Soap note women’s health

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Question

From the professor

Try to incorporate the Q&A portion of your subjective data and rewrite it into your HPI and ROS, Example- “When did your symptoms start…, pt answered: 3 days ago” , “Do you notice any vagina discharge or pelvic pain? No, I do not have pain but I notice some discharge.”, “Does the discharge have any smell? Is it thick, or thin? What color is it? It does have a smell, and it is watery discharge.”

You can rewrite this in your HPI.

“Pt in clinic complaining of vaginal discharge that approximately started 3 days ago.. Pt states she is having a thin white vaginal discharge with odor”

ROS

Gyn- denies pelvic pain, reports positive watery vaginal discharge, reports positive vaginal odor …

Start transforming your Q&A into a narrative format for your SOAP note. This is how SOAP notes are documented in clinic and your notes will start to look like them as well. You may also notice that it takes you lesser time to write your notes because you are not typing the questions. For one of the items on the prompt, it asks “what additional questions would you ask”, I am expecting that you have theoretically asked your patient and that I am reading only the narrative version of your conversation.

Also

1. Answer the chart/s completely and in your own words. Do not copy and paste information from the text or websites. I understand some treatments and characteristics cannot be paraphrased, but even typing/writing them yourselves VS using the copy and paste tool is a way to learn the information. Do not forget to cite your source. If there is any data that catches my attention, I look at your source to see where you found that information.

2. Your response to the prompt NEEDS to be in a SOAP note format, as if you are documenting this theoretical visit. I need to see the CC, HPI, Hx, ROS (please see previous announcement in week 1). If you are including questions to ask, make sure those answers are written INSIDE your HPI or ROS

3. Make sure your ROS and Physical Exam is NOT a copy paste from a source. I do expect a thorough exam–but the exam and the ROS need to relate to what is appropriate to the visit. Example- a patient comes in with a complaint of vaginal discharge and the exam included- visual acuity 20/20- visual acuity is not performed on a visit like this. This signals me that you took a template from a source and did not personalize it.

If you are using a template, ensure that you rewrite the template, edit the template, and make sure it relates to the prompt. I don’t mind having heart and lungs and the basics examined, but if you are including the webber test and rinne test in a vaginal discharge visit- it is obvious that you took this template and did not edit it nor tailor it to your patient.

4. Make sure that your medication includes the dosage and how you want the patient to take the medication (sig). Make sure your plan is specific- example- your patient is having irregular bleeding and you ordered an “ultrasound”. What is this ultrasound for? What type of ultrasound- abdominal, transvaginal, breast? I need to see the type of diagnostic test that you want to order and why? Again, this shows me your knowledge. Same with medication, you diagnosed your patient with a vaginal infection and your treatment plan cannot be “give antibiotics”. Which antibiotics? How much? Why? Again, this mimics a patient visit where you diagnose patient with an infection and the prescription you give to the pharmacy is “antibiotics”. This will not be accepted.

5. DO NOT PLAGIARIZE. DO NOT COPY from a source and not paraphrase nor cite the source. I understand a lot of you use a template in the ROS and physical exam, I understand that, but it MUST be tailored to the patient. These DBs and SOAP notes mimic a theoretical patient and we must work with integrity and honesty. False documentation is a crime, you can lose your license and can be charged with crime. Let us stop this practice now in school so we will not carry this over in the real clinic world.

6. If I am asking you to rewrite your initial response- this is my way of giving you a chance to correct some mistakes or to include missing data. This rewrite does not count as a peer response. I still expect you to respond to 2 peers on 2 separate days and one of the responses needs to be about the other prompt.

 

Mental Health Nursing RUA: Scholarly Article

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QUESTION

The impact of social media on mental health

Purpose

The student will review, summarize, and critique a scholarly article related to a mental health topic.

Course outcomes: This assignment enables the student to meet the following course outcomes.

(CO 4) Utilize critical thinking skills in clinical decision-making and implementation of the nursing process for psychiatric/mental health clients. (PO 4)

(CO 5) Utilize available resources to meet self-identified goals for personal, professional, and educational development appropriate to the mental health setting. (PO 5)

(CO 7) Examine moral, ethical, legal, and professional standards and principles as a basis for clinical decision-making. (PO 6)

(CO 9) Utilize research findings as a basis for the development of a group leadership experience. (PO 8)

Due date: Your faculty member will inform you when this assignment is due. The Late Assignment Policy applies to this assignment.

Total points possible: 100 points

Preparing the assignment

1) Follow these guidelines when completing this assignment. Speak with your faculty member if you have questions.

a. Select a scholarly nursing or research article, published within the last five years, related to mental health nursing. The content of the article must relate to evidence-based practice.

You may need to evaluate several articles to find one that is appropriate.

  • b. Ensure that no other member of your clinical group chooses the same article, then submit your choice for faculty approval.

c. The submitted assignment should be 2-3 pages in length, excluding the title and reference pages.

