, p. 422). Another question I should have asked was “Is the lump movable?” as lumps that are movable are often benign. “Hard irregular poorly circumscribed nodules, fixed to the skin or underlying tissues, strongly suggest cancer” (Bates, Szilagyi, & Hoffman, 2017, p. 438). NSG 6020 Week 1 Discussion HISTORY collection

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Discussion Question 2

Based on your performance and the expert feedback in your 
PHYSICAL EXAM
 collection, describe two errors in your exam performance or documentation. Use specific references from your text to explain the importance of these findings in correct assessment of this client.

In my assessment of Rachael, I failed to note the consistency of the lumps in her breast.  It is important to note the consistency of any lumps and determine if they are soft, firm, or hard (Bates, et al., 2017).   I also failed to note delimitation. NSG 6020 Week 1 Discussion HISTORY collection Delimitation is describing the boundaries of the lumps.  Noting whether the lumps are well circumscribed or not is another important detail in the breast assessment.  “Assess and describe the characteristics of any nodule: location, size, shape, consistency, delimitation, tenderness, and mobility” (Bates, et al., 2017, p. 438).

Discussion Question 3

Based on your performance on the 
PHYSICAL EXAM
collection, describe one key finding that you included in your list and describe a specific physical exam that you can perform at the point-of-care to further evaluate the finding. Use specific references from your text. NSG 6020 Week 1 Discussion HISTORY collection.

One key finding in my physical assessment was a one centimeter right axillary lymph node that was firm but mobile.  To further evaluate this finding, I can completely examine the axillary area.  The text explains exactly how to examine for lymph nodes: “To examine the left axilla, ask the patient to relax with the left arm down and warn the patient that the examination may be uncomfortable. Support the patient’s left wrist or hand with your left hand. Cup together the fingers of your right hand and reach as high as you can toward the apex of the axilla. Place your fingers directly behind the pectoral muscles, pointing toward the midclavicle. Now press your fingers in toward the chest wall and slide them downward, trying to palpate the central nodes against the chest wall. Of the axillary nodes, the central nodes are most likely to be palpable. One or more soft, small (<1 cm), nontender nodes are frequently felt” (Bates, et al., p. 440). If any of the centrally located nodes are large, tender, or hard, or if there is a concerning lesion in the axillary nodes drainage areas, palpate for the other groups of axillary lymph nodes in the pectoral, lateral, and subscapular nodes, as well as re-examine the infraclavicular and supraclavicular nodes (Bates, et al., p. 441.) NSG 6020 Week 1 Discussion HISTORY collection Discussion Question 4 Based on your performance and the expert feedback in your  ASSESSMENT  identification of problem categories, choose one missed/incorrect category and use specific references from your text to explain the importance of this category in arriving at correct differential diagnoses for this client. A missed category that I missed was the unintentional weight loss experienced by Rachael.  Malignancy is linked to unexplained weight loss Gannavarapu, et al., 2018).  Unintentional weight loss should therefore always be investigated further.  As this patient has hypothyroidism, which is generally associated with weight gain, rather than weight loss, this weight loss is of even greater concern. NSG 6020 Week 1 Discussion HISTORY collection. Discussion Question 5 Based on your performance and the expert feedback in your  ASSESSMENT  of differential diagnoses, describe one incorrect/missed differential diagnosis and use specific references from your text to support the inclusion of the diagnosis for this client One diagnosis I missed was fat necrosis.  Upon exam, if breast dimpling or retraction is seen, this suggests underlying cancer.  Cancer can cause fibrous strands to be attached to the skin and fascia which lie over the pectoral muscles.  This may cause dimpling inward of the skin during contraction of the muscle.  Sometimes, this sign may signify a benign condition such as fat necrosis, but it should always be evaluated further to be sure (Bates, et al., 2014, p. 436.) NSG 6020 Week 1 Discussion HISTORY collection.   Discussion 2 Discussion Question 1 Based on your performance and the expert feedback in your HISTORY collection, describe two missed questions and your understanding of why they were important to collect for this case history. Use specific references from your text to explain. The first question I missed was does your breast problem come and go? To assist a patient in describing a complaint, a nurse practitioner must know how to ask salient and focused questions to draw out necessary information. It is important to know the particular symptoms that  brought the patient to seek medical help. The second question I missed was when did the problems of your breast start? It is important to ask this history question because identifying when the problem first started and  how it has changed or progressed since the onset helps in the assessment, evaluation and diagnosis process. NSG 6020 Week 1 Discussion HISTORY collection. Discussion Question 2 Based on your performance and the expert feedback in your PHYSICAL EXAM collection, describe two errors in your exam performance or documentation. Use specific references from your text to explain the importance of these findings incorrect assessment of this client. My first error was I did not auscultate required respiratory locations, which would have better identified the patient’s lung pathology. Auscultating the lungs for adventitious sounds, particularly crackles at the bases, which might indicate heart failure while other adventitious sounds could indicate a respiratory rather than cardiac cause. NSG 6020 Week 1 Discussion HISTORY collection. My second error was I did not auscultate lung in the correct order. To get a correct assessment of a patient lung field auscultation needs to be done in the correct order because breath sounds vary in intensity, volume and duration depending from each base of the lung to another. Discussion Question 3 Based on your performance on the PHYSICAL EXAM collection, describe one key finding that you included in your list and describe a specific physical exam that you can perform at the point-of-care to further evaluate the finding. Use specific references from your text. One key finding is breast lumps found in the right breast through breast examination of the patient. This is a physical exam I will perform at the point of care. Discussion Question 4 Based on your performance and the expert feedback in your ASSESSMENT identification of problem categories, choose one missed/incorrect category and use specific references from your text to explain the importance of this category in arriving at correct differential diagnoses for this client. One missed category in my assessment was breast mass/lump, neoplastic. In Rachael’s case, the presence of multiple masses excludes nearly all other diagnoses, Rachael’s family history, and the presence of an axillary lymph node is a must-not-miss NSG 6020 Week 1 Discussion HISTORY collection. It is important to arrive at the correct differential diagnoses for this client because this client’s history meets specific criteria for being  high risk for breast cancer which includes of her age, family history, (first degree relative with breast cancer), personal history (history of ductal hyperplasia), present history, and surgical history (breast biopsy) (16, Goolsby, Grubbs, 2015). Discussion Question 5 Based on your performance and the expert feedback in your ASSESSMENT of differential diagnoses, describe one incorrect/missed differential diagnosis and use specific references from your text to support the inclusion of the diagnosis for this client. Breast abscess was of the one incorrect diagnosis. It contradicts the fact that Rachael experienced no pain and suffered no trauma also with the breast examination. NSG 6020 Week 1 Discussion HISTORY collection Rachael had no pain, breasts were not red, or warm to touch, and breasts had no swelling, which are general symptoms of breast abscess. The patient also did not have a high temperature or feel unwell. Although any breast mass should be carefully evaluated and usually warrants further testing like biopsy and mammogram (17 Bickley, 2016). NSG 6020 Week 1 Discussion HISTORY collection

Part A

In the first part of this discussion, you are encouraged to think about the language used by both professionals and lay people to refer to individuals with substance use disorders.

Terms like “drunk”, ”junkie”, ”pot head’ and “coke head” may seem obviously derogatory. But what do you think about referring to people as “addicts” or “alcoholics”?

What do you think is the impact of labeling someone as a ”addict, alcoholic, substance-user, or abuser” as opposed to referring to them as ”a person with a substance use disorder”? substance use disorder essay

How might differences in language to to refer to people with substance use disorder, impact how we think about our patients?

