WEEK1/ANSWER TO PROFESSOR/ DICUSSION

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WEEK1/ANSWER TO PROFESSOR/ DICUSSION

first part is my discussion

 

Physical Examination

Physical examination is the evaluation of anatomic findings by using observation, percussion, palpation, and auscultation to obtain information about the patient. Many people who visit healthcare providers follow their instructions but wonder what they are doing or what they are looking for. During a physical examination, a healthcare practitioner is gathering cues to be able to diagnose. When a physical examination is thoughtfully integrated with the information that they provide, history, and path physiology, they should yield at least 20% data that is necessary for diagnosis and management of the patient (Sawyer, 2012). An examination of a 12-year-old child to find the likely cause of the symptoms portrayed would assist in diagnosing the child.

You are admitting a 12-year-old child to your unit. The mother states that the child has a history of unexplained blackout episodes, headaches, sleep disturbances, and is presently exhibiting tremors. What is the most likely cause of these symptoms? What actions would you take during the interview process? Explain.

I have chosen the 12 year old patient for this discussion.

When conducting a physical assessment on children it is imperative to start the collaboration relationship process between the patient and their family members and myself, as the nurse with effective communication strategies. I would first introduce myself to the patient and mother of the patient and explain to the both of them the purpose of the assessment being performed and how the information that they provide will be utilize appropriately. One important aspect to explain to both of them is that the information that they provide to me is protected by HIPAA.

I would then use open-ended questions (i.e. what brings you in today) to direct the interview to gain the patient’s history from either the child or from the mother. If more information is needed then I would utilize closed-ended questions or direct statements (i.e. how long has these symptoms been going on) to clarify any additional information.

Next, I would take the patient’s vitals and a complete head-to-toe assessment with an emphasis on the neurological system exam, all while explaining to the patient and the mother the reason for me having to do this. By me explaining step-by-step what I am doing will help me to better build a rapport with them as well as giving the patient and the mother a sense of being aware of what is going on, so that if they have any questions I will be able to answer these for them.

It would be pretty apparent that with the symptoms that the patient is experiencing may be due to some type of neurological condition. Patient would then need to be referred to a neurologist for further testing to confirm a proper diagnosis.

 

What should the “culture and environment of safety” look like when preparing and administering medications?

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  1. What should the “culture and environment of safety” look like when preparing and administering medications?
  2. Discuss a common breach of mediation administration.
  3. Identify three (3) factors that lead to errors in documentation related to medication administration.
  4. What can I do to prevent medication errors?

identify the AACN BSN Essential that you have selected by name and number;

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  1. identify the AACN BSN Essential that you have selected by name and number;
  2. explain why you selected this Essential; and
  3. explain how this Essential will be used to improve quality in your future professional nursing career.

Professor’s Post: As our course comes to a close, please reflect on the knowledge you have gained during this course.  The AACN Essentials of Baccalaureate Education for Professional Nursing Practice (2008) and the Massachusetts Department of Higher Education Nursing Initiative (2016) nursing core competencies have helped set the stage for your future BSN courses (Chamberlain College of Nursing, 2018).  The knowledge and understanding you have gained from these resources will help shape and guide your practice as a professional nurse.  For this week, focus your attention on the AACN Essentials of Baccalaureate Education for Professional Nursing Practice, but I encourage you to use both of these resources during your future coursework and during your practice as a professional nurse.

Identify the 5 peer-reviewed articles you reviewed, citing each in APA format.

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The Assignment: (4-5 pages)

In a 4- to 5-page paper, synthesize the peer-reviewed research you reviewed. Be sure to address the following:

  • Identify the 5 peer-reviewed articles you reviewed, citing each in APA format.
  • Summarize each study, explaining the improvement to outcomes, efficiencies, and lessons learned from the application of the clinical system each peer-reviewed article described. Be specific and provide examples.

Research Critique Guidelines

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Research Critique Guidelines

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

Successful completion of this assignment requires that you provide a rationale, include examples, or reference content from the study in your responses.

Qualitative Study

Background of Study:

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

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

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

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

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

Method of Study:

· Were qualitative methods appropriate to answer the research questions?

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

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

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

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

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

· When a researcher uses the grounded theory method of qualitative inquiry, the researcher may develop a framework or diagram as part of the findings of the study. Was a framework developed from the study findings?

Results of Study

· What were the study findings?

· What are the implications to nursing?

