Monthly Archives: May 2023

Everyone should have an approved topic for your final paper on an ethical dilemma of your choosing. This week’s assignment is to write the first, and most important, part of your paper ( my topic is  Incompetent/Impaired Nurses )

This is the Introduction—Summary of What is Known about the Issue (See Grading Rubric for Final Paper)

1. Why is this topic important to investigate?
2. What is the scope, context and significance of the topic as an ethical dilemma?
3. Highlight the importance of the problem/issue and make general statements about the problem/issue
4. Summarize the current understanding and background information about the topic
5. Include one referenced source that will support your introductory thoughts about your topic.
6. APA 7th edition format; full sentences, attention to grammar

Complete a 2-year professional career development plan.

  o Include your short- and long-term objectives and goals.

  o Evaluate your present position in relation to these goals and create a list of your current experience and    skills.

  o Identify your strengths and weaknesses and those areas that need further development.

  o Prepare a plan of action to achieve your goals.

    • Write a 2-3 page paper in APA format, include a cover page.

 I NEED A RESPONSE TO THIS ASSIGNMENT

2 REFERENCES

Diagnosis from Diagnostic and Statistical Manual of Mental Health Disorders, DSM-5 and justification

The most likely DSM diagnosis for the patient is Major Depressive Disorder, recurrent episode, severe with psychotic features.

I diagnosed the patient with Major Depressive Disorder, recurrent episode, severe, with psychotic features because of the symptoms she is exhibiting like being sad, anxious, depressed most of the time, cutting self ,suicide attempts by overdose on acetaminophen. He continues to be withdrawn to self. According to the American Psychiatric Association (2013), this diagnosis can be specific if the patient exhibits signs of anxiety, with melancholic features; or mixed with atypical features and mood-incongruent psychotic features. Also, if the patient has during the same 2-week period shown five or more of the following symptoms: In the case study the patient continues to manifest

Depressed mood example, feeling sad, empty, or hopeless (most of the day, nearly every day) 

 clearly diminished or loss of interest or pleasure in all, or almost all, activities most of the day, nearly every day

-Feelings of worthlessness as stated by patient after the breakup.

-Fatigue and loss of energy nearly every day

-Insomnia nearly every day.

-Recurring and persistent suicidal ideation without or a suicide attempt or a precise plan for committing suicide.
The above symptoms enumerated are based on what is specific on the patient from the list in the DSM-5 because this is what the patient presents with (American Psychiatric Association, 2013). Also, Oyama and Piotrowski (2013), states that depression is mostly used to express diverse feeling.

Explain group Therapeutic Approaches you might use with this Client

CBT is the treatment modality I will use to treat the client through cognitive restructuring and positive self-talk to eliminate negative thoughts. It attempts to correct cognitive distortions, particularly negative conceptions of one’s self.

Possible ways of coping with these feelings discussed along with activities that may help to reduce the symptoms.

Explain Expected Outcomes for the client based on these Therapeutic approaches

Open Communication with therapist and staff about depression

Improved sleep patterns

Reduced Anxiety

Legal and/or ethical implications related to counseling each client

            Ethically both the child and parents should be involved in the child’s healthcare decisions. According to Vitello (2013the parents give legal consent for treatment and thus the physician ought to carry the parent along with treatment plans, and medication management. Communication is important because any misunderstanding between parent and prescribers’ instruction can be harmful to the child. Effective communication between the parent and the provider is important because the parent is accountable to guarantee that the child is medicated as ordered and to report any adverse effect. Purnell (2014) advices that understanding communication styles, the cultural variances and values, and other communication competencies is important to be acquainted with the patients from different cultures.  

References

American Psychiatric Association. Task Force on DSM-IV. (2013). Diagnostic and statistical      manual of mental disorder: DSM-IV. Washington, D.C.: American Psychiatric.

Oyama, O. P., & Piotrowski, N. P. (2013). Depression. Magill’s Medical Guide (Online Edition).

Purnell, L. D. (2014). Guide to culturally competent health care. F.A. Davis.

Vitello, B. (2013). How effective are the current treatments for children diagnosed with    manic/mixed bipolar disorder? CNS Drugs, 27(5), 331-333. doi:10.1007/s40263-013-     0060-3 https://mym.cdn.laureate-  media.com/2dett4d/Walden/NURS/6630/02/mm/therapy_for_pediatric_clients_with   mood disorders/1.html

1. Discuss your state NP community in terms of scope of practice. Include the your state’s scope of practice for NPs including: ( I leave in Maryland)
   • Level of independence of practice 
   • Prescribing authority 
   • Any limitations of practice 
   • Process for obtaining licensure in your state 
   • Certification and education requirements for licensure. 
2. If you live in a restricted or reduced practice state, how has patient care been impacted in your local community from these barriers?  For instance, is the ED used for primary care?  Are the EDs overcrowded with long wait times?  Are there urgent care clinics readily available? Is there adequate access to primary care?  If you live in a full practice, how has independent practice of the APN resulted in improved patient access to healthcare?   
3. How does access to NPs impacts any healthcare disparities?  

