Explain why the sources selected should provide the best evidence for the chosen diagnosis.

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  • Competency 1: Interpret findings from scholarly quantitative, qualitative, and outcomes research articles and studies.
    • Explain why the sources selected should provide the best evidence for the chosen diagnosis.
  • Competency 2: Analyze the relevance and potential effectiveness of evidence when making a decision.
    • Describe the best places to complete research and what types of resources one would want to access to find pertinent information for the diagnosis within the context of a specific health care setting.
  • Competency 4: Plan care based on the best available evidence.
    • Identify five sources of online information (medical journal databases, websites, hospital policy databases, et cetera) that could be used to locate evidence for a clinical diagnosis.
  • Competency 5: Apply professional, scholarly communication strategies to lead practice changes based on evidence.
    • Describe communication strategies to encourage nurses to research the diagnosis, as well as strategies to collaborate with the nurses to access resources.
    • Communicate using writing that is clear, logical, and professional with correct grammar and spelling using current APA style.

Professional Context

As a baccalaureate-prepared nurse, you will be responsible for providing patient-centered, competent care based on current evidence-based best practices. You will be required to do research, analysis, and dissemination of best evidence to stay abreast of these best practices. Understanding where to go to find credible sources and locate evidence, as well as which search terms to use, is the foundation of incorporation of best practices.

Scenario

You are supervising three nurses working on the medical-surgical floor of a local teaching hospital. This hospital is nationally recognized as a leader in education and has a computer lab with an online library where staff has access to medical research databases (that is, CINAHL, PubMed, Medline, and Cochrane library) and online sources of all hospital policies, procedures, and guidelines, and computers at nurse workstations that also have access to these resources. (For this scenario, use the Capella University Library to simulate the hospital’s online library.) You have given the nurses their patient assignments and you have all participated in shift report. A new nurse who just completed orientation and training a week ago approaches you and tells you that one of the assigned patients has a diagnosis he or she is very unfamiliar with. Knowing that patient-centered care based on best practices is imperative to positive patient outcomes, you want to assist this nurse to find research that can be utilized to provide the best care for this patient. Describe how you would communicate with this nurse to encourage him or her to research the diagnosis. Assume you will assist in the quest to locate evidence, then describe where you would go within the facility and what resources you would look for. These resources may include websites, journals, facility policies or guidelines, or any other sources of online information.

You may choose the diagnosis for the patient in this scenario. Choose something you would find interesting to research or that applies to a clinical problem you would be interested in addressing. Create a list of at least five sources that could be used to find evidence, with the best source listed first, and explain why the sources you chose are best to find evidence for the diagnosis you chose and the clinical scenario. You are only evaluating the sources of evidence (database, website, policy database or website, et cetera). You are not actually completing a search and selecting evidence. Consider the following examples: a nursing journal in CINAHL may not be the best source of evidence for information on how to administer medications through a central-venous catheter, whereas a hospital policy database found on a website may not be the best source of information on caring for a patient with a rare chromosomal abnormality.

Preparation

To help ensure you are prepared to complete this assessment, review the following resources related to the Capella library. These resources will provide you an overview of the types of tools, resources, and guides available in the library. This may be useful in forming a better understanding of the library to apply to the hypothetical situation laid out in the scenario of this assessment.

Remember, it is also appropriate to look toward databases and resources outside of the Capella library, such as organizational policies, professional organizations, and government health care resources.

You are encouraged to complete the Evaluating the Credibility of Evidence activity. This activity offers an opportunity to practice evaluating the credibility of evidence. These skills will be necessary to complete Assessment 1 successfully and is for your own practice and self-assessment. Completing this activity is also a way to demonstrate course engagement.

Instructions

The purpose of this assessment is to understand where to find evidence that can be applied to clinical scenarios and to learn effective communication and collaboration with clinical staff during the process of evidence location. As a baccalaureate-prepared nurse, you will not only use research for self-improvement in your clinical role, but you will also serve as a mentor to supervised nursing staff. Therefore, you will need to be able to communicate and collaborate effectively to guide them toward resources to find research, as well as support them through the initial evidence location process. In doing so, nurses can gain access to evidence that can be analyzed and utilized to stay current on best practices. This allows them to provide safe, patient-centered care and improve patient outcomes.

For this assessment:

  • Describe your role as a baccalaureate-prepared nurse supervising clinical staff nurses with regard to communication and collaboration in locating evidence for application to a nursing practice scenario.
  • Compile a list of five online databases or other online sources (that is, websites, journals, facility policies or guidelines, et cetera) that can be used to research evidence to apply to this scenario and describe to which of these you would direct a nurse colleague to search for evidence.
  • Describe where you might go in the clinical setting to complete this research and how you would access the desired, relevant research within research databases or other online sources.