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

Ethical Considerations

· Was the study approved by an Institutional Review Board?

· Was patient privacy protected?

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

Conclusion

· Emphasize the importance and congruity of the thesis statement.

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

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

· Integrate a summary of the knowledge learned.

Quantitative Study

Background of Study:

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

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

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

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

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

Methods of Study

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

· Was informed consent obtained from the subjects or participants?

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

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

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

· How were data collected in this study?

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

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

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

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

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

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

Results of Study

· What is the researcher’s interpretation of findings?

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

· What limitations of the study were identified by researchers?

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

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

· What suggestions are made for further studies?

Ethical Considerations

· Was the study approved by an Institutional Review Board?

· Was patient privacy protected?

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

Conclusion

· Emphasize the importance and congruity of the thesis statement.

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

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

· Integrate a summary of the knowledge learned.

Case Study Assignment

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Case Study Assignment

Guidelines with Scoring Rubric

Purpose

The purpose of this case study assignment is to

1) Analyze provided subjective and objective information to diagnose and develop a management plan for the case study patient.

2) Apply national diabetes guidelines to case study patient management plan.

3) Demonstrate mastery of SOAP note writing.

Course Outcomes

Through this assignment, the student will demonstrate the ability to:

1. Employ appropriate health promotion guidelines and disease prevention strategies in the management of mature and aging individuals and families.

2. Formulate appropriate diagnoses and evidence-based plans of care for mature and aging individuals and families using subjective and objective data.

3. Incorporate unique patient cultural preferences, values, and health beliefs in the care of mature and aging individuals and families

4. Integrate theory and evidence based practice in the care of mature and aging individuals and their families

6. Conduct pharmacologic assessment addressing polypharmacy, drug interactions and other adverse events in the care of mature and aging individuals and their families.

7. Apply evidence-based screening tools to perform functional assessments with aging individuals and their families as appropriate.

Due Date: Sunday 11:59 p.m. MT at the end of Week 5

Total Points Possible: 200 points

Preparing the Assignment

The assignment is a paper, which is to be written in APA format using the provided assignment template. The paper shall not exceed 20 pages.

Review the attached patient visit information. You are provided with the subjective and objective exam findings. As the provider, you are to diagnose the case study patient and develop the management plan for this case study patient.

Use the provided case study template for your paper. Review the APA Manual to adhere to APA formatting.

Introduction: briefly discuss the purpose of this paper.

Assessment: review the provided case study information.

Identify the primary, secondary and differential diagnoses for the patient. Use the 601 Clinical SOAP note format as a guide to develop your diagnoses.

Each diagnosis will include the following information:

1. ICD 10 code.

2. A brief pathophysiology statement which is no longer that two sentences, paraphrased and includes common signs and symptoms of the diagnosis and proper citation.

3. The patient’s pertinent positive and negative findings, including a brief 1-2 sentence statement, which links the subjective and objective findings (including lab data and interpretation).

4. A rationale statement, which summarizes why the diagnosis was chosen.

5. Do not include quotes, paraphrase all scholarly information and provide an in text citation to your scholarly reference. Use the Reference Guidelines document for information on scholarly references.

Plan (there are five (5) sections to the management plan)

1. Diagnostics. List all labs and diagnostic test you would like to order. Each test includes a rationale statement following the listed lab, which includes the diagnosis for the test, the purpose of the test and how the test results will contribute to your management plan. Each rationale statement is cited.

2. Medications: Each medication is listed in prescription format. Each prescribed and OTC medication is linked to a specific diagnosis and includes a paraphrased EBP rationale for prescribing.

3. Education: section includes personalized detailed education on all five (5) subcategories: diagnosis, each medication purpose and side effects, diet, personalized appropriate exercise recommendations and warning sign for diagnosis and medications if applicable. All education steps are linked to a diagnosis, paraphrased, and include a paraphrased EBP rationale. Review the NR601 Clinical SOAP note guideline for more detailed information.

4. Referrals: any recommended referrals are appropriate to the patient diagnosis and current condition, is linked to a specific diagnosis and includes a paraphrased EBP rationale with in text citation.

5. Follow up: Follow up includes a specific time, not a time range, to return to PCP office for next scheduled appointment. Includes EBP rationale with in text citation.

