Describe two external stressors that are unique to adolescents. 

Discuss what risk-taking behaviors may result from the external stressors and what support or coping mechanism can be introduced.

What’s good or bad about bacteria

Module 4 Discussion

Nicole Bachich

St. Thomas University

This patient is a 75-year-old woman who presents with complaints of chest pain. Chest pain is a common presenting symptom with various causes (Ayerbe, González, Gallo, Coleman, Wragg, & Robertson, 2016). This patient’s chest pain began when she was walking up the steps and at that time, she rated it an 8 out of 10. In order to collect more subjective data, I would ask this patient to describe her pain in more detail. First, I would ask her to describe the pain. This patient described her pain as burning or aching. I would want to know if the burning, aching pain was constant or if it would come and go. The patient denied that the pain radiated to her arm, but I would ask if it radiated to the upper chest. I would ask her if she was diaphoretic when the pain occurred. I would also ask the patient if laying down caused more pain. Other questions to ask this patient would be if she took anything to try and relieve the pain and I would ask her about any drug or alcohol use in her present or past. Cocaine use can