Monthly Archives: May 2023

1. In your own words explain what the 2 step TST is and why it is used?  This is NOT a description of the TB test itself.  It is the use of the TWO step test, which is not simply a description of the procedure.

2. In your own words explain the diagnostic tests used for influenza and why they are important (in addition to knowing what the patient has)?  

3. “How does smoking affect my lungs?  Why does it increase my risk of developing COPD?”

Again, full credit if in your own words.  The book is an excellent resource about this, but you need to be able to explain it to a lay person!

please read each assignment carefully and complete!

A 47-year-old obese female complains of pain in her right wrist, with tingling and numbness in the thumb and index and middle fingers for the past 2 weeks. She has been frustrated because the pain causes her to drop her hair-styling tools.

Use the Episodic/Focused SOAP Template and create an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each

As we have discovered over the past few weeks, the U.S. has continued to see increasing incidence of diabetes as one of the top eight disease burdens.  The prevalence has increased globally with a ranking of 3rd in 2016 for the leading cause of disabilities in the U.S. (The U.S. Burden of Disease Collaborators, 2018). This is even more alarming with the world’s aging population who is at greater risk for developing diabetes and the multitude of complex complications.  Adults 60 years or older often have higher co-morbidities secondary to age that when combined with diabetes lead to diabetes-related conditions, such as myocardial infarctions, lower extremity amputations,  renal disease, cognitive impairment and dementia, and visual disturbances, which place them at higher risks for death and disability (Valencia et al., 2018). Diabetes management continues to be essential in the prevention of diabetes related complications. Evidence has shown that diabetes self-management, medication management, dietary compliance and exercise, and patient education continue to be primary interventions in the management of this complex disease. However, as these have not demonstrated improvements in glycemic control or prevention of hypoglycemic serious events, the need to add additional interventions utilizing technology are warranted.  One such intervention is the addition of continuous glucose monitoring in both type 1.

Continuous glucose monitoring (CGM) has arisen over the last decade initially as an adjunct treatment to finger sticks and A1C monitoring (Hirsch et al., 2019).  In response to patient preference, compliance with treatment and monitoring plans, quality of monitoring, and cost effectiveness, more studies and evaluation of CGM has emerged. In addition, the need to prevent serious complications related to hypoglycemic events also led to more research and trials in the use of continuous glucose monitoring (Bergenstal, 2018).   

In our organization, most patients do not continue using their insulin pumps or continuous glucose monitors during acute events in the hospital. Implementation of a research-based intervention such as CGM for Type 1 diabetics would allow for stabilization of patient glucose levels and prevent serious complications related to hypoglycemia that we often have seen.

What are the potential benefits and harms related to your selected practice problem when considering a research-based intervention for your practice change project?

The use of CGM in diabetes is believed to allow for several benefits. First, it can assist in the prevention of hypoglycemia in patients who often are not aware of extreme drops in glucose levels.  Routine finger glucose sticks were often the standard in diabetic monitoring but were not always performed as scheduled or felt to be of high importance to adults with diabetes. CGM allows for real time data to be reviewed by patients; can identify quick changes in the patient’s glucose levels with meals or exercise and warns patients of hypoglycemic events that may otherwise have been unnoticed (Bergenstal, 2018).  Studies have shown that the use of CGM has allowed for better control of A1C levels, less time in hyperglycemic events, and decreased incidences of severe hypoglycemic events (Hirsch, et al., 2019).  Using the CGM during the hospitalization allows for monitoring of glucose levels during times of stress and acute illness and can be essential in the prevention of hyper-hypo events during periods of NPO status related to diagnostic testing.

Studies have shown some concerns related to CGM especially in the use of older adults. First, as with any new technology, patients must receive product instructions and all educational information related to the therapy.  To perform this implementation, several guidelines to ensure safe and ethical patient practices must be followed. Our goals for the intervention should answer clear questions regarding the purpose and benefits that CGM will provide to our patients. Patients are to be provided education regarding the monitoring that will occur and should have their privacy maintained, updated on any changes in their treatment plan, and monitored closely for any adverse effects during their hospitalization (NIH).  Older patients may not have a clear understanding of this advanced treatment or how the use of smart phones or recording devices work. They may need additional education and support while hospitalized.  

Are there competing personal or professional values related to this research-based intervention that might impact the implementation of this intervention in your practice setting?

There are several types of devices that could be used our intervention. We would wish to reduce bias and evaluate the benefits and impediments of various models prior to implementation.  Cost effective monitors would be preferred but not at the expense of utilizing a poorly reviewed technology that does not have quality outcomes for our patients. In review of types of CGM, there are newer models that are inserted into the subcutaneous tissue and allow for quick removal if needed. Previous studies show these to be effective and safe for insulin dosing but do need further evaluation of hypoglycemic events (Elshimy & Correa, 2020).  As it would be necessary to ensure accuracy of glucose levels via the continuous monitors, fingersticks, and lab draws may still be needed. Patients may be confused as to why they are receiving multiple interventions. We would wish to reduce patient fears and anxiety by supporting and re-educating as needed.