2) Include the following sections (detailed criteria listed below and in the Grading Rubric must match exactly).

a. Introduction (10 points/10%)

Establishes purpose of the paper

  • Captures attention of the reader
  • b. Article Summary (30 points/30%)

Statistics to support significance of the topic to mental health care

  • Key points of the article
  • Key evidence presented
  • Examples of how the evidence can be incorporated into your nursing practice
  • c. Article Critique (30 points/30%)

Present strengths of the article

  • Present weaknesses of the article
  • Discuss if you would/would not recommend this article to a colleague
  • d. Conclusion (15 points/15%)

Provides analysis or synthesis of information within the body of the text

  • Supported by ides presented in the body of the paper
  • Is clearly written
  • e. Article Selection and Approval (5 points/5%)

Current (published in last 5 years)

  • Relevant to mental health care
  • Not used by another student within the clinical group
  • Submitted and approved as directed by instructor
  • f. APA format and Writing Mechanics (10 points/10%)

Correct use of standard English grammar and sentence structure

  • No spelling or typographical errors
  • Document includes title and reference pages
  • Citations in the text and reference page
  • For writing assistance (APA, formatting, or grammar) visit the APA Citation and Writing page in the online library.

Please note that your instructor may provide you with additional assessments in any form to determine that you fully understand the concepts learned in the review module.

Grading Rubric Criteria are met when the student’s application of knowledge demonstrates achievement of the outcomes for this assignment.

Assignment Section and Required Criteria (Points possible/% of total points available) Highest Level of Performance High Level of Performance Satisfactory Level of Performance Unsatisfactory Level of Performance Section not present in paper

Introduction

(10 points/10%) 10 points 8 points 0 points

Required criteria

1. Establishes purpose of the paper

2. Captures attention of the reader Includes 2 requirements for section. Includes 1 requirement for section. No requirements for this section presented.

Article Summary

(30 points/30%) 30 points 25 points 24 points 11 points 0 points

Required criteria

1. Statistics to support significance of the topic to

mental health care

2. Key points of the article

3. Key evidence presented

4. Examples of how the evidence can be incorporated

into your nursing practice Includes 4 requirements for section. Includes 3 requirements for section. Includes 2 requirements for section. Includes 1 requirement for section. No requirements for this section presented.

Article Critique

(30 points/30%) 30 points 25 points 11 points 0 points

Required criteria

1. Present strengths of the article

2. Present weaknesses of the article

3. Discuss if you would/would not recommend this

article to a colleague Includes 3 requirements for section. Includes 2 requirements for section. Includes 1 requirement for section. No requirements for this section presented.

Conclusion

(15 points/15%) 15 points 11 points 6 points 0 points

1. Provides analysis or synthesis of information within

the body of the text

2. Supported by ides presented in the body of the paper

3. Is clearly written Includes 3 requirements for section. Includes 2 requirements for section. Includes 1 requirement for section. No requirements for this section presented.

Article Selection and Approval

(5 points/5%) 5 points 4 points 3 points 2 points 0 points

1. Current (published in last 5 years)

2. Relevant to mental health care Includes 4 Includes 3 Includes 2 Includes 1 No requirements for

3. Not used by another student within the clinical group 4. Submitted and approved as directed by instructor requirements for section. requirements for section. requirements for section. requirement for section. this section presented.

Discussion 2 Advanced Patho

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QUESTION

Discussion Topic: Module 2 DiscussionModule 2 Discussion

null

icon Discussion 2

Hematopoietic:
J.D. is a 37 years old white woman who presents to her gynecologist complaining of a 2-month history of intermenstrual bleeding, menorrhagia, increased urinary frequency, mild incontinence, extreme fatigue, and weakness. Her menstrual period occurs every 28 days and lately there have been 6 days of heavy flow and cramping. She denies abdominal distension, back-ache, and constipation. She has not had her usual energy levels since before her last pregnancy.

Past Medical History (PMH):
Upon reviewing her past medical history, the gynecologist notes that her patient is a G5P5with four pregnancies within four years, the last infant having been delivered vaginally four months ago. All five pregnancies were unremarkable and without delivery complications. All infants were born healthy. Patient history also reveals a 3-year history of osteoarthritis in the left knee, probably the result of sustaining significant trauma to her knee in an MVA when she was 9 years old. When asked what OTC medications she is currently taking for her pain and for how long she has been taking them, she reveals that she started taking ibuprofen, three tablets each day, about 2.5 years ago for her left knee. Due to a slowly progressive increase in pain and a loss of adequate relief with three tablets, she doubled the daily dose of ibuprofen. Upon the recommendation from her nurse practitioner and because long-term ibuprofen use can cause peptic ulcers, she began taking OTC omeprazole on a regular basis to prevent gastrointestinal bleeding. Patient history also reveals a 3-year history of HTN for which she is now being treated with a diuretic and a centrally acting antihypertensive drug. She has had no previous surgeries.

Case Study Questions

Name the contributing factors on J.D that might put her at risk to develop iron deficiency anemia.

Within the case study, describe the reasons why J.D. might be presenting constipation and or dehydration.

Why Vitamin B12 and folic acid are important on the erythropoiesis? What abnormalities their deficiency might cause on the red blood cells?

The gynecologist is suspecting that J.D. might be experiencing iron deficiency anemia.
In order to support the diagnosis, list and describe the clinical symptoms that J.D. might have positive for Iron deficiency anemia.

If the patient is diagnosed with iron deficiency anemia, what do you expect to find as signs of this type of anemia? List and describe.