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How might these differences in language impact how patients view and think about themselves and how they participate in treatment?

Part B

Next, using what you have learned in the module lectures and in the video, please address the following questions:

Discuss the importance of having a thorough patient assessment (also called a psychosocial assessment or psychosocial history) prior to beginning substance use disorder treatment.

What are some common barriers or obstacles you might expect when attempting to complete an assessment?

What are potential strengths and drawbacks of using one or more validated screening tools as part of the assessment process? substance use disorder essay

While some prefer an open-ended interview approach, what are the advantages of a structured assessment approach?

How does the assessment of a patient connect to the level of care, interventions and counseling methods the counselor chooses?

 

Terminology, screening and assessment

Part A

Question 1.

Although referring to people as addicts and alcoholics is not derogatory, the use of these terms is still discouraged since they inadvertently stigmatize the people who have addictive behaviors since it presents the notion that they are personally culpable for the condition and deserve punishment. In fact, these terms are pejorative. As stigmatizing and pejorative terms, they affect the behavior and perceptions of medical personnel, patients, their family members and the rest of the community. Instead, the individuals with these conditions should be described using the clinical condition and test results. To be more precise, alcoholics should be referred to as persons with alcohol use disorder and addicts should be referred to as persons with substance use disorder (Kelly, Wakeman & Saitz, 2015).

Question 2.

As earlier indicated, labeling someone as an addict, alcoholic, substance-user or abuse stigmatizes the individual since it presents the notion that the individual is personally culpable for the condition and deserves punishment. Referring to the person as a substance abuser or individual with substance use disorder creates the perception that the individual is a victim deserving of respect and care, rather than blame and punishment (Kelly, Wakeman & Saitz, 2015).

Question 3.

The language used to refer to persons with substance use disorder has an impact on how we think about the patient. That is because they affect our behavior and perception. For instance, the use of derogatory and stigmatizing terms creates the notion that the individual made the informed personal choice to have the condition and should be blamed and punished. On the other hand, substance use disorder is a term that would invoke sympathy, showing that the individual should neither be blamed nor punished for having the disorder. As such, the terms used to refer to the individuals with the disorder determine whether they will be blamed or accepted by other stakeholders (Kelly, Wakeman & Saitz, 2015) substance use disorder essay.

Question 4.

The terminologies have an effect on how patient perceive themselves and behave. The use of derogatory and stigmatizing terms reduces the patients’ self-worth and makes them less receptive to treatment since they would consider the condition as a deserved punishment for past vices. In contrast, the use of non-derogatory and non-stigmatizing terms improve the patients’ self-worth, making them feel that they deserve treatment and care. This makes them receptive to treatment as they feel that the condition is an unfortunate incidence that can be corrected through faithfully adhering to the treatment regime (Kelly, Wakeman & Saitz, 2015).

Part B

Question 1.

A thorough patient assessment prior to treatment beginning is important since it serves three functions. Firstly, it determines whether the patient can withstand the stresses of the selected treatment plan or if it is necessary to adopt an alternative treatment approach. This is based on the risk assessment results. Secondly, it determines if it is necessary to modify the treatment plan based on the presented physicals, history and classification system. Thirdly, it determines if the patients require supplementary treatment based on other presenting conditions and how they would affect the treatment plan (Wheeler, 2014) substance use disorder essay.

Question 2.

There are five common barriers to completing an assessment. The first barrier is reliance on technology, other medical personnel and other resources such that their absence hinders the assessment. The second barrier is lack of time and interruptions that make it difficult to conduct a comprehensive assessment. The third barrier is facility/hospital culture that presents policies and standards that could hinder efforts to collect some information. The fourth barrier is lack of confidence that hinders medical personnel from conducting assessments. The final barrier is specialty area that limits medical personnel to conducting assessment in areas in which they specialize (Wheeler, 2014).

Question 3.

Validated screening tools used in assessment processes have some strengths and weaknesses. The strengths of these screening tools include ability to assess several areas, availability in different versions and languages, sensitivity for the targeted condition, and ease of administration. The drawbacks include interpretation complexity as patient demographics (cultural background, education and age) affect scores, inability to detect subtle effects, non-comprehensive approach that ignores potentially important information, and having a narrow scope that does not allow for non-classic cases to be assessed (Wheeler, 2014).

Question 4.

Structured assessment approaches offer some advantages. Firstly, they improve the relevance of the collected information, especially when they use algorithms and prompts. Secondly, they reduce the incidence of missed information. Thirdly, they improve the quality and completeness of clinical documentation. Fourthly, they improve communication between patients and medical personnel substance use disorder essay. Fifthly, they improve implementation of care. Sixthly, they act as real-time visualization tools that provide clarity to the case. Finally, they bring the patient into the discussion early thereby improving the value and quality of the collected information (Wheeler, 2014).

Question 5.

The assessment of a patient is linked to the level of care, intervention and counseling methods chosen. This occurs through evidence-based protocols and guidelines that improve and standardize care by employing guidelines for care that are adapted to meet the unique needs of each case. In fact, the results of the assessment act as input for personalizing the evidence-based care guidelines for each case (Wheeler, 2014). substance use disorder essay

 

 

References

Kelly, J., Wakeman, S. & Saitz, R. (2015). Stop talking ‘dirty’: Clinicians, language, and quality of care for the leading cause of preventable death in the United States.
American Journal of Medicine
, 128, 8–9.

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

ihuman HISTORY collection discussion

Discussion Question 1

Based on your performance and the expert feedback in your 
HISTORY
collection, describe two missed questions and your understanding of why they were important to collect for this case history. Use specific references from your text to explain ihuman HISTORY collection discussion.

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One of the questions that I did not ask was, “Does she have any pain anywhere? If so where?” I guess I did not ask this because I assumed the patient wouldn’t be able to verbalize if she were having pain. The mother’s response was “I think she is having pain because she has been fussy, but she can’t tell me where.” I did ask if the patient had been tugging at her hears though. I should have asked this question to the mother and also used the FLACC scale and compare the patient’s facial expression. FLACC scale, for children aged two to seven, assesses a child’s pain based on their facial expression, leg and arm movements, the extent of crying and ability to be consoled (Sickkids Staff, 2009). I also did not ask if the patient was having discharge or bleeding from her ears. Buttaro, Trybulski, Polgar-Bailey, and Sandberg-Cook explain, “Discharge in the canal without acute otitis externa suggests perforation” (p. 374). Purulent discharge in the ear canal may be sampled for culture and used as a basis for antibiotic selection (Buttaro, Trybulski, Polgar-Bailey, and Sandberg-Cook, p. 374). This would be important information to have. The drainage would be beneficial to test for sensitivity especially if the ear infection were recurrent.

Discussion Question 2

Based on your performance and the expert feedback in your 
PHYSICAL EXAM
 collection, describe two errors in your exam performance or documentation. Use specific references from your text to explain the importance of these findings in correct assessment of this client.

 

An error in the physical exam I made was inspecting the eyes with an ophthalmoscope. I should have only assessed the eyes by looking at the conjunctiva to assess hydration. I would not use the ophthalmoscope on a 2-year-old because it would not be necessary for this patient and she would probably not sit still. If it were more serious to assess her eyes I would. Using the ophthalmoscope to visualize the fundus is one of the most challenging skills of physical examination, and one of the most critical when assessing head-ache and changes in mental status (Bickley, p. 238). The other physical examination that I missed was a visual inspection of the chest wall and lungs. Since the patient is having a cough, fever, and runny nose and diagnosis of upper respiratory infection is on my radar I should have chosen this exam in order to assess for retractions. If retractions are present then the patient is working to breathe and maybe in respiratory distress. Abnormal muscle retraction of the intercostal spaces occurs during inspiration, most visible in the lower intercostal spaces (Bickley, p. 319) ihuman HISTORY collection discussion.