In addition, education to nursing staff and providers is essential prior to implementation of this intervention.  With some current challenges with nurse staffing in our organization, there may be barriers to nurse buy-in with additional tasks being assigned to them during the trial. I would wish to ensure that nurses understand the reason for the trial and can engage in their importance to prevent events of hypoglycemia and improve patient outcomes.

What types of objections might be raised? How will you explain your decision to key stakeholders to address these objections?

Some objections related to the intervention may be related to the inexperience and knowledge of providers and nursing staff. Some may find the process to perform the data retrieval as difficult or as added tasks to the workload. There may also be barriers related to cost and accuracy. Sharing that CGM has noted accuracy of a 10% absolute difference when compared to capillary glucose results may reduce these concerns (Elshimy & Correa, 2020).  Training superusers to better understand the CGM, provide education to patients, and insert the monitor can assist with workflow and quality controls during the hospitalization (Hirsch et al.., 2019).  In addition, the cost of this intervention may be covered by insurance or Medicare dependent upon the patient’s current diabetes management.   

The continuation of a CGM is shown to improve glycemic control for patients and could be worn for up to 14 days. This could provide clearer results for primary care physicians upon retrieval after discharge.  There would be the need to continue patient education and understanding related to care for the monitor as well as any self-management interventions based upon glucose results.  Education on the monitor screen and retrieval of results would be needed.  If older or cognitively challenged patients have difficulties with manipulation or understanding of the CGM, it may require removal and return to standard treatment modality and fingersticks may be needed. Teach-back for patient education is necessary in the evaluation for safe glucose monitoring and care after discharge (Hirsch et al., 2019).

Diabetes continues to be a leading healthcare concern and relies upon various modalities of self care in the maintenance of glucose levels.  Using continuous glucose monitoring while in the hospital could prevent episodes of hypoglycemia that many diabetics are prone to during acute illness. There is evidence that this intervention has been successful in maintaining glucose control in type 1 diabetics and is being evaluated more often now in the treatment for type 2 as well. 

I need a comment for this discussion board at least 2 paragraphs and 2 sources no later than 5 years.

What are social determinants of health?  Explain how social determinants of health contribute to the development of disease.  Describe the fundamental idea that the communicable disease chain model is designed to represent. Give an example of the steps a nurse can take to break the link within the communicable disease chain.

Resources within your text covering international/global health, and the websites in the topic materials, will assist you in answering this discussion question.

Due Date: Tuesday 22

POST1 

Professor Question 

Thank you for your main post regarding success strategies as an online learner.  You have noted the value of prioritizing as a time management skill.  Are there other skills you can think of that might support you?  With your comment regarding “perfection” – this can be a barrier to completing your assignments on time.  How do you propose getting around this?     

My Initial Post

             Nursing education can be challenging. However, it is crucial for all learners to be willing to go through these challenges in order to gain new skills that will be of help in the practice setting. Most nurses find it hard to close the gap between theory and practice, especially for those who are newly transitioning into practice (Windey, 2017). In this discussion, I will present one strategy that has enabled me to become better when it comes to technology use over the years especially in as far as my education and profession are concerned. In both cases, I have mastered ways of maneuvering through different databases especially in nursing research. This has been very advantageous to both my academic progress as well as my practice. In nursing, research is inevitable especially if evidence has to be the basis of practice (Black et al., 2015). Optimizing on tools that are offered by different databases when searching for evidence or when doing an academic paper has allowed me to not only make good use of technology but also completing these activities in an effective manner. 

 I tend to take so much time before finishing some activities   and this is because of the need to perfect what I do. This is good but I can make improvements on time management in order to be more efficient. One strategy that I should consider when it comes to time management is prioritizing. This is a strategy that I believe shall allow me to know what to do first before moving to the next thing. I should also consider the use of a rapid planning model and effective decision making depending on the prevailing circumstances and the tasks that need to be completed. As a student and practitioner, I have to capitalize on critical thinking especially in the making of decisions. This is always considered to be important for patient outcomes (Chen, Chen & Pai, 2019).

References

Black, A. T., Balneaves, L. G., Garossino, C., Puyat, J. H., & Qian, H. (2015). Promoting evidence-based practice through a research training program for point-of-care clinicians. The Journal of Nursing Administration, 45(1), 14

Chen, F. F., Chen, S. Y., & Pai, H. C. (2019). Self-reflection and critical thinking: The influence of professional qualifications on registered nurses. Contemporary nurse, 55(1), 59-70

Windey, M. (2017). Transition to Practice: Sharing Experiences and Insights. Journal for Nurses in Professional Development, 33(1), 42

POST 2

PROFESSOR QUESTION

 I  love learning  about your mission to impact through social change the nursing profession.  Your missing is to enhance and promote the dignity and respect for our wonderful profession.  As you know, nurses are considered the “most trusted” profession.  I know for myself, I have patients who rely on my as there main health care provider for a variety of issues, and typically will first check with me prior to make health care decisions…..and I am in a “specialty practice”. 