Labs results came back for the patient. Hb 10.2 g/dL; Hct 30.8%; Ferritin 9 ng/dL; red blood cells are smaller and paler in color than normal. Research list and describe for appropriate recommendations and treatments for J.D.

Cardiovascular
Mr. W.G. is a 53-year-old white man who began to experience chest discomfort while playing tennis with a friend. At first, he attributed his discomfort to the heat and having had a large breakfast. Gradually, however, discomfort intensified to a crushing sensation in the sternal area and the pain seemed to spread upward into his neck and lower jaw. The nature of the pain did not seem to change with deep breathing. When Mr. G. complained of feeling nauseated and began rubbing his chest, his tennis partner was concerned that his friend was having a heart attack and called 911 on his cell phone. The patient was transported to the ED of the nearest hospital and arrived within 30 minutes of the onset of chest pain. In route to the hospital, the patient was placed on nasal cannula and an IV D5W was started. Mr. G. received aspirin (325 mg po) and 2 mg/IV morphine. He is allergic to meperidine (rash). His pain has eased slightly in the last 15 minutes but is still significant; was 9/10 in severity; now7/10. In the ED, chest pain was not relieved by 3 SL NTG tablets. He denies chills.

Case Study Questions

For patients at risk of developing coronary artery disease and patients diagnosed with acute myocardial infarct, describe the modifiable and non-modifiable risk factors.

What would you expect to see on Mr. W.G. EKG and which findings described on the case are compatible with the acute coronary event?

Having only the opportunity to choose one laboratory test to confirm the acute myocardial infarct, which would be the most specific laboratory test you would choose and why?

How do you explain that Mr. W.G temperature has increased after his Myocardial Infarct, when that can be observed and for how long? Base your answer on the pathophysiology of the event.

Explain to Mr. W.G. why he was experiencing pain during his Myocardial Infarct. Elaborate and support your answer.

care plan 1

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QUESTION

Hi! Please follow the following instructions on how to complete this care plan. Attach you find the template to fill it out and an example of how it should look as well (obviously not the same information). Make sure to include all APA citation and references on its own page at the end. Make it sound complete and detailed.

Age: 93 yr old, gender, male, weight: 69 kg, bmi: 28.72, height: 155 cm, religion: catholic, language: english, marital status: make it up, occupation: make it up, health insurance: make it up, current work status, highest grade completed : make it up.

Alcohol/Smoking/Drug use/Sexual and Reproductive health: Patient denies alcohol, electronic vaping, substance use, and tobacco use. Support system: family lives in

but is aware. Siblings: N/A.

Name of significant other/primary caregiver: make it up.

Current medical diagnosis: Calcific tendinitis in the right elbow

Diagnostic Data and Results: Right elbow x-ray read impression:no evidence of acute fracture or traumatic malalignment. Extensive demineralization a small calcification along the lateral joint line that could represent combination of calcific tendinopathy in CPPD arthropathy. Right hip with pelvis x-ray read impression: no evidence of acute fracture or tramuatic malalignment. 

Surgical procedures (current and past): arthroplasty replacement total knee level 5 (right knee) in 12/19/2017, appendectomy, cataract, and shoulder. 

Past Health History:A-fibrilation, chronic anticoagulation, Hypertension, hypercholesterolemia, meningioma, osteoarthritis of glenohumeral joint, and right shoulder pain(explain how its ongoing).

History of Present Illness: 93 year old male with a paroxysmal a fib on Eliquis, dyslipidemia, permanent pacemaker, demetia. chronic right shoulder pain, gait disturbance, BPH who arrived via rescue for evaluation of a fall. History is taken from a wife at bedside as patient is pleasantly confused. Patient states that he fell as he was standing up. Wife denies any head trau,a that patient sustained. In the ER, he complains a lot of right elbow pain and is unable to move the right upper extremeity.( Make sure if the pt stated it, put it in quotations) Paraphrase this. 

Review of Systems: follow the example as to things to include. this is subjective, must be what the pt explain or denies. Make it up in accordance to the pt’s info. MAKE SURE IT CORRELATES AND MAKES SENSE. THINGS TO INCLUDE HOWEVER: 

for musculoskeltal: reports right shoulder pain, fall at home. Integumentary: bleeding lacerations to the right upper extremeity. Neurologic: memory loss. Psychitaric: confusion and agitated at night. 

Health Assessment: make sure to follow the example when completing it for this one. Make sure these key points are listed: Skin: skin is warm, right elbow laceration, right distal wrist laceration with bleeding noted. Neuro: poor judgment and insight, appropriate mood and affect. 

For patho, make sure to use APA citations edition 7 and include in text citations

Baseline and current vital signs/Frequency: T: 37 C, HR 90, RR:15, BP:140/117, SPO2:99%, AND Taken every 4 hours (Q4)

Allergies/Side effects: NKA

Diet with rationale : a regular diet, explain why and how they are able to eat their full amount of nutrients with no problems. describe with a good rational.

Activity order: make it up

Limitations/prosthetic devices: make it up, pt is on fall risk

Use the following 4 data results for data:

Potassium: 3.9 mmol/L

C02 in blood: 23 mmol/L

Troponin I (Quant): 0.04 ng/mL.