• Consider how patient care has been impacted in your local community by these practice barriers.
  • For instance, is the ED used for primary care?
  • Are the EDs overcrowded with long wait times?
  • Are there urgent care clinics readily available?
  • Is there adequate access to primary care?
  • Are your rural communities adequately served?
  • What healthcare limitations are present in your communities?
• Consider how unrestricted, independent practice of the APRN resulted in improved patient access to healthcare?
• Include in your discussion how access to NPs impacts any healthcare disparities. 
  • Be sure you clearly understand the concept of “health disparities” as you address this portion of the discussion.

As a reminder, all writing submitted should reflect graduate student quality and APA writing rules. All writing informed by outside sources should include APA formatted citations and associated scholarly, current references.

Buppert, C. (2017). Nurse practitioner’s business practice & legal guide (6th ed.). Burlington, MA: Jones & Bartlett.

• Chapter 8 – Risk Management

Letz, K. (2017). The NP guide: Essential knowledge for nurse practitioner practice. (3rd ed.). American College of Nurse Practitioner Faculty. Las Vegas, NV.

• Chapter 11 – Justifying and promoting the profession

Teitelbaum, J. B., & Wilensky, S. E. (2017). Essentials of health policy and law (3rd ed.). Burlington, MA: Jones & Bartlett Publishers.

• Chapter 13 – Public Health Preparedness policy

I need someone who can answer quiz online questions emergency nursing

it is 10 question in 30 min

the quiz will start after 3 hours

Attention Wizard Kim       

Please pay attention to Week 8 Discussion: Quality indicators in Long-term care and Home health care.

 Please pay attention to learning resources for citations.

 Response 1

TC presents to urgent care with a right-shoulder pain 8/10 due to a work injury. The patient has no ROM in the effected shoulder and reports no neck pain. As a healthcare provider there are several things that need to be asked to understand this patient’s pain and pain management. How the injury occurred, if the pain gets better or worse with anything, how long has this pain been occurring for, and what type of pain is TC experiencing should be asked (Woo & Robinson, 2020). The patient should also be assessed for any depression or anxiety via a mental health screen for a history as well as to see if the pain is causing any changes in affect. A past medical history as well as a full physical exam should also be completed prior to making recommendations for pain management. Asking the patient if he is currently on any medications, specifically pain medications will be a useful tool to help decide what treatment will work best for this patient. In addition, allergies need to be considered.
The goal of pain management is to treat the pain but with the least adverse reactions possible (Woo & Robinson, 2020). The best way to accomplish this is to start with non-pharmaceutical management. Ice would be my first recommendation when the patient arrives. If upon assessment this patient has an injury that is affecting the muscle or tendon as most shoulder pain from work occurs from than ice can be put on the patient (Workers Injury Law and Advocacy Group, 2020). The patient’s pain being an 8 out of a 10 on the 0-10 scale however would alert me to give him at least an anti-inflammatory medication as well if not contradicted by information gathered during the history intake and physical examination. I would give TC 1,000mg of acetaminophen due to his high pain scale every 4 to 6 hours (Harvard Health, 2020). This patient may be asked for a urine sample as well for a tox screen to ensure there will be no medication contradictions as well as to assess if this patient is a drug seeker. If this were not sufficient for pain control and there were no other contradictions noted I would try a low dose of hydrocodone.
Instructions for TC would include to rest the shoulder and to ice the shoulder for 10-15 minutes at a time for the first day or two of the injury (Michigan Medicine, 2018). Instructions for acetaminophen include taking with some food to avoid GI upset as well as to not mix with alcohol or loop diuretics, beta-adrenergic blockers, or zidovudine medications (Woo & Robinson, 2020). If the patient were on one or more of these medications I would consider using a non-steroidal anti-inflammatory (NSAID) medication instead of acetaminophen such as Naprosyn. Also, the patient should not exceed the total daily maximum of 4,000mg per day as acetaminophen poisoning is common and dangerous (Woo & Robinson, 2020). Instructions for hydrocodone include not to take with alcohol or other opioid medication. Hydrocodone can cause respiratory distress, low blood pressure, altered mental status, nausea, vomiting, hallucinations, incoordination, constipation, and lethargy (Woo & Robinson, 2020). TC should be instructed not to drive while taking this medication. All opioid medications can become addictive as well so screening and education on this topic is also vital for TC. Lastly I would inform TC to follow-up with his provider and return to urgent care if symptoms get worse or new ones arise.
The DEA Drug Classification Schedule has five categories. Schedule one includes substances that are not for medical purposes or have not been legally endorsed for medical purposes and are highly abused when used such as heroin (DEA, 2020). Schedule two are also high risk for abuse however are used in a medical setting for example hydromorphone. Schedule three includes medications like Tylenol/Codeine which have a less risk of addictive abuse but still could be abused (DEA, 2020). Schedule four medications have a low risk for abuse and addiction as consequence of consumption and they include medications such as Ambien (DEA, 2020). And lastly, are schedule five drugs which do not contain the same narcotic properties as the other categories of drugs. This would include cough syrup and Lyrica (DEA, 2020).