Discussion Question 3

Based on your performance on the 
PHYSICAL EXAM
 collection, describe one key finding that you included in your list and describe a specific physical exam that you can perform at the point-of-care to further evaluate the finding. Use specific references from your text.

 

One key finding that I found was bilateral tympanic membranes with erythema and severe bulging. I visualized this by using the otoscope. The otoscope allows you to visualize the ear canal and drum (Bickley, p. 245). I will start by positioning the patient’s head so that I can see comfortably through the otoscope (Bickley, p. 245). Bickley explains how to inspect the ear using an otoscope as,

“First straighten the ear canal, grasp the auricle firmly but gently and pull it upward, backward, and slightly away from the head. Insert the speculum gently into the ear canal, directing it somewhat down and forward and through the hairs, if any. Inspect the ear canal, noting any discharge, foreign bodies, redness of the skin, or swelling. Cerumen, which varies in color and consistency from yellow and flaky to brown and sticky or even too dark and hard, may wholly or partly obscure your view. Identify the handle of the malleus, noting its position, and inspect the short process of the malleus. Gently move the speculum so that you can see as much of the drum as possible, including the pars flaccida superiorly and the margins of the pars tensa. Look for any perforations.” (p. 245-246).ihuman HISTORY collection discussion

Discussion Question 4

Based on your performance and the expert feedback in your 
ASSESSMENT
 identification of problem categories, choose one missed/incorrect category and use specific references from your text to explain the importance of this category in arriving at correct differential diagnoses for this client.

 

One of the problem statements that I did not include in my list is the patient being exposed to other sick children at school and a history of the common cold. The presence of sinus and nasal congestion is relevant because otitis media is typically secondary to a cold or sinus infection (Goolsby and Grubbs, p. 131). Signs and symptoms of otitis media commonly are a current or recent history of symptoms consistent with an upper respiratory infection, including nasal congestion, sinus pressure/fullness, or sore throat (Goolsby and Grubbs, p. 132). The patient has symptoms of fever, cough, and runny nose. Upon physical inspection, the patient’s pharynx noted to have erythema and exudate.

Discussion Question 5

Based on your performance and the expert feedback in your 
ASSESSMENT 
of differential diagnoses, describe one incorrect/missed differential diagnosis and use specific references from your text to support the inclusion of the diagnosis for this client.

 

One of the diagnoses that I did not consider was influenza. I am not sure why I didn’t include this in my differential diagnosis list. Maybe if the scenario stated which time of year it was I would have considered it. Buttaro, Trybulski, Polgar-Bailey, and Sandberg-Cook explain,

“Influenza is an acute infection of the respiratory tract caused by influenza virus type A or B. It is usually a self-limited disease that occurs in outbreaks, primarily during the winter months. Influenza is transmitted from person to person through respiratory secretions that contain the virus. These respiratory secretions are spread in the form of droplets that are produced when a person talks, coughs, or sneezes. The virus is detectable and maybe shed in respiratory secretions up to 24 hours before the onset of symptoms. After an incubation period of 1 or 2 days, there is an abrupt onset of symptoms. These symptoms include fever, chills, headache, malaise, myalgia, and loss of appetite. Respiratory symptoms are also present but are usually overshadowed by the severity of the systemic symptoms. Respiratory symptoms include dry cough, nasal congestion with clear discharge, and sore throat. The cough is usually the most prominent of these respiratory symptoms. The patient’s temperature rises rapidly after onset, peaking at 37.7° C to 40° C (100° F to 104° F) in about 12 hours. The fever typically begins to decline on the second or third day but may last as long as 4 to 8 days” (p. 1241).

 

 

Discussion 2

 

Discussion Question 1

(In this week two assignment, I am still figuring out how to navigate iHuman.  The program completely froze up on me after nearly completing it, twice.  It also reported several questions as “missed”, even though I had asked those questions to this patient’s mother.  I am hoping to soon work out the kinks in iHuman and hopefully will not continue to have these difficulties in the coming weeks.)

One of my missed history questions was “How high is her fever?”  I did ask Emma’s mother if she had a fever but failed to ask how high her fever had spiked.  This is important to know as a health care provider, as a low-grade fever and a high fever can dictate very different plans of care (Goolsby & Grubbs, 2015).  Another question I failed to ask was “What treatments has she had for her fever?”  When her mother informed me that she had given Emma Tylenol, I assumed that she had given her Tylenol for her fever, but I should not have assumed this, and should have followed up on the timing and dosage of the Tylenol, as well as the reasoning behind why she had given the Tylenol.  In addition, I should have asked what Emma’s response to the Tylenol was, and whether her fever had responded to it.

Discussion Question 2

The two missed exams reported were eyes and chest wall and lungs- visual inspection.  It is important to check for conjunctivitis in any child with upper respiratory infection symptoms.  It is also important to check for the use of accessory muscle use when breathing in a child with upper respiratory infection symptoms (Bickley, Szilagyi, & Hoffman, 2017).  (Again, I did perform this exam, but must have done something wrong for it to not have registered on iHuman).

Discussion Question 3

One key finding I included was cough.  According to Goolsby and Grubbs (2014), a cough is common complaint, but nonspecific in nature.  A cough is an important defense mechanism and is often the reason why patients seek treatment.  Cough can be a symptom of a mild or serious ailment (Goolsby and Grubbs, 2014).  When a cough lasts less than three weeks, it is classified as acute.  If it lasts three to eight weeks, it is classified as subacute.  A chronic cough lasts eight weeks or longer.  These classifications help to distinguish potential diagnoses.  Performing a thorough history and physical helps to determine possible causes and differentiate between severe illnesses and mild illnesses, such as asthma, COPD, acute or chronic bronchitis, GERD, heart failure, or lower or upper respiratory infections (Goolsby and Grubbs, 2014, p. 211-212).  Taking a thorough medication history will help to exclude a cough that is induced by an ACE inhibitor.  The patient’s prior treatment for cough, whether prescribed or self-treated, should also be recorded.

Discussion Question 4

One missing category in my assessment was an influenza PCR.  I did send a rapid influenza diagnostic test, but I should have also sent an influenza PCR.  An influenza PCR can be more specific than a rapid influenza test and so should have been done.

Discussion Question 5

            
I did not include the possible diagnosis of pertussis.  Pertussis is a cough that is paroxysmal with a “whoop” at the end (Bickley, et al., 2017, p. 923). Due to the increase in pertussis infections, both the CDC and ACOG recommend that women receive the TDaP during pregnancy, between the 27
th
 and 36
th
weeks (Bickley, et al., 2017, p. 937).

Advanced Practice Nursing Role Development Essay

Assignment 1

​​​ Interview Assignment (20 points)

Interview Guide

• The purpose of this assignment is to explore the role of the advanced professional nurse in depth as she /he functions in the context of the institution in which he/she is employed. Compare and contrast the observed /evaluated role to that cited in professional guidelines, theory, and research.