   Have you experienced any barriers to your mission?  If so, what were your lessons learned? 

Initial Post

             Social change is one of the greatest focus that is presented in the mission and vision of Walden. Health professionals are prepared to be able to meet the current and emerging challenges in the health care delivery system. This standpoint by Walden is properly aligned with the AACN competencies. The competencies are related to different domains including patient care, knowledge and practice, practice-based learning and improvement, professionalism, interpersonal and communication skills, personal and professional development, interprofessional collaboration and systems-based practice. When health workers are properly prepared to meet the competencies in all these domains, it means that they are not only ready to handle the challenges in the health care industry but also that they are ready to bring the desired social changes in their areas of practice and to the nursing profession.

 Nurses are considered to be agents of change (Rafferty, 2018). This is how see myself as I pursue my professional and career goals. One of the most important aspects of my individual nursing philosophies is that I should be able to use all the available tools in order to bring the necessary social changes as a nurse. One tool that is always appreciated as a tool for change in population health is advocacy. I believe in the power of good policies in bringing desirable changes in the health care industry. As such the standpoint by Walden on social change is something that I resonate with (Williams, Phillips & Koyama, 2018).

 Thus, one of my professional goals is to continue to promote the respect and dignity of the nursing profession. A second professional goal is to make use of the current evidence to bring the best outcomes in my area of practice. The ability of evidence in influencing outcomes is a well-known relationship (Li, Cao & Zhu, 2019). From the two goals, it is clear that I have properly integrated Walden’s standpoint on social change in my professional goals. 

References

Li, S., Cao, M., & Zhu, X. (2019). Evidence-based practice: Knowledge, attitudes, implementation, facilitators, and barriers among community nurses—systematic review. Medicine, 98(39)

Rafferty, A. M. (2018). Nurses as change agents for a better future in health care: the politics of drift and dilution. Health Economics, Policy and Law, 13(3-4), 475-491.

Williams, S., Phillips, J., & Koyama, K. (2018). Nurse advocacy: Adopting a health in all policies approach. Online Journal of Issues in Nursing, 23(3)

Reply separately to two of your classmates posts (See attached classmates posts, post#1 and post#2). 

INSTRUCTIONS:

Your responses should be in a well-developed paragraph (300-350 words) to each peer. Integrating an evidence-based resource!

Note: DO NOT CRITIQUE THEIR POSTS, DO NOT AGREE OR DISAGREE, just add informative content regarding to their topic that is validated via citations. 

– Utilize at least two scholarly references per peer post. 

Please, send me the two documents separately, for example one is the reply to my peers Post #1, and the second one is the reply to my other peer Post #2.

– Minimum of 300 words per peer reply.

– TURNITIN Assignment.

Background: I live in South Florida, I am currently enrolled in the Psych Mental Health Practitioner Program, I am a Registered Nurse, I work in a Psychiatric Hospital.

Capstone Project Change Proposal Presentation for Faculty Review and Feedback 

Create  a professional presentation of your evidence-based intervention and  change proposal to be disseminated to an interprofessional audience of  leaders and stakeholders. Include the intervention, evidence-based  literature, objectives, resources needed, anticipated measurable  outcomes, and how the intervention would be evaluated. Submit the  presentation in LoudCloud for feedback from the instructor.

While  APA style is not required for the body of this assignment, solid  academic writing is expected, and documentation of sources should be  presented using APA formatting guidelines, which can be found in the APA  Style Guide, located in the Student Success Center.

You are not required to submit this assignment to LopesWrite.

See attachments belowsomeone to write this paper on the black panther a new paper not a previous written paper 

For this Assignment, you will examine the stakeholders impacted by the implementation of the Affordable Care Act (ACA). Your paper must include the following topics:

• Differentiate between at least three groups of stakeholders impacted by the ACA.
• Examine the financial impact of the ACA on each group of stakeholders.
• Summarize benefits of the ACA on each group of stakeholders.
• Summarize drawbacks of the ACA on each group of stakeholders. 

The word count for your paper, excluding the title page and references page, will be 800-1200 words. You must include a minimum of (5) different scholarly references.

Assignment Requirements

Before finalizing your work, you should:

• be sure to read the Assignment description carefully (as displayed above);
• consult the Grading Rubric (under the Course Resources) to make sure you have included everything necessary; and
• utilize spelling and grammar check to minimize errors. 

 Your writing Assignment should:

• follow the conventions of Standard English (correct grammar, punctuation, etc.);
• be well ordered, logical, and unified, as well as original and insightful;
• display superior content, organization, style, and mechanics; and
• use APA formatting and citation style.