BUN on Blood: 35 mg/dL

For solution bags: make it up. have at least 1.

For meds, use these: atorvastatin (Lipitor) 80 mg tablet oral daily, docusate sodium (colace) 100 mg capsule oral BID, doxazosin (cardura) 4 mg tablet oral BID, famotidine (pepcid) 20 mg tablet oral daily, haloperidol lactate (Haldol) 5 mg/mL vial 1 mg 0.2 mL, IV push, once. Make sure when describing rationales and nursing implications to cite and include the citation on the side and at the last page for references.

For theories: use 2, may be the same ones as on the example.

For nursing diagnosis, must be a part of NANDA 1 nursing diagnosis. MUST BE NANDA, must be a complete nursing diagnosis

When completing the assessment data, the goals, and the interventions, subjective and objective data may be made up but it must make sense. Make sure you write the three nursing diagnosis and subjective and obejctive data that belong to it.

HOWEVER, YOU ONLY HAVE TO ELABORATE ON THE MOST IMPORTANT NURSING DIAGNOSIS which will be the first one on the list. Make sure it has one short term goal, one long term goal, and three interventions per goal. There must be a rationale for each intervention.  Make sure to include references at the end.

FOR ALL RATIONALES, MAKE SURE THERE IS IN TEXT CITATIONS AND REFERENCES AT THE END

ROLE TRANSITION TO ADVANCED PRACTICE NURSING ST Thomas University Role Transition to Advanced Practice Nursing Discussion

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QUESTION

Instructions:

You should respond to your peers by extending, refuting/correcting, or adding additional nuance to their posts. 

I need to reply to the student below:

  • Barriers for Advanced Practice Nursing
  • Student: Rachel

NUR-512 ROLE TRANS TO ADV PRC

Over the course of the last few decades, advanced practice nursing has been confronted with a number of difficulties. (Altman, Butler, & Shern, 2016; Poghosyan, 2018) Some examples of the challenges that advanced method nursing faces include the fact that different states have different ranges of method, that orders must be signed off on by a physician, and that there are differences in the billing methods that are used by medical professionals and advanced practice nurses in Medicare.

According to Altman, Butler, and Shern (2016), only thirteen out of the fifty states in the United States have allowed advanced nurse practitioners to carry out their duties with full method authority since 2016. This is because the ranges of technique vary from state to state in the United States. Full method authority is defined as “the consent of nurse practitioners (NPs) to assess patients, identify, order and analyze diagnostic tests, and launch and handle therapies—including recommend medications—under the special licensure authority of the state board of nursing” (American Association of Nurse Practitioners [AANP], 2021, paragraph 1). This definition was provided by the American Nurse Practitioners Association (AANP). According to the American Association of Nurse Practitioners (AANP), as of the year 2021, almost half of the states have made full method authority accessible for nurse practitioners. This type of authority enables nurse practitioners to provide treatment for the state board of nursing rather than for a licensed physician.

According to Altman et al. (2018), removing this barrier will undoubtedly make it possible for advanced registered nurse practitioners (ARNP) to practice to the fullest extent of their education, learning, and training. Additionally, it will increase the number of healthcare providers working in primary care, which will subsequently allow for increased access to medical care for individuals. The major technique that would be utilized to overcome this impediment would be to grant entire method authority in each of the fifty states and territories that make up the United States of America. This would make it possible for everyone to have improved access to medical care. In order to equip ARNPs with the ability to deliver the highest possible level of care for each and every individual, the American Association of Nurse Practitioners (AANP) is collaborating with state boards of nursing and lawmakers in states that do not have total method authority (AANP, 2021).

An additional challenge is that, according to the criteria set out by the government, ARNPs are required to have a medical expert approve an order that is positioned in a number of states (Poghosyan, 2018). According to Poghosyan (2018), this makes it relatively difficult for ARNPs to provide home health care, despite the fact that they are the ones who provide one-on-one supervision. Advocate for full practice authority in the remaining states to ensure that advanced registered nurse practitioners (ARNPs) are able to provide the finest possible home healthcare services to patients. This is the most effective way to overcome this impediment.

The final obstacle that stands in the way of new nursing methods is the disparity in billing that exists between ARNPs and physicians. It is more advantageous for medical care techniques to charge for nurse practitioner services under the name of the physician in jurisdictions where advanced registered nurse practitioners (ARNPs) are required to work under a certified medical professional (Poghosyan, 2018). This allows the organization to collect a larger amount of reimbursement. In spite of the fact that this is advantageous for the company, it is not advantageous for the ARNPs. This is due to the fact that they are considered to be “invisible providers” (p. 1), and the high quality of treatment that is linked to individual end results is determined in an incorrect manner, which is essential for efficiency evaluations for ARNPs under Medicare (Poghosyan, 2018). It is necessary to make it possible for nurse practitioner services to be invoiced without the need for them to be supervised by a physician in order to overcome this impediment. According to Poghosyan (2018), this would not only make it possible to achieve more precise individual outcomes, but it would also facilitate more straightforward payment procedures.