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• Guidelines:

a. Develop an Interview Guide with 10 questions, which reflect the topics reviewed in the course such as: professional expectations, health policy, reimbursement, professional role history, theoretical foundations of research and EBP, ethics in healthcare, leadership, interprofessional collaboration, and/or any other relevant issues that affect the professional role Advanced Practice Nursing Role Development Essay.

b. Using the developed interview guide, schedule an interview with an advanced professional nurse to learn about their role within the health care system. Please include the interview questions in your paper (see APA 6th ed. for guidelines to writing an interview). Prior to the interview, review the mission, vision, and goals of this agency. Does this professional nurse carry out the mission, vision, and goal of the agency and how?

This paper should be 5 pages and NO MORE than 5 pages (excluding title page, abstract, and reference page) and include. Advanced Practice Nursing Role Development Essay.

• Title page

• Abstract

• Introduction

• Interview (include questions)

• Conclusion

• Reference page (minimum of 4 references, excluding your text)

APA 6th ed. is the required format, double-spaced, 12 point font.

 

Abstract

The advanced practice registered nurse has become an important cornerstone in the provision of primary health care in the country. They bridge a very important gap between the physician and the disadvantaged in the society. In a country where health care is one of the most expensive commodities, the APRN has an important role to play in ensuring affordable universal health coverage for all Advanced Practice Nursing Role Development Essay. To achieve this, the advanced practice nurse has very well defined professional roles that fit in well with this objective of primary health care for all. Unfortunately, in the quest to exercise their designated roles the APRNs find themselves facing resistance and limitations both from the system and the healthcare fraternity itself. These frustrations and hindrances are the factors that are threatening to derail the noble objective of having advanced practice nurses, as had been envisioned by the pioneers of the discipline in 1965.

Key words: advanced practice nurse, APRN roles, interview.

The Roles of the Advanced Practice Registered Nurse (APRN) According to Professional Guidelines As Opposed to the Reality on the Ground: An Interview with Lauren O’Connor, PhD, ARNP, ANP-BC

Introduction

The title of APRN refers to a nurse who has undergone extensive advanced training and education at the postgraduate level with at least a masters degree in their specialty. This nurse is registered, certified, and licensed to practice by the state in which they are practicing. The high level of training and education equips the APRN with all the necessary skills to offer the highest level of clinical care to the patient. However, this is an inclusive term that encompasses the different role specialties of the APRN, viz. the certified nurse midwife (CNM), the clinical nurse specialist (CNS), the certified nurse practitioner (CNP), and the certified registered nurse anaesthetist or CRNA (DeNisco & Barker, 2014). Because of their training, the APRN possesses the competence to independently evaluate, diagnose, order and interpret laboratory and non-laboratory tests, treat, and follow up patients. This is what the APRN is trained and qualified to do. However, the situation on the ground is more often than not dissimilar to the picture painted above. Some serious limitations still exist and which hinder and impede the APRN from practicing to the full extent of their abilities and education. These issues are largely to do with recognition and acceptance by the state healthcare system and physician cadres, reimbursement or payment for services rendered, and prescriptive independence (Gordon et al., 2012; DeNisco & Barker, 2014). The first training program for nurse practitioners aiming at equipping them with primary health care skills was in 1965. It was a certificate course. By 1970, tremendous progress had been made such that the course was now being offered as a bachelors and masters degree (Hain & Fleck, 2014) Advanced Practice Nursing Role Development Essay.

The National Council of State Boards of Nursing (NCSBN) APRN Advisory Committee and the APRN Consensus Work Group have outlined the roles of the advanced practice nurse in the
Consensus Model for APRN regulation
, which is a policy guideline (DeNisco & Barker, 2014). These roles are four and they flow from the four designations of the APRN as stated previously. Thus the APRN serves the clinical nurse specialist role, the nurse anaesthetist role, the nurse-midwife role, and the nurse practitioner role. Other roles of the advanced practice nurse have also emerged with the passage of time and include the clinical nurse leader role and the nurse educator role (DeNisco & Barker, 2014). According to the American Nurses Association (ANA, n.d.), though, these four broad APRN roles can be spread out into finer specific roles as follows:

Evaluation, diagnosis, treatment, and follow up of patients at the primary health care level;

Provision of reproductive health care, especially to vulnerable women in ethnic minorities and immigrant populations;

Provision of expert nursing advice and guidance to bedside nurses on the best evidence-based practices (EBPs);

Implementation of pain management and delivery of sufficient and appropriate anaesthesia (nurse anaesthetists) for patients undergoing surgery;

Engaging in continuous knowledge acquisition and development for the betterment of the nursing profession;

Provision of preventive care and promotion of health. Advanced Practice Nursing Role Development Essay.

The APRN also acts as a valuable team member in the health care chain, working in close collaboration with physicians and other clinicians while referring difficult cases as appropriate. This paper looks at the practical discrepancies that are currently present  in terms of what the guidelines indicate are the roles of the APRN and what happens in reality. The views of an experienced and practicing APRN will be sought through interview questions concerning this pertinent matter of professional roles.

Interview

It is not easy to get the real picture of the challenges and limitations that APRNs experience on their role in practice by merely reading literature. For this reason, an interview was found to be one of the most effective ways to get primary unadulterated information on the subject. This was to get a feel of the actual role of the APRN in practice and the factors that impact this role. The telephone interview was scheduled with a practicing APRN. Lauren O’Connor [PhD, ARNP, ANP-BC] is a nurse practitioner who has been practicing the profession for 15 years. She teaches at the university and is an associate professor who has published several hard-hitting peer-reviewed journal articles and opinion pieces. Her pet subjects are full practice authority (FPA) for APRNs, equitable reimbursement for APRNs by payers, and admission rights for nurse practitioners in hospitals. Because of her wide expertise and experience, she is the most suitable person to respond to the questions that touch on the advanced practice nursing role. The vision of her agency is “To be the state leader in the provision of holistic primary health care to marginalised communities and minority groups.” Its vision is “To significantly reduce the prevalence of non-communicable diseases and conditions together with mental health issues like depression in the target population.” And its goal is “To achieve sustainable and affordable primary health care for ethnic minorities and marginalised communities in the catchment area by the year 2025.”

I started by asking Lauren, “What are some of the professional expectations that you would advise the new APRN to look forward to?” She answered that the new entrants should expect a fulfilling and rewarding career that will give them an opportunity to exercise their talents and put to practice their education. However, she cautioned that the advanced practice nurse should expect to find some hurdles here and there; and that it is important for them to anticipate these hurdles so as not to be disillusioned. She went ahead to single out what she termed as the “most challenging” obstacle to the APRN’s role – the lack of recognition of the nurse practitioner in some quarters. Next I asked Dr. Lauren, “Considering the history of the APRN’s professional role, do you think a lot has changed up to the present for the better?” she responded that: Advanced Practice Nursing Role Development Essay.

Since 1965 when the first certificate course for nurse practitioners was started by Loretta Ford and Henry Silver, a lot of water has passed under the bridge. The contemporary APRN is a highly educated health professional capable of managing even the most challenging of ailments. Certainly, the APRN’s role has expanded since then. (L. O’Connor, personal communication, September 12, 2019).