Response 2

The treatment plan for pain has been a much-discussed topic with different opinions that may have pharmacological companies and government agencies at odds of how to treat pain in this country. The one thing everyone agrees is that pain is “real” and affects millions of people worldwide with ineffective treatment for different reasons. According to Woo (2020), pain can be defined as the duration of the pain is either acute or chronic and the source of the pain. The attempt by large corporations in the late 1990’s to treat pain resulted in millions of people dying of an overdose or with addiction that has cost millions of dollars in healthcare treatments (CDC, 2020). In this case study, there are a few things to consider.

        TC comes to the clinic due to a work-injury with an 8 out of 10 pain and is unable to do ROM to the shoulder. The first action that this clinician would take is to assess the patient’s shoulder, his skin, and also take a detailed history of medications, and allergies. After identifying TC’S home medications, if any, and allergies, this prescriber prescribes a fast-acting opioid medication to help with the pain such as morphine. The next step would be sending TC to do an X-Ray and possible follow-up with orthopedic.

        While treating TC for acute pain with opioid morphine is important to understand that this treatment option would be just until his pain is controlled and the necessary X-rays and other tests are obtained. Understanding that the inflammatory process has started the moment the injury occurred as a body’s defense mechanism and healing process (Roma et al., 2020). In this situation, an anti-inflammatory, NSAIDs such as Ibuprofen could be prescribed to control his pain, if there were no fracture noted. The use of an NSAID would decrease the need to use an opioid which is associated with chemical dependency (Woo, 2020). Also, a topical agent could be prescribed in adjunction with the NSAID to help in the treatment of the pain. By prescribing the Lidocaine patch to be applied to the site would help in the control of pain with continuous therapy.

        The teaching to TC would include following the instructions from the orthopedics. Take medications as prescribed. When taking NSAIDS make sure to take with food and a full glass of water and stay up for at least 30 minutes to prevent any GI disturbance, do not take any other medication that is not approved by the clinician, and report to the clinician if the pain is at a comfortable level. Educate TC to report to the clinician if the pain is increasing and the injury is not getting any better to contact the clinician and not to initiate any home remedies without first consulting a prescriber.

        The classification of medication according to the US Drug Enforcement Administration (DEA) drug classification scheduled is to guide prescribers into prescribing drugs. It is designed to regulate the manufacturing, distribution, and dispensing of medications classified as “controlled” (Woo, 2020). The schedule is bound to follow those rules. It is divided into five categories. Scheduled I is drugs that are not prescribed for medical use and have a high potential for abuse, for example, heroin, LSD, marijuana, ecstasy, methaqualone, and peyote (DEA, 2020). In the scheduled II are drugs with high potential for abuse, and may lead to psychological or physical dependency, some examples are Vicodin, Dilaudid, Demerol, OxyContin, Fentanyl, Dexedrine, Adderall, and Ritalin (DEA, 2020). In the scheduled III comes drugs with moderate potential for abuse which are Tylenol with codeine, ketamine, anabolic steroids, and testosterone (DEA, 2020). In Scheduled IV are drugs with low potential for abuse or dependence, some are Xanax, Soma, Darvon, Darvocet, Valium, Talwin, Ambien, and Tramadol (DEA, 2020). Lastly, comes the schedule V which are drugs with low potential for abuse, and contains preparations with a limited quantity of certain narcotics. It is mostly used as an antidiarrheal, antitussive, and analgesic needs, some examples are Robitussin AC, Lomotil, Motofen, Lyrica, and Parepectolin (DEA, 2020). This classification is an important tool for the prescriber to follow and understand how each medication is used and the level of addiction that it can have in patients.

 Respond with a  well-developed paragraph (300–350 words to each peer), integrating an evidence-based resource that is different than the one used for the initial post.

Respectfully agree and disagree with your peers’ responses and explain your reasoning by including your rationales in your explanation.
 

After reading chapters seven (7) and eight (8), choose one of the following conditions and discuss the implications and potential solutions nurses can offer to the older adult.

when writing your weekly discussions: – A minimum of three paragraphs per DQ. Each paragraph should have a minimum of three sentences.

All answers or discussions comments submitted must be in APA format according to Publication Manual American Psychological Association (APA) (6th ed.) 2009 ISBN: 978-1-4338-0561-5

Discussions must have a minimum of two references, not older than 2015.

Part (1)  After discussion with your preceptor, name one financial aspect, one quality aspect, and one clinical aspect that needs to be taken into account for developing the evidence-based change proposal. Explain how your proposal will, directly and indirectly, impact each of the aspects.

Part {11}  Now that you have completed a series of assignments that have led you into the active project planning and development stage for your project, briefly describe your proposed solution to address the problem, issue, suggestion, initiative, or educational need and how it has changed since you first envisioned it. What led to your current perspective and direction?

 Identify a population to assess and develop an evidence-based, primary care health promotion recommendations to deliver in their own communities (Ex: Hispanics-Diabetes, Africanamericans and Prostate Cancer,etc).