Immunology Question

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QUESTION

Arthropod-borne viruses(arboviruses)posea majorandglobal threat to human health, aided and abetted in

widespread and efficient transmission by their formidable mosquito vectors. While there are multiple viruses that
fall under this category worldwide, only a small proportion cause human disease.
In the Americas the region covering South, Central, and North America, and the Caribbean Islands the
increasing incidence and expanding geographic reach of arboviruses pose a growing and significant public health
challenge. Of greatest concern are the most prevalent of the arboviruses: dengue virus, chikungunya virus, and
Zika virus. How do these viruses cause disease and what are their clinical manifestations? How does our immune
system combat these viral infections? How do we test for and treat arboviral diseases? Are vaccines available for
any of these viral diseases or are they still in the developmental pipeline?
Arboviral infections have clinical and laboratory features similar to COVID-19, SARS-CoV-2, and influenza virus,
which can complicate treatment, especially in regions where only limited access to well-resourced testing and
treatment facilities might be available. What factors could pose additional challenges to disease control, and how
can some of these obstacles be overcome?
Arboviruses can be imported from endemic areas into non-endemic countries by infected travellers and may
establish new areas of local transmission in the presence of vectors and a susceptible population. Diseases caused
by dengue, chikungunya, and Zika viral infections are transmitted to humans through bites of infected mosquitoes,
primarily females of the Aedes genus (mainly, Aedes aegypti). Does this mean that vector-borne diseases might
be easier to prevent and control when the vector is targeted instead of the virus, or is it more complicated than
that? Recent advances in scientific technologies like genome sequencing and transcriptomics have increased our
understanding of vector biology, especially A. aegypti. What anti-arboviral immune responses are activated in
mosquitos? Are they immune tolerant to arboviruses? Could our knowledge of mosquitoes on a molecular level
help in treatment of arboviral diseases in humans?
Arboviral diseases are currently considered one of the greatest public health concerns in the Americas. To
underscore this growing concern, in March 2022, the World Health Organisation (WHO) launched the Global
Arbovirus Initiative, “an integrated strategic plan to tackle emerging and re-emerging arboviruses with epidemic
and pandemic potential, focusing on risk monitoring, pandemic prevention, preparedness, detection and response,
and building a coalition of partners”. In March 2023, the WHO reported increased transmission and expansion of
dengue and chikungunya cases outside of their historic areas of transmission in Central and South America and
the Caribbean. Even higher transmission rates are expected in the summer of 2023 due to weather conditions
favouring vector proliferation. Climate is closely linked to the ecological range, population dynamics, and disease
transmission rates of mosquitos. Northwards habitat expansion of some Aedes genus mosquitoes has already
been established from the United States into Canada, despite the harsh Canadian winters which would typically
be detrimental to mosquito reproduction. What would be the impact of climate change, warmer seasonal
temperatures, and extreme weather events, on the incidence and spread of arboviral diseases? What could this
mean in terms of the burden to public health?

Format: Your paper can
refer to any assigned course content (required/recommended readings (e.g., papers, textbook), references
provided on slides), or additional references that you find on your own. Please do NOT reference lecture slides.
Assignment Content: Your assignment can be approached in several ways, including (but not limited to) the
above prompts where you can focus on the:
1. Pathogenesis of arboviral diseases with a focus on 1 to 2 arboviruses (either dengue, chikungunya, or Zika
virus). How do these viruses cause disease and what are their symptoms? You should include a discussion of
anti-arboviral immune responses in humans. Consider how immune responses might differ in healthy versus
immunocompromised populations, and what that might mean in terms of treatment.
2. Transmission in endemic versus non-endemic regions of the Americas. What roles do vectors play and how
does our understanding of vector biology help in combatting and controlling arboviral diseases?
3. Epidemiological factors determining arboviral occurrence rates, distribution, and control of spread in
endemic compared to non-endemic regions. Do historical trends match what we are currently seeing?
Discuss the factors that might be contributing to changes in the epidemiology of arboviruses and their
vectors.
4. Focus on the treatment and prevention of arboviral diseases. What antiviral therapies are currently used to
treat patients with arboviral infections? What might be done to protect people from infection in the first
place? Do vaccines against arboviruses exist, or can we leverage our knowledge of mRNA vaccine technology
developed against COVID-19 to target arboviruses?

post a discussion in agreement or against

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Question

The evaluation topic centers on the Treat and Reduce Obesity Act of 2023, which widens Medicare coverage for intensive behavioral therapy and includes diverse healthcare providers. Additionally, the act extends coverage under Medicare’s prescription drug benefit to encompass drugs used for obesity treatment or weight loss management in overweight individuals. The evaluation will focus on assessing the effectiveness of these expanded coverage measures in addressing obesity, their influence on healthcare costs, and potential criticisms or challenges in implementation.

Question of the Evaluation Procedure/Process/Criteria and Results 

Evaluation Procedure 

The “Treat and Reduce Obesity Act of 2023” proposes Medicare amendments to address obesity. It expands coverage for behavioral therapy, involves various healthcare providers, and extends Medicare Part D to include obesity medications. The evaluation involves coordination, specific settings, and the Secretary submitting periodic reports to Congress detailing provisions and recommendations for improved coordination among federal agencies in supporting obesity research and clinical care (H.R. 4818, 118th Cong., 2023-2024). 