I next asked Dr. Lauren, “What is your view on the professional relationship between APRNs and physicians as at present?” Her answer was that most physicians are working “seamlessly” with advanced practice nurses. However, she noted that there is still a sizeable number of practicing physicians that do not properly understand the role of the APRN. These physicians are the ones frustrating the professional efforts of the nurse practitioners, according to Dr. Lauren. In fact, she says that some of them have gone as far as using their professional bodies to lobby against granting of full practice authority to APRNs in some the states that are still restrictive. Next I asked her, “How bad is the question of selective reimbursement by payers towards APRNs – especially the Centres for Medicare and Medicaid Services or CMS?” Her answer was:

It is quite bad, although slow progress is being made. Many advanced nurse practitioners still have to bill ‘incident-to’ physicians’ services. This means their contribution to the healthcare system remains hidden. Furthermore, their income is reduced as they have to pay the physician whose name they use to bill. (L. O’Connor, personal communication, September 12, 2019).

On health policy I asked her, “Is the federal health policy adequate to empower APRNs, given that the Affordable Health Care Act of 2010 relies on them for the increased primary health care burden?” to this question, her response was straight forward: “No. It is not adequate. What makes it even more ineffective in my opinion are the disparate legislations and regulations of different states that at times do not align with the aspirations of the federal government” (L. O’Connor, personal communication, September 12, 2019). On practice philosophy, I asked Dr. Lauren “Are the current APRNs basing their interventions on the theoretical framework of research and evidence-based practice or EBP?” Her response was simply “Yes. EBP is nowadays the cornerstone of all interventions and therapies.” I then asked her, “Do you feel that you’re sufficiently involved in championing the mission, vision, and goals of the agency that you work for, and how?” Her response was:

Of course. I do this my adopting a Total Quality Management or TQM philosophy. This means I strive to reduce “defects” in my APRN practice to the very minimum. These defects include issues like misdiagnosis, unwarranted prescription of scheduled drugs, and lack of respect for the ethical principle of autonomy. L. O’Connor, personal communication, September 12, 2019) Advanced Practice Nursing Role Development Essay.

The last 3 questions I asked her were, “How are APRNs agents of change in a country of expensive healthcare, with regard to ethics?” “What is the place of APRNs in healthcare leadership?” and “To what extent are APRNs vulnerable to malpractice suits?” Her answers: “APRNs are guided by nonmaleficence; leadership is one of their roles; and they are very vulnerable to suits hence must take individual indemnity cover for the same.”

Conclusion

APRN roles are defined by professional scopes of practice and guidelines. However, there still exists hindering limitations to the full expression of these roles.

References

American Nurses Association [ANA] (n.d.).
Advanced practice registered nurse (APRN): APRNs practice specialty roles
. Retrieved 12 September 2019 from
https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/aprn/

Bloom, L. (2018).
How to write an interview in APA format
. Retrieved 12 September 2019 from
https://work.chron.com/write-interview-apa-format-6612.html

DeNisco, S. & Barker, A. (2014).
Introduction to the role of advanced practice nursing
. Retrieved 12 September 2019 from bit.ly/2mbdGwR

Gordon, J.M., Lorilla, J.D. & Lehman, C.A. (2012). The role of the clinical nurse specialist in the future of health care in the United States.
Perioperative Nursing Clinics
, 7, p. 343-353. Doi: 10.16/j.cpen.2012.06.006

Hain, D. & Fleck L.M. (2014). Barriers to NP practice that impact healthcare redesign.
The Online Journal of Issues in Nursing, OJIN
, 19(2). Doi: 10.3912/OJIN.Vol19No02Man02 Advanced Practice Nursing Role Development Essay

Developmental Assessment and the School-Aged Child

Developmental Assessment and the School-Aged Child sample essay

The needs of the pediatric patient differ depending on age, as do the stages of development and the expected assessment findings for each stage. In a 500-750-word paper, examine the needs of a school-aged child between the ages of 5 and 12 years old and discuss the following:

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Compare the physical assessments among school-aged children. Describe how you would modify assessment techniques to match the age and developmental stage of the child.

Choose a child between the ages of 5 and 12 years old. Identify the age of the child and describe the typical developmental stages of children that age.

Applying developmental theory based on Erickson, Piaget, or Kohlberg, explain how you would developmentally assess the child. Include how you would offer explanations during the assessment, strategies you would use to gain cooperation, and potential findings from the assessment.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. Developmental Assessment and the School-Aged Child sample essay.

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

 

Child Developmental Assessment

Child development assessment is the processes of obtaining basic data about their growth and development. The essential aspect of the data being collected include cognitive, language, physically/motor, social-emotional and approaches to learning. Thus, while collecting the information the assessor aims at gaining a record growth in all the areas. Other than growth monitoring, child assessment is also essential in identifying children with special needs that may require extra support (Kaufman, 2018). When the thorough examination is conducted, the assessor identifies a specific need which is vital in determining the interventions required to support the child. Child evaluation also allows the assessor to develop an individualized strategy for a child or group of them in the same age that he/she will use to provide care. Furthermore, the process of assessment involves the parents or guardians of the child thus, developing common ground between the care provider and the parents for providing child support. Thus, Child development assessment cannot be overemphasized.

Human needs vary with age; hence data obtained is different at each age. Also, the mode of assessment used is dynamic. For instance, a 5-year old more of the information obtained is from the parent or the caregiver, unlike the twelve-year-old who can express themselves coherently. Observation is one of the techniques used in the assessment where the care provider gets to interact with the child and draws a conclusion based on their conduct. The other methods include parent ratings, care providers rating, portfolios, and standardized test. However, all the methods are best applicable for different ages. In some situations, there is a need to modify the techniques, for example, reading out the questions on a standardized test for a five-year-old and writing answers for them. The same approach when used on a twelve-year-old they are left to read, interpret and even answer the questions on the test with minimal assistance. Developmental Assessment and the School-Aged Child sample essay.

Ten-year-old Ray was born at 37 weeks with 2600grams via SVD and was NBU for two weeks due to birth asphyxia. He had gained 400grams by the time he was leaving the NBU. Ray was breastfed exclusively for the first 6 months and was weaned with different soft foods gradually. The child could roll over at 4 months and began sitting down at 6. Ray was hospitalized for severe malnutrition for a month while he was 9 months. According to the mother, that delayed his milestone and he only crawled when he was 16 months. The child started walking without support at 19 months. Ray could say four-letter words “mama” and “tata” at 6 months and at 24 months he could say complete simple sentences. He relates well with all other members of the family apart from his elder brother who according to the mother does not give Ray or other children the attention they want. Developmental Assessment and the School-Aged Child sample essay. The child joined a school at 4 years and his performance is average. He is an obedient boy loved by the teacher and other students at school.

Erik Erikson a psychologist classified human development into 8 stages. Ray fits in the 4th stage known as Industry vs. Inferiority which has children between 5-12 years. According to Erik, the basic virtue at this stage is competency (Cherry, 2018). While assessing Ray based on Erik’s theory, the assessor should focus on his ability to read and write. At this stage, he is expected to have cognitive skills mostly natures in school where he can do simple sums. Peer group is vital at this stage and the child will gain self-esteem (Rubin, Bukowski & Bowker, 2015). The care provider is likely to obtain information on Ray’s best friend, the kid he doesn’t like and who he would love to be associated with. That forms the circle where the children he hates make him feel inferior. For the examiner to gain cooperation, he should carry out the assessment when Ray is with his friends.

Child development assessment is vital in determining their welfare. It activity provides opportunities for the care provider to establish any special needs that the kid may require. Moreover, the assessment provides a ground where both the care provider and the parent can chip in together to provide support for the child. However, the needs of the child change with time and hence the mechanisms used in assessing as well as the results (Kaufman, 2018). Psychology theories like that of Erik can be used to determine what is expected of a child at a specific age during evaluation.