Be sure to address the following in this assessment, which correspond to the grading criteria in the scoring guide. Please study the scoring guide carefully so that you will know what is needed for a distinguished score.

  • Describe communication strategies to encourage nurses to research the diagnosis, as well as strategies to collaborate with the nurses to access resources.
  • Describe the best places to complete research and what types of resources you would want to access to find pertinent information for the diagnosis within the context of a specific health care setting.
  • Identify five sources of online information (medical journal databases, websites, hospital policy databases, et cetera) that could be used to locate evidence for a clinical diagnosis.
  • Explain why the sources of online information selected should provide the best evidence for the chosen diagnosis.
  • Communicate using writing that is clear, logical, and professional with correct grammar and spelling using current APA style.

Note: While you are not selecting and evaluating specific evidence to help with the clinical diagnosis, you should still be citing the literature and best practices to support your description of your communication and collaboration approach. Additionally, it is appropriate to cite best practices related to EBP and evaluating databases to support your explanation as to why you selected the five sources of online information that you did.

Submission Requirements

Your assessment should meet the following requirements:

  • Length of submission: 1–2 pages (not including the reference page) description of communication, collaboration, and evidence location process, including a list of databases or other sources with description of why they are appropriate for clinical scenario diagnosis (that is, something that would be useable in professional practice for other nurses). Be sure to include an APA-formatted reference page at the end of your submission.
  • Number of references: Cite a minimum of three sources of scholarly or professional evidence that supports your findings and considerations. Resources should be no more than five years old.
  • APA formatting: References and citations are formatted according to current APA style.

Portfolio Prompt: Remember to save the final assessment to your ePortfolio so that you may refer to it as you complete the final Capstone course.

STEP #2: How to THINK Like a Nurse by Recognizing Clinical RELATIONSHIPS Six Essential Clinical Relationships:

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STEP #2: How to THINK Like a Nurse by Recognizing Clinical RELATIONSHIPS Six Essential Clinical Relationships:

1. RELATIONSHIP of the past medical history and current medications 2. RELATIONSHIP between RELEVANT present problem data and the primary medical problem 3. RELATIONSHIP between RELEVANT clinical data and the primary problem 4. RELATIONSHIP between the primary medical problem and nursing priority 5. RELATIONSHIP between the primary care provider’s orders and primary problem 6. RELATIONSHIP between diseases in PMH that may have contributed to the development of the current problem

History of Current Problem: John Gates is a 59-year-old male with a history of diabetes type II and hypertension who was at work when he had sudden

onset of right-sided weakness, right facial droop, and difficulty speaking. He was transported to the emergency

department (ED) where these symptoms continue to persist. It has been one hour from the onset of his neurologic

symptoms when he presents to the ED. You are the nurse responsible for his care.

1. What is the RELATIONSHIP of the past medical history and current medications? (Which medication treats which condition? Draw lines to connect)

Past Medical History Home Meds:

Diabetes mellitus type II-poorly controlled

Hypertension

Hyperlipidemia

Gouty arthritis

Smokes 1 ppd x 40 years

Lisinopril

Indomethacin

Aspirin

Metformin

Simvastatin

Patient Care Begins:

Current VS: P-Q-R-S-T Pain Assessment: T: 99.2 F/37.3 C (oral) Provoking/Palliative: Unable

P: 118 (irregular) Quality:

R: 20 (regular) Region/Radiation:

BP: 198/94 Severity:

O2 sat: 99% room air Timing:

Current Assessment:

GENERAL

APPEARANCE:

Appears anxious–he is aware and appears to be concerned about changes in neuro status.

RESP: Breath sounds clear with equal aeration bilaterally, non-labored respiratory effort

CARDIAC: Pink, warm & dry, no edema, heart sounds irregular–S1S2, telemetry rhythm is atrial

fibrillation, pulses strong, equal with palpation at radial/pedal/post-tibial landmarks

NEURO: Is anxious, restless, and agitated, speech is currently slurred and difficult to understand, facial droop present on right side, pupils equal and reactive to light (PEARL), both right

upper extremity (RUE) and right lower extremity (RLE) notably weak (3/5) in comparison to

left, which is strong (5/5), right pronator drift present, unable to hold right arm up, right

visual deficit cut present

GI: Abdomen soft/non-tender, bowel sounds audible per auscultation in all 4 quadrants

Able to swallow saliva

GU: Voiding without difficulty, 700 mL urine clear/yellow,

SKIN: Skin integrity appears intact, right foot not assessed at this time

© 2016 Keith Rischer/www.KeithRN.com

Lab/diagnostic Results: What diagnostic results are RELEVANT and must be interpreted as clinically significant by the nurse?