Process Procedure  

In addressing the obesity epidemic, the “Treat and Reduce Obesity Act of 2023” outlines key findings on prevalence and health impacts. The legislation empowers the Secretary to expand providers for intensive behavioral therapy, emphasizing coordination. Additionally, it amends Medicare Part D to cover obesity medications for weight management with comorbidities. Regular reports to Congress are mandated, detailing implemented provisions and amendments, along with recommendations for improved coordination in obesity research and clinical care (H.R. 4818, 118th Cong., 2023-2024). 

Criteria and Results 

The Treat and Reduce Obesity Act of 2023 (H.R. 4818) proposes amendments to the Social Security Act, expanding behavioral therapy providers and including obesity medications in Medicare Part D. Findings highlight obesity prevalence and related risks, with the Secretary of Health and Human Services required to report annually on Act implementation (Treat and Reduce Obesity Act of 2023, 2023). 

Discuss How Social Determinants Impact the Topic 

Health disparities persist in communities across the United States and globally, spanning various diseases. The culture of health inequities is, in part, driven by an imbalance in funding for biomedical research, originating from government agencies, private foundations, industry, and other funding sources (Shiramizu et al., 2016). The Treat and Reduce Obesity Act of 2023 acknowledges social determinants, focusing on age-related disparities in obesity rates among adults aged 60 and over. The Act expands healthcare provisions, addressing diverse needs and potential socioeconomic disparities. Periodic reporting to Congress emphasizes commitment to monitoring and mitigating systemic factors influencing obesity. In essence, the bill targets age-related disparities, enhances healthcare access, and promotes a comprehensive approach to obesity prevention and treatment (Treat and Reduce Obesity Act of 2023, 2023). 

Reflection: What did you learn about Policy Evaluation? 

In reflecting on policy evaluation, it becomes evident that nurses, regardless of their role, expertise, or education level, possess a valuable skill set in evaluating the effectiveness of their efforts. The nursing process, with its foundational step of evaluation, provides a robust framework. Moreover, the principles utilized to assess clinical interventions are transferable to program/outcomes or policy evaluation. The critical aspects of evaluating impact, effectiveness, and value are instrumental in enhancing healthcare policies and programs, meeting the needs of stakeholders, and identifying areas for improvement (Milstead & Short, 2019, p. 117). Studying H.R. 4818 highlights the essence of effective policy evaluation: addressing obesity through targeted Social Security Act amendments. Data-driven findings emphasize obesity’s impact on Medicare, with specific criteria for intervention like expanding healthcare providers and extending Medicare Part D. The bill’s structure, with clear goals and periodic reporting, showcases key elements for successful policy evaluation defined issue focus, data-driven insights, targeted interventions, and ongoing oversight for improvement.  

References 

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed., pp. 117). Jones & Bartlett Learning. 

Shiramizu, B., et al. (2016). Leading by Success: Impact of a Clinical and Translational Research Infrastructure Program to Address Health Inequities. Journal of Racial and Ethnic Health Disparities. Advance online publication. https://doi.org/10.1007/s40615-016-0302-4Links to an external site. 

Treat and Reduce Obesity Act of 2023, H.R.4818, 118th Cong. (2023-2024). https://www.congress.gov/bill/118th-congress/house-bill/4818?q=%7B%22search%22%3A%22H.R.+4818%3A+Treat+and+Reduce+Obesity+Act+of+2023%22%7D&s=1&r=1Links to an external site. 

Treat and Reduce Obesity Act of 2023. H.R. 4818, 118th Cong. (2023-2024.). GovTrack.us. Retrieved January 22, 2024, from https://www.govtrack.us/congress/bills/118/hr4818Links to an external site.

Complex Adult Health RUA Interdisciplinary Management of Healthcare

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QUESTION

TOPIC- 

Early Mobility of the Ventilated Patient

Purpose

The purpose of this assignment is for the student to present a complete picture of interdisciplinary care using specific therapeutic modalities in the care of a complex adult health client. The student will demonstrate clinical reasoning skills and will discuss interdisciplinary care that had been incorporated and/or anticipated using a healthcare technology or therapeutic modality for the care of the complex health client.

Course outcomes: This assignment enables the student to meet the following course outcomes:

1. Provide patient and family centered nursing care to adults with complex health needs using theories and principles of nursing and related disciplines. (PO 1)

2. Initiate the use of appropriate resources in direct care responsibilities within complex adult health situations. (PO 2)

3. Demonstrate effective therapeutic communication and relationship skills in family centered nursing care to adults with complex health needs. (PO 3)

4. Demonstrate effective clinical decision making based on critical thinking skills and legal, ethical, and professional standards and principles when caring for patients and families with complex adult health needs. (POs 4 and 6)

5. Implement a plan of care for continued personal, professional, and educational development related to nursing practice with complex adult health situations. (PO 5)

7. Use evidence including research findings from nursing and related disciplines to answer clinical questions related to nursing care of patients with complex adult health needs. (PO 8)

Due date: Your faculty member will inform you when this assignment is due. The Late Assignment Policy applies to this assignment.

Total points possible: 100 points

Preparing the assignment

Follow these guidelines when completing this assignment. Speak with your faculty member if you have questions.

1) Choose a therapeutic modality or healthcare technology.