References

Cherry, K. (2018). Erik Erikson’s Stages of Psychosocial Development. 
Retrieved Juny
, 
5
, 2018.

Kaufman, A. S. (2018). 
Contemporary intellectual assessment: Theories, tests, and issues
. Guilford Publications.

Rubin, K. H., Bukowski, W. M., & Bowker, J. C. (2015). Children in peer groups. 
Handbook of child psychology and developmental science
, 1-48.

Course Code

Class Code

Assignment Title

Total Points

NRS-434VN

NRS-434VN-O502

Developmental Assessment and the School-Aged Child

100.0

Criteria

Percentage

Unsatisfactory (0.00%)

Less than Satisfactory (75.00%)

Satisfactory (79.00%)

Good (89.00%)

Excellent (100.00%)

Content

80.0%

Comparison of Physical Assessment Among School-Aged Children

25.0%

A comparison of physical assessments among different school-aged children is omitted.

An incomplete comparison of physical assessments among different school-aged children is summarized. How assessment techniques would be modified depending on the age and developmental stage of the child is omitted or contains significant inaccuracies.

A general comparison of physical assessments among different school-aged children is summarized. How assessment techniques would be modified depending on the age and developmental stage of the child is generally described. More information or support is needed for clarity or accuracy.

A comparison of physical assessments among different school-aged children is presented. How assessment techniques would be modified depending on the age and developmental stage of the child is described. Some information is needed for clarity.

A detailed comparison of physical assessments among different school-aged children is presented. How assessment techniques would be modified depending on the age and developmental stage of the child is thoroughly described. Insight is demonstrated into the physical assessment of school age children.

Typical Assessment for a Child of a Specific Age

25.0%

The typical developmental stage of a child between the ages 5 and 12 is not described.

The typical developmental stage of a child between the ages 5 and 12 is summarized. The summary contains significant inaccuracies for the age of the child.

The typical developmental stage of a child between the ages 5 and 12 is generally described. The description contains some inaccuracies for the age of the child.

The typical developmental stage of a child between the ages 5 and 12 is described. The overall description is accurate. Some information is needed for clarity.

The typical developmental stage of a child between the ages 5 and 12 is accurately and thoroughly described.

Developmental Assessment and the School-Aged Child sample essay

Developmental Assessment of a Child Using a Developmental Theory (Erickson, Piaget, Kohlberg)

30.0%

A child assessment based on a developmental theory is omitted.

A child assessment based on a developmental theory is partially summarized. Partial strategies to gain cooperation and for how explanations would be offered during the assessment are presented. The potential findings expected from the assessment are omitted or are incorrect. There are significant inaccuracies.

A child assessment based on a developmental theory is generally described. General strategies to gain cooperation and for how explanations would be offered during the assessment are presented. The potential findings expected from the assessment are summarized. There are minor inaccuracies.

A child assessment based on a developmental theory is described. Appropriate strategies to gain cooperation and for how explanations would be offered during the assessment are presented. The potential findings expected from the assessment are described. Some information is needed for clarity.

A child assessment based on a developmental theory is thoroughly described. Well-developed strategies to gain cooperation and for how explanations would be offered during the assessment are presented. The potential findings expected from the assessment are all accurate and described in detail.

Organization and Effectiveness

15.0%

Thesis Development and Purpose

5.0%

Paper lacks any discernible overall purpose or organizing claim.

Thesis is insufficiently developed or vague. Purpose is not clear.

Thesis is apparent and appropriate to purpose.

Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose.

Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.

Argument Logic and Construction

5.0%

Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources.

Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility.

Argument is orderly, but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis.

Argument shows logical progressions. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative.

Clear and convincing argument that presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.

Mechanics of Writing  (includes spelling, punctuation, grammar, language use)

5.0%

Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used.

Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, or word choice are present.

Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used.

Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used.

Writer is clearly in command of standard, written, academic English.

Format

5.0%

Paper Format  (use of appropriate style for the major and assignment)

2.0%

Template is not used appropriately or documentation format is rarely followed correctly.

Template is used, but some elements are missing or mistaken; lack of control with formatting is apparent.

Template is used, and formatting is correct, although some minor errors may be present.

Template is fully used; There are virtually no errors in formatting style.

All format elements are correct.

Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)

3.0%

Sources are not documented.

Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors.

Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.

Sources are documented, as appropriate to assignment and style, and format is mostly correct.

Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.

Total Weightage

100%

Developmental Assessment and the School-Aged Child sample essay

NRS-434 Developmental Assessment and the School-Aged Child Rubric

Course Code

Class Code

Assignment Title

Total Points

NRS-434VN

NRS-434VN-O502

Developmental Assessment and the School-Aged Child

100.0

Criteria

Percentage

Unsatisfactory (0.00%)

Less than Satisfactory (75.00%)

Satisfactory (79.00%)

Good (89.00%)

Excellent (100.00%)

Content

80.0%

Comparison of Physical Assessment Among School-Aged Children

25.0%

A comparison of physical assessments among different school-aged children is omitted.

An incomplete comparison of physical assessments among different school-aged children is summarized. How assessment techniques would be modified depending on the age and developmental stage of the child is omitted or contains significant inaccuracies.

A general comparison of physical assessments among different school-aged children is summarized. How assessment techniques would be modified depending on the age and developmental stage of the child is generally described. More information or support is needed for clarity or accuracy.

A comparison of physical assessments among different school-aged children is presented. How assessment techniques would be modified depending on the age and developmental stage of the child is described. Some information is needed for clarity.

A detailed comparison of physical assessments among different school-aged children is presented. How assessment techniques would be modified depending on the age and developmental stage of the child is thoroughly described. Insight is demonstrated into the physical assessment of school age children.

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Typical Assessment for a Child of a Specific Age

25.0%

The typical developmental stage of a child between the ages 5 and 12 is not described.

The typical developmental stage of a child between the ages 5 and 12 is summarized. The summary contains significant inaccuracies for the age of the child.

The typical developmental stage of a child between the ages 5 and 12 is generally described. The description contains some inaccuracies for the age of the child.

The typical developmental stage of a child between the ages 5 and 12 is described. The overall description is accurate. Some information is needed for clarity.

The typical developmental stage of a child between the ages 5 and 12 is accurately and thoroughly described.

NRS-434 Developmental Assessment and the School-Aged Child Rubric

Developmental Assessment of a Child Using a Developmental Theory (Erickson, Piaget, Kohlberg) NRS-434 Developmental Assessment and the School-Aged Child Rubric

30.0%

A child assessment based on a developmental theory is omitted.

A child assessment based on a developmental theory is partially summarized. Partial strategies to gain cooperation and for how explanations would be offered during the assessment are presented. The potential findings expected from the assessment are omitted or are incorrect. There are significant inaccuracies.

A child assessment based on a developmental theory is generally described. General strategies to gain cooperation and for how explanations would be offered during the assessment are presented. The potential findings expected from the assessment are summarized. There are minor inaccuracies.

A child assessment based on a developmental theory is described. Appropriate strategies to gain cooperation and for how explanations would be offered during the assessment are presented. The potential findings expected from the assessment are described. Some information is needed for clarity.

A child assessment based on a developmental theory is thoroughly described. Well-developed strategies to gain cooperation and for how explanations would be offered during the assessment are presented. The potential findings expected from the assessment are all accurate and described in detail.

Organization and Effectiveness

15.0%

Thesis Development and Purpose

5.0%

Paper lacks any discernible overall purpose or organizing claim.