Medication costs: in this section students will research the costs of all prescribed and OTC monthly medications that you have prescribed and that the patient is currently taking that you would like to continue. Students may use Good Rx, Epocrates or another resource (students may use local pharmacy websites) which provides medication costs. Students will list each medication, the monthly cost of the medication and the reference source. Students will calculate the monthly cost of the case study patient’s prescribed and OTC medications and provide the total costs of the month’s medications. Reflect on the monthly cost of the medications prescribed. Discuss if prescriptions were adjusted due to cost. Discuss if will you use medication pricing resources in future practice.

SOAP note: A focused SOAP note, written on a separate page, follows the assignment. The SOAP note is written following the provided Clinical SOAP note format.

· The subjective section is organized to follow the Clinical SOAP note format. The ROS is focused; only pertinent body systems are included. Only provided information is included in the ROS. No additional data is added.

· The objective section is maintained as written, no additional information is added.

· The assessment section includes only the diagnoses and ICD 10 codes. Diagnosed are labeled as primary, secondary or differential diagnoses. Rationale is not included in the SOAP note.

· The plan includes five sections. Rationale is not included in the SOAP note.

The assignment will be submitted through TurnItIn. Due to the common language in a large group assignment, it is possible that similarity scores can exceed 25%. It is the student’s responsibility to review the TII paper and assure that sections of original work contain low similarity. If there are concerns, please contact your instructor.

Category Points % Description
Assessment 50 25 Each diagnosis, primary, secondary and differential, includes the ICD10 codes in parentheses next to each diagnosis. Diagnosis is consistent with the guideline recommendations or scholarly reference.

Each diagnosis includes a one to two sentence paraphrased pathophysiology statement explains the diagnosis and a rationale statement. The rationale statement includes pertinent positive and negative subjective and objective findings from the history and physical exam, which links this diagnosis to your patient. Pertinent lab results are interpreted within the rationale statement.
Evidence-Based Practice (EBP) 50 25 National guidelines, including the American Diabetes Association Standards and Medical Care in Diabetes-2018 or later (or article related to 2018 Guidelines) are used to support the primary diagnosis and develop the plan.

Every diagnosis rationale must include an in text citation to a scholarly reference. Each action step or order within all plan sections includes an in text citation to an appropriate reference as listed in the Reference Guidelines document. All cited information is paraphrased, no quotes included. Reference interpretation is accurate. Diagnoses plans are consistent with the guideline recommendations.
Plan: diagnostics 10 5 All ordered diagnostics tests are linked to a diagnosis and include a paraphrased EBP rationale with citation. Each diagnosis is included in the plan.

Plans are consistent with the guideline recommendations or scholarly reference.
Plan: medications 10 5 Each prescribed and OTC medication is linked to a diagnosis, and include a paraphrased rationale EBP rationale. Diagnosis is clearly stated in the rationale statement.

Plans are consistent with the guideline recommendations or scholarly reference
Plan: education 10 5 All education steps are linked to a diagnosis, paraphrased, and include an EBP rationale. Section includes personalized detailed education on diagnoses, medications, diet, exercise and warning signs. Personalized diet and exercise recommendations are included.

Plans are consistent with the guideline recommendations or scholarly reference.
Plan: Referrals 10 5 All recommended referrals are appropriate for the patient diagnosis; each referral is linked to a specific diagnosis and includes a paraphrased EBP rationale.

Plans are consistent with the guideline recommendations or scholarly reference
Plan: Follow up 10 5 Follow up includes a specific time/date to return to PCP office. Includes EBP rationale with in text citation. Only follow up information is listed in this section. Plans are EBP and consistent with the guideline recommendations.
Medication costs 10 5 Monthly medication costs are calculated and a total cost for the month’s medication is included.

All medications including OTCs are included.

Medication cost citation is included. Summary/reflection statement is included.
SOAP note 20 10 This SOAP note is an example of a patient chart entry. SOAP note included at end of assignment before the reference page.

SOAP note includes all elements and is formatted exactly as described in the Clinical SOAP note guidelines document. Rationales are not included. Only provided information is included in the SOAP note.
Grammar, Syntax, APA 10 5 APA format, grammar, spelling, and/or punctuation are accurate, or with zero to one errors. All referenced information is cited, “according to” is not used.
Organization 10 5 Paper is developed in a logical, meaningful, and understandable sequence using the provided assignment template

Rationale length does not exceed template directions. SOAP note presents case study findings in a logical, meaningful, and understandable sequence following provided format.

The paper does not exceed 20 pages.
Total  200 100 A quality assignment will meet or exceed all of the above requirements.