2) Examples of a therapeutic modality include Extracorporeal Membrane Oxygenation, Automatic rotating pronation beds, right and/or left ventricular assist devices, nontraditional ventilator modes.

3) Examples of healthcare technology can include regional O2 saturation monitoring (NIRS).

4) Refer to your faculty member if your selection requires prior approval.

5) For writing assistance, visit the Writing Center.

6) Include the following sections (detailed criteria listed below and in the Grading Rubric):

a. Introduction 5 points/5%

The chosen therapeutic modality or healthcare technology meets one of the following criteria:

o Has been introduced recently at the bedside for care of the complex adult patient.

o Is a non-traditional modality for very ill patients in special circumstances.

o Is being used in a new way to treat a patient with complex needs.

o Requires specific training above and beyond general entry-level nursing education.

Introduce the therapeutic modality or healthcare technology.

Name the therapeutic modality or healthcare technology.

A brief fictional case is used to illustrate the therapeutic modality or healthcare technology.

b. Explanation and Background15 points/15%

Include a clear QUESTION of the therapeutic modality or healthcare technology.

  • Discuss how the therapeutic modality or healthcare technology works.

Describe the patient population it is used for.

Include medication, safety, and cost considerations as applicable.

c. Risks and Benefits15 points/15%

Describe how the therapeutic modality or healthcare technology can benefit the patient.

  • Discuss ways to promote positive outcomes.
  • Explain the complications that may arise.
  • Discuss considerations for preventing complications.

d. Interdisciplinary team’s Roles and Responsibilities20 points/20%

  • Identify all interdisciplinary team members caring for the patient, such as respiratory therapy, assistive personnel, providers, case managers, clinical nurse specialists, and researchers.
  • Describe the roles and responsibilities of each member of the healthcare team that is involved in the use of the therapeutic modality or healthcare technology.
  • Discuss the roles and responsibilities of the nurse as a member of the interdisciplinary team caring for the patient.
  • e. Nursing Scope of Practice 15 points/15%

Discuss the knowledge needed for the Registered Nurse to provide care for the patient using the therapeutic modality or healthcare technology.

  • Describe skills needed for the Registered Nurse to provide care for the patient using therapeutic modality or healthcare technology.
  • Discuss attitudes needed for the Registered Nurse to provide care for the patient using therapeutic modality or healthcare technology.
  • f. Patient Education 20 points/20%
  • Describe the information to be taught to the patient and/or family.

Discuss how information will be taught.

  • Discuss potential cultural considerations to teaching
  • Explain how the effectiveness of the teaching will be evaluated.
  • g. Conclusion 5 points/5%

Provide a summary of the paper.

  • No new information is introduced.
  • Include additional resources for further learning.

CCC Diagnosing Kawasaki Disease Strawberries and Symptoms Discussion

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Question

Peer response to Adam

  • A 10-year-old Asian patient presents with an erythematous maculopapular rash, conjunctivitis, a mild fever of 102.1 and a strawberry tongue. The rash started 4 days ago. How are you going to evaluate this patient? What is the differential diagnosis for this patient? Describe your treatment plan based on current guidelines.

The “strawberry tongue” noted in the prompt immediately draws one’s mind to Kawasaki disease (KD). This thought is then supported by the other information given. Diagnostic criteria for KD include fever for at least 5 days along with 4 out of 5 other criteria to include: 1) conjunctival injection without exudate, 2) oral or pharyngeal erythema or strawberry tongue, 3) erythema or edema in the feet and hands or periungual desquamation, 4) maculopapular rash, and 5) cervical lymphadenopathy (Gorelik et al., 2022). The patient’s Asian ancestry also makes KD more likely (Owens & Plewa, 2023). The patient has fever and 3 other diagnostic criteria, although we do not know how long the fever has been present. If cervical lymphadenopathy or feet and hand erythema and edema are present, complete criteria for KD would be present (Gorelik et al., 2022).

Evaluation for suspected KD should include a CBC, CMP, ESR, CRP, and UA. Expected findings in KD would be low hemoglobin, elevated serum WBC, elevated platelet count, low serum albumin, elevated liver enzymes, elevated inflammatory markers, and sterile pyuria (Owens & Plewa, 2023). Other findings that may be present on labs are elevated bilirubin, elevated Pro-BNP, and a positive finding on a viral respiratory panel (Owens & Plewa, 2023). Current or recent viral respiratory infection is a common finding in patients diagnosed with KD and siblings of patients that have had KD are 10-20 times more likely to experience the illness (Owens & Plewa, 2023). These facts make a thorough history very important. If KD is diagnosed, an echocardiogram is the only necessary test and it will rule out coronary artery aneurysm (Owens & Plewa, 2023).

There are many differentials based on clinical findings of KD. Some of these include peritonsillar abscess, retropharyngeal abscess, group A strep pharyngitis, measles, scarlet fever, rheumatic fever, rocky mountain spotted fever, adenovirus, enterovirus, meningitis, and mononucleosis, among others (Owens & Plewa, 2023). The large number of possible differentials makes the history and thorough physical examination even more important.