Thesis is insufficiently developed or vague. Purpose is not clear.

Thesis is apparent and appropriate to purpose.

Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose.

Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.

Argument Logic and Construction

5.0%

Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources.

Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility.

Argument is orderly, but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis.

Argument shows logical progressions. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative.

Clear and convincing argument that presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.

Mechanics of Writing  (includes spelling, punctuation, grammar, language use)

5.0%

Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used.

Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, or word choice are present.

Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used.

Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used.

Writer is clearly in command of standard, written, academic English.

Format

5.0%

Paper Format  (use of appropriate style for the major and assignment)

2.0%

Template is not used appropriately or documentation format is rarely followed correctly.

Template is used, but some elements are missing or mistaken; lack of control with formatting is apparent.

Template is used, and formatting is correct, although some minor errors may be present.

Template is fully used; There are virtually no errors in formatting style. NRS-434 Developmental Assessment and the School-Aged Child Rubric

All format elements are correct.

Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)

3.0%

Sources are not documented.

Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors.

Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.

Sources are documented, as appropriate to assignment and style, and format is mostly correct.

Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.

NRS-434 Developmental Assessment and the School-Aged Child Rubric

Total Weightage

100%

Foundations of EBP eMAR Paper

Identify a project from a department at your place of employment that demonstrates a commitment to an improvement in patient care. (A project – introduction of eMAR, electronic medical record)

Why is this project/study important?

What role would an APN play in this project?

Identify a PICOT question that you could use to guide the research of the identified problem.

Provide 5 databases that you might use for your research, and give a short description of each.

What barriers do you foresee in implementing this project?

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The purpose of this paper is to get students thinking about what EBP is and how they would go about identifying and implementing a project.  The directions state:  
 
4 pages in length, 
not including the title and reference page
. (points will be deducted for papers over or under required length)

references on the project topic should be < 5 years old Foundations of EBP eMAR Paper. Foundations of EBP Paper Foundations of EBP Paper RUBRIC Ratings Pts This criterion is linked to a Learning Outcome Project Identification Clearly identifies a project or study demonstrating a commitment to improvement in care. Department, key players, goals are identified. 3.0 pts This criterion is linked to a Learning Outcome Identifies Importance of Project/Study The purpose of the project/study is clearly identified Foundations of EBP eMAR Paper 2.0 pts This criterion is linked to a Learning Outcome Evaluates the role of the APN in this project All key elements are present: the role of the APN specific to this project. How does the scope of practice, standards of care, social, legal and economic factors influence the research project or study? 5.0 pts This criterion is linked to a Learning Outcome PICOT Question r/t the project/Study All key elements of a PICOT question are present: P- Patient, problem or population I – Intervention C – Comparison O – Outcome T- Time 5.0 pts This criterion is linked to a Learning Outcome Identifies Databases Identifies 5 appropriate databases available for research with a short description of each 3.0 pts Foundations of EBP eMAR Paper This criterion is linked to a Learning Outcome Identifies Barriers to Implementation All key elements are present 2.0 pts This criterion is linked to a Learning Outcome APA Format Paper is the required length and consistently documented in APA format 1.0 pts Introduction of eMAR, electronic medical record Electronic health records have been adopted in the healthcare system for about decade now. Their development sought to improve the quality and safety of the patients through efficient paperless record keeping. Electronic medication administration records (eMAR) describe the server-based electronic medication administration system designed to replace the paper form of medical recording. eMAR is useful in rehabilitation facilities, long-term care, assisted living and institutional pharmacies. Its main roles include automating the medical tracking, distribution and re-ordering process as well as safe treatment (Vicente et al., 2017) Foundations of EBP eMAR Paper. It also saves time and labor force as well as reduces medical errors that might otherwise undermine the safety of the patient. This paper describes a project on the introduction of eMAR, its importance, the APN related roles and a PICOT question that guides the research as well as the relevant databases employed in this research. Consequently, the paper presets the foreseen barriers to the implementation of the project. Importance Poor record keeping has resulted in the increase of healthcare cost over the years due to the occurrence of errors, cumbersome storage of medical records and job burnout among other factors. However, the introduction of Health Information Technology for Economic and Clinical Health (HITECH) Act ten years ago has seen notable adoption of multiple technologies in the healthcare sector. For instance, eMAR introduction has brought about a revolution in patient care with its rapid replacement of the paper medical administration recording. This has helped in saving time, labor, increasing efficiency and reduction of errors as well as maintenance of confidentiality. Moreover, the introduction of the technology is crucial in maintaining a seamless flow of information via integrated systems that decrease the possibilities of medical errors, duplication of data entry and also saves time in the healthcare facility (Seibert et al., 2014). Therefore, it also increases safety of the patient and the quality of healthcare provided Foundations of EBP eMAR Paper. Role of the APN Advanced practice nurse play notable roles in the introduction of organizational change. The professional practice of APNs is derived from a reflective experience characterized by a wide range of nursing skills and knowledge. They are involved in the admission of patients, prescription of drugs as well as referrals. Considering that the electronic medical administration records are designed to improve the safety of the patient in these areas, the APN will be actively engaged in the change process. Their roles will include interdisciplinary collaboration geared towards ensuring the effectiveness of the project in increasing the safety of the patients. This will involve advisory and consultative services that will promote evidence-based practice and use of the new technology (ED Management, 2018) Foundations of EBP eMAR Paper. Moreover, APNs will be involved in planning, implementing and evaluating the health programs involved in the eMAR systems to ensure efficiency. PICOT questions helps in finding the best available evidence to influence the nursing practice. PICOT stands for P-Patient/Problem, I-Intervention, C-comparison, O-Outcome and T-Time. The problem demanding the organizational change is the increase in healthcare cost for patient due to lack of a standardized and efficient medical administration recording system. The intervention addressed by the project is the introduction of eMAR system in the healthcare organization. Consequently, the project is comparing the intervention with the paper electronic medical administration records on the comparison section of the question. On the other hand, the anticipated outcome of the project is the increased efficiency with regard to safety and healthcare cost reduction for a period of six months through which the project is expected to run. Therefore, the PICOT question guiding the research study is, “Does the introduction of the electronic medical administration records increase the efficiency and safety of the patients within six months?” Foundations of EBP eMAR Paper. Databases and Description Elsevier Science Direct provides a wide range of access to medical research materials. The database is a subscription-based website containing four categories of journals namely the health sciences, life sciences, engineering and physical sciences. It provides multiple e-books, academic journals which exceed 12 million pieces (Friedlander & Khan, 2016) Foundations of EBP eMAR Paper. The articles present are interdisciplinary, high quality and help find answers to research questions in wide range of areas including my project on the introduction of the electronic medical administration records. I was able to research on patient’s safety in the automation era. Another database used in this research is the Cochrane Library-Wiley online library. This database provides independent, high quality collection of healthcare evidence that informs decision-making and helps answer various research questions. The collection of databases is published by Wiley and hosts material science, health science and peer reviewed journals and is accessed through subscription. The database provided articles on the effects of eMAR application on the safety of the patients. Notably, CINAHL is the most in-depth and largest database for nursing research. It refers to the Cumulative Index of Nursing and Allied Health Literature and is effective particularly in qualitative research studies. It covers all fields of nursing including the electronic medical record area which makes it relevant for this project. Further research was conducted in the MEDLINE via PubMed database. This site contains online books, science journals, citations and other literature material for life sciences and biomedical subjects through the free search engine access, PubMed. This site was effective in understanding the organizational and quality changes brought about by the project introduction. Lastly, I used the ERIC database. This is the Education Resources Information Center that provides full-text and indexed education literature material on the online digital library. It is run by the U.S. National Library of Education (NLE) and contains documents, synopsis, reports, books, studies, tests and pamphlets relevant in multiple study fields including healthcare (Friedlander & Khan, 2016). This site was crucial in providing an overview of the eMAR system Foundations of EBP eMAR Paper. Barriers to Implementation The implementation of the eMAR is challenged by several barriers including the hospital culture (ED Management, 2018) Foundations of EBP eMAR Paper. The hospital staff is used to the use of paper medical administration recording which might affect the implementation of the electronic system. The change in the organization culture might cause stress and low productivity as well as resistance from workers. According to Relias Media (2019), poor usability of EMR results in concerns of staff burnout as well as patient safety concerns. This is evident in the increased number of medical errors discovered in various health organization departments that placed the patients’ lives at risk. The privacy concerns may also act as barriers to the implementation of the project. This is because, the confidentiality of the sensitive medical records is legally demanded and thus, cyberattacks such involving data mining and hacking can undermine the privacy and security of the patients information (Aldosari, 2017). The cost of purchase, training, hiring and installation of electronic medical health record is also high which could limit the implementation of the electronic medical administration records Foundations of EBP eMAR Paper. References Aldosari, B. (2017). Patients’ safety in the era of EMR/EHR automation.  Informatics in Medicine Unlocked ,  9 , 230-233. ED Management. (2018). Hospitals Leverage Safety Huddle to Reduce Patient Harm, Boost Transparency, and Drive Culture Change. Friedlander, R. R., & Khan, A. M. (2016).  U.S. Patent No. 9,230,060 . Washington, DC: U.S. Patent and Trademark Office. Relias Media. (2019). Poor EMR Usability Linked to Patient Safety Concerns, Clinician Burnout. Retrieved from www.reliasmedia.com/articles/144399-poor-emr-usability-linked-to-patient-safety-concerns-clinicianburnout on September 11,2019 Seibert, H. H., Maddox, R. R., Flynn, E. A., & Williams, C. K. (2014). Effect of barcode technology with electronic medication administration record on medication accuracy rates.  American Journal of Health-System Pharmacy ,  71 (3), 209-218. Vicente Oliveros, N., Gramage Caro, T., Pérez Menendez‐Conde, C., Álvarez‐Díaz, A. M., Martín‐Aragón Álvarez, S., Bermejo Vicedo, T., & Delgado Silveira, E. (2017). Effect of an electronic medication administration record application on patient safety.  Journal of evaluation in clinical practice ,  23 (4), 888-894 Foundations of EBP eMAR Paper.