RELEVANT Results: Clinical Significance: No abnormalities noted,

no mass, no bleed, no

shift present

Make a clinical JUDGMENT. Is a PROBLEM present? Based on your identification and TRENDING of RELEVANT clinical data, is a problem present?

If a problem is present, what is it?

What is the underlying cause/pathophysiology of this primary problem?

THINK Like a Nurse by Recognizing Clinical RELATIONSHIPS 2. What is the RELATIONSHIP between RELEVANT current problem data and the primary medical

problem?

Complete Blood Count (CBC) Current High/Low/WNL? Previous:

WBC (4.5-11.0 mm 3) 6.8 7.9

Hgb (12-16 g/dL) 14.8 16.1

Platelets(150-450x 103/µl) 228 201

Neutrophil % (42-72) 71 79

Basic Metabolic Panel (BMP) Current High/Low/WNL? Previous:

Sodium (135-145 mEq/L) 133 139

Potassium (3.5-5.0 mEq/L) 4.1 4.5

Glucose (70-110 mg/dL) 222 128

Creatinine (0.6-1.2 mg/dL) 1.5 1.1

Coag

PT/INR (0.9-1.1 nmol/L) 1.1 n/a

RELEVANT Current Problem Data: How Does it Relate to Primary Medical Problem?

© 2016 Keith Rischer/www.KeithRN.com

3. What is the RELATIONSHIP between RELEVANT clinical data and the primary problem? RELEVANT VS Data: How Does it Relate to Primary Problem?

RELEVANT Assessment Data: How Does it Relate to Primary Problem?

RELEVANT Lab Data: How Does it Relate to Primary Problem?

4. What is the RELATIONSHIP between the primary medical problem and nursing priority(ies)?

Nursing Priority(ies): How Nursing Priority will help Resolve Primary Medical Problem:

© 2016 Keith Rischer/www.KeithRN.com

5. What is the RELATIONSHIP between the primary care provider’s orders and primary problem? Care Provider Orders: How it Will Resolve Primary Problem:

Establish peripheral IV

12 lead EKG stat

Labetalol 10-20 mg IV prn every 15

minutes to keep SBP 160-180

CT head stat

Cardiac monitor continuous

NPO

Alteplase IV dose per pharmacy

(if CT negative for bleed)

6. Is there a RELATIONSHIP between diseases in the patient’s past medical history that may have contributed to the development of the current problem?

(Which disease likely developed FIRST, then started a “domino effect”?)

Past Medical History What Came FIRST:

Diabetes mellitus type II-poorly

controlled

Hypertension

Hyperlipidemia

Gouty arthritis

Smokes 1 ppd x 40 years

What Then Followed:

  1. Lisinopril Indomethacin Aspirin Metformin Simvastatin:
  2. Current VS:
  3. PQRST Pain Assessment:
  4. P 118 irregular:
  5. UnableQuality:
  6. R 20 regular:
  7. UnableRegionRadiation:
  8. BP 19894:
  9. UnableSeverity:
  10. UnableTiming:
  11. Current Assessment:
  12. Appears anxioushe is aware and appears to be concerned about changes in neuro status:
  13. RESP:
  14. CARDIAC:
  15. NEURO:
  16. GI:
  17. GU:
  18. Voiding without difficulty 700 mL urine clearyellow:
  19. SKIN:
  20. Clinical SignificanceNo abnormalities noted no mass no bleed no shift present:
  21. Current:
  22. Previous:
  23. WBC 45110 mm 3:
  24. HighLowWNL68:
  25. 79:
  26. Hgb 1216 gdL:
  27. HighLowWNL148:
  28. 161:
  29. HighLowWNL228:
  30. 201:
  31. Neutrophil 4272:
  32. HighLowWNL71:
  33. 79_2:
  34. Current_2:
  35. Previous_2:
  36. HighLowWNL133:
  37. 139:
  38. HighLowWNL41:
  39. 45:
  40. Glucose 70110 mgdL:
  41. HighLowWNL222:
  42. 128:
  43. HighLowWNL15:
  44. 15Coag:
  45. HighLowWNLCoag:
  46. 11Coag:
  47. HighLowWNL11:
  48. na:
  49. RELEVANT Current Problem DataRow1:
  50. How Does it Relate to Primary Medical ProblemRow1:
  51. RELEVANT VS DataRow1:
  52. How Does it Relate to Primary ProblemRow1:
  53. RELEVANT Assessment DataRow1:
  54. How Does it Relate to Primary ProblemRow1_2:
  55. RELEVANT Lab DataRow1:
  56. How Does it Relate to Primary ProblemRow1_3:
  57. Nursing PriorityiesRow1:
  58. How Nursing Priority will help Resolve Primary Medical ProblemRow1:
  59. How it Will Resolve Primary ProblemEstablish peripheral IV 12 lead EKG stat Labetalol 1020 mg IV prn every 15 minutes to keep SBP 160180 CT head stat Cardiac monitor continuous NPO Alteplase IV dose per pharmacy if CT negative for bleed:
  60. What Then Followed:
  61. Answer1:
  62. Answer2:
  63. Answer3:

1. What other information do you need?

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1. What other information do you need?

2. What has she used in the past?  Why did she stop a method?  How many partners in past 12 months?

3. What are her current cycles like?

4. When was her last gyn exam and what were the results of the tests?

5. Are her migraines with or without auras?

6. What method has she considered.

7. What are you next steps/considerations?

8. What teaching should you do?

9. What methods are appropriate for Elaine?

Questions 

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Questions 

1. Two required elements that a single social media site must have to meet the needs of her study group are the ability to share ideas and experiences (chat), and share information (store documents). Research several social media sites that meet both of the required elements for Grace’s group. Select one social media tool, include its website, and explain your rationale for selecting that tool.

Selected Social Media Tool (and website)

[Write your response here.]

Rationale

[Write your response here.]

2. Grace discovers that not all of the members of the group use the social media tool she selected. In your own words, create a set of simple instructions that other members of the group could follow to ensure full group participation.

[Write your response here.]

3. Grace decides to establish a set of “ground rules” from the outset when she forms the study group. Create a set of “ground rules” that will help to create a group with full participation by all members and that will not place members of the group at risk, for either privacy or academic (plagiarism) concerns. Provide your reasoning for the “ground rules” you established.

Ground Rules

[Write your response here.]

Rationale

[Write your response here.]

4. In a specific week, the assignment is particularly challenging. One of the students in the study group offers to post the “answers” he received from a student who completed this same assignment last year from the same instructor. Grace knows that one of her close friends in the study group is at risk of failing if she does not do well on this assignment. Describe how Grace might handle this situation to reduce the academic risk of plagiarism for herself, her friend, and other members of the study group.

[Write your response here.]

 

MN577 Unit 9 Pregnancy Case Review Chart

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MN577 Unit 9 Pregnancy Case Review Chart

Description of the case chosen:

Case #1: Jane

Jane is a 42-year-old G4P2103. Jane is divorced and works long, hard hours as a real estate agent. Jane was having irregular and heavy menses for 6 months, and then they abruptly stopped 3 months ago. Jane has been having nausea and vomiting for 6 weeks but attributed it to having the flu recently. She also admits to gaining about 10 pounds in the last few months and experiencing breast tenderness. Jane comes to the clinic today to discuss menopause symptoms and treatment. During the visit, a urine pregnancy test came back positive. During the exam, you palpate a 16-week-size uterus and get fetal heart tones of 165. Jane is in disbelief.

Subjective data, identify both given and needed data Objective findings, identify both given and needed data Diagnostic or laboratory testing needed with rationales List of three differential diagnoses with rationales Medications and or treatments needed with rationales Patient education needed Referrals for collaborative care needed with rationales

· Make sure to address all sections. Do not leave any section blank.

· Include relevant subjective and physical objective findings.

· Identify appropriate diagnostic and laboratory testing needed.

· List at least three differential diagnoses with rationales for choosing.

· Identify usual medications, treatments, or patient education needed.

· Determine referrals for collaborative care.

· Summarize the case study and include any further research, diagnostics, procedures, or follow-up needed.

Question 1

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Question 1

Interpret Mr. Fitts’s laboratory results.  Interpretation means to tell me what is abnormal and what is normal.  If the lab is abnormal, please tell me what it can be attributed to.

Question 2

Based on the laboratory data and assessment findings, the health care provider diagnoses Mr. Fitts with iron deficiency anemia. What clinical manifestations of iron deficiency anemia does Mr. Fitts have?

Question 3

Explain iron deficiency anemia and identify the probable cause of D.G’s anemia.

Question 4

How is iron deficiency anemia treated?

Question 5

Identify dietary iron sources to include in Mr. Fitts’s teaching.

Question 6

What are important points to include when teaching patients taking oral iron supplements? Please be specific as to what to take them with and what are the side effects.

Question 7

What evaluative parameters could you use to determine whether Mr. Fitts’s anemia is resolving?  In other words how are you going to know he is getting better and please be specific to labs and potential assessment findings.