If a diagnosis of KD is made, the most current clinical practice guidelines were released in 2021 by the American College of Rheumatology and the Vascular Foundation. Treatment is somewhat based on echocardiogram findings, so at diagnosis, an echo should be done (Gorelik et al., 2022).  Intravenous immunoglobulin (IVIG) is the standard treatment for KD (Gorelik et al., 2022). 2 gm/kg over 10-12 hours has been suggested (Owens & Plewa, 2023). If the patient is less than 6 months old or has a Z-score greater than or equal to 2.5 in the left descending or right coronary artery following echocardiogram, either glucocorticoids or an immunomodulatory agent should be added to the IVIG treatment (Gorelik et al., 2022). With persistent fever or a return of fever within 36 hours of this treatment, it should be repeated (Gorelik et al., 2022). A third treatment of only glucocorticoid or immunomodulatory agent may be considered if the fever again returns or persists within 36-48 hours after the second treatment (Gorelik et al., 2022). Use of high dose aspirin is also strongly recommended in acute KD while fever persists (Gorelik et al., 2022). Doses of aspirin range from 80-100 mg/kg/day divided every 6 hours (Owens & Plewa, 2023).

References

Gorelik, M., Chung, S. A., Ardalan, K., Binstadt, B. A., Friedman, K., Hayward, K., Imundo, L. F., Lapidus, S. K., Kim, S., Son, M. B., Sule, S., Tremoulet, A. H., Van Mater, H., Yildirim?Toruner, C., Langford, C. A., Maz, M., Abril, A., Guyatt, G., Archer, A. M., … Mustafa, R. A. (2022). 2021 American College of Rheumatology/Vasculitis Foundation guideline for the management of Kawasaki Disease. Arthritis & Rheumatology, 74(4), 586–596. https://doi.org/10.1002/art.42041

Owens, A. M., & Plewa, M. C. (2023). Kawasaki Disease. In: StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK537163/

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Nursing Role and Scope

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QUESTION

Peer response 1: ANA 

In the realm of clinical experiences, behaviors demonstrating authority and the acceptance of responsibility are pivotal to the operation of healthcare environments. One distinct observation of authority was noted in the behavior of a senior nurse overseeing the admission process of new patients. This individual’s demonstration of authority was characterized by clear communication, decisiveness, and the ability to delegate tasks effectively. The senior nurse provided direct instructions to junior nurses and healthcare assistants, ensuring that all necessary steps were taken for the patients’ admission, including documentation and initial health assessments. The clarity of instructions, coupled with a confident demeanor and the capability to make swift decisions, underscored the senior nurse’s authoritative role.

In contrast, a memorable instance of an RN (Registered Nurse) accepting responsibility occurred in a situation where there was a delay in administering medication to a patient due to a miscommunication. The RN, upon realizing the mistake, immediately acknowledged the oversight to the patient and their family. This acceptance of responsibility was done openly and sincerely, with the RN explaining the cause of the delay and the steps that would be taken to prevent such occurrences in the future. Additionally, the RN informed the supervisory staff about the incident and participated in a review of communication procedures within the team.

These observations highlight the importance of authoritative behavior and the acceptance of responsibility in clinical settings. The ability to command respect and ensure efficient workflow, as demonstrated by the senior nurse, is essential for maintaining order and ensuring patient care standards. Similarly, the willingness to accept responsibility, as shown by the RN, is crucial for building trust with patients and their families, as well as fostering a culture of accountability and continuous improvement within healthcare teams.

These reflections are based on direct observations during clinical rotations and underscore the significance of leadership qualities and professional accountability in nursing practice. Such behaviors not only influence the quality of patient care but also contribute to the professional development of nurses and the overall effectiveness of healthcare teams.

References:

Johnson, A., & Thompson, B. (2021). *Leadership in Nursing Practice: Understanding Authority and Responsibility*. Philadelphia, PA: Lippincott Williams & Wilkins.

Martinez, L. F., & Garcia, E. P. (2020). “Accountability in Nursing: A Review of Responsibility Acceptance in Clinical Incidents”. *Journal of Clinical Nursing Studies*, 8(3), 112-118. https://doi.org/10.1016/j.jcns.2020.05.00

Peer response 2: DAYANA

A critical situation where an individual was a leader but needed to have the role of a manager is when the team leader empowered the nurses by sharing information regularly. Sharing information plays a critical role in gaining trust among the team members. That enables the nurses to act responsibly since all the team members are aware of the problems and situations they will encounter (Munro & Hope, 2020). The nurses have an opportunity to focus on achieving the desired outcomes and include the amount of excellence required to remain productive.

A situation in which a manager needs more ability to lead a group of people is when the team leader needs more effective communication skills. For managers to succeed in overseeing teams, they must have effective communication. It is worth noting that each group member has a unique personality, and there are possibilities of miscommunication (Afriyie, 2020). Failure to communicate effectively meant that the nurses could not do what they were expected of them and complete it on time.

A situation in which a manager is also a leader is when the human resource manager is mindful and growth-oriented. It is worth noting that the best leaders should have the ability to incorporate mindfulness into their activities within the organization. Whenever leaders and managers become mindful and self-aware, they always motivate the best of the nurses to become the best of themselves. Another situation is when the manager remained transparent, hence behaving like a leader. That included sharing information with all the nurses within the healthcare organization as a way of building trust. Transparency provides employees with an opportunity to communicate honestly, hence developing solutions to their challenges.