Ventilator Associated Pneumonia (VAP) PICOT Systematic Review

Research problem

Patients under mechanical intubation in the ICU commonly experience problems in oral health which increase their risk to nosocomial infections. In the ICU, Ventilator-Associated Pneumonia (VAP) is the most prevalent hospital-acquired infection and it leads to additional medical costs, prolonged admissions and even death.

Purpose of the Study

To evaluate the impact that routine oral care using chlorhexidine gluconate has on Ventilator-Associated Pneumonia and patient health outcomes among patients in the ICU receiving mechanical ventilation.

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Procedure, Inclusion and Exclusion Criteria

           
The inclusion criterion was as follows: studies that were
r
andomized clinical trials and  compared the use of chlorhexidine and a placebo among adults who were on mechanical ventilation since July 2013.The process started by identifying randomized clinical trials which compared a placebo and chlorhexidine in adults were identified, evaluated for bias and extracted. Existing differences were resolved by consensus. Studies that were eligible were analyzed using a random effects meta-analysis.

Findings

Cardiac surgery patients who were randomized to chlorhexidine had few lower respiratory tract infections

Conclusion

Routine oral care using chlorhexidine can prevent infections of the lower respiratory tract in both cardiac and non-cardiac patients. For patients on mechanical ventilation, chlorhexidine is the gold standard of care that reduces the risk s of VAP with good patient-centered outcomes. Ventilator Associated Pneumonia (VAP) PICOT Systematic Review.

Implications to Nursing Practice

ICU patients under mechanical intubation should receive routine oral care using chlorhexidine to prevent VAP. Policies on the similar routines that encourage oral care using chlorhexidine should also be implemented in clinical settings,

PICOT Statement

            Among Intubated patients aged 40 years or older in  ICU settings (P) how does using oral 0.2% Chlorhexidine 8 hourly (I) compared to using normal saline (C) reduce the risk of Ventilator-Associated Pneumonia (O) during hospitalization(T)?

 

References

Klompas, M., Speck, K., Howell, M. D., Greene, L. R., & Berenholtz, S. M. (2014). Reappraisal of routine oral care with chlorhexidine gluconate for patients receiving mechanical ventilation: systematic review and meta-analysis. 
JAMA internal medicine
, 
174
(5), 751-761. Ventilator Associated Pneumonia (VAP) PICOT Systematic Review.

Intellectual Developmental Disorder Treatment options Essay

Intellectual development disorder is associated with deficits an individual’s intellect characterized by experiential learning, academic learning, abstract thinking, planning, judgment and reasoning (Zheng & Chen, 2016). The treatment of this disorder involves the alleviation of symptoms and multiple options are available for the management of this disease. Each treatment intervention is uniquely tailored for specific individual to meet their personal needs. Intellectual Developmental Disorder Treatment options Essay.

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Behavioral Intervention is effective in the treatment of intellectual developmental disorder. It involves the use of techniques and behavioral changes. Behavioral interventions seek to teach the functional alternative behaviors and reduce the associated symptoms. The techniques used include modelling, fading, prompting and reinforcements. Another intervention is applied behavior analysis (ABA) that utilizes the learning theory principles to bring about positive and meaningful change of behavior in the patient (Schuengel et al., 2019). These changes develop self-control, social, communication and self-monitoring skills. They are also applicable in the daily and structured settings as well as group and individual instruction. Intellectual Developmental Disorder Treatment options Essay. Peer-Mediated treatment also engages children with disabilities in activities that boost their competency in communication.

Notably, pharmacological therapy is also effective in treating intellectual developmental disorder. It entails the use of medication to treat children for early developmental delays. Psychological therapy involving psychiatrists, geneticist, special education therapist, physical therapist or occupational and speech therapist is also necessary in treatment. Environmental arrangement organizes the surrounding to promote communication. The aim is to set the communication occasion and increase the environmental interest. The patient comments and expresses desires to understand and enquire about the environment thus improving the communication and learning skills. Moreover, Functional communication training (FCT) replaces challenging behavior with the appropriate communication and behavioral alternatives that improve their cognitive levels. On the other hand, Incidental teaching teaches elaborate communication attempts and interesting opportunities using prompt questions. Intellectual Developmental Disorder Treatment options Essay.

References

Schuengel, C., van Rest, M. M., Stanford, C. E., & Hastings, R. P. (2019). Impact of Research About the Early Development of Children With Intellectual Disability: A Science Mapping Analysis. In 
Frontiers in Education
 (Vol. 4, p. 41). Frontiers.

Zheng, X. F., & Chen, J. J. (2016). Evaluation of intellectual development level of 300 children with language disorder. 
Zhongguo dang dai er ke za zhi= Chinese journal of contemporary pediatrics
, 
18
(11), 1115-1118. Intellectual Developmental Disorder Treatment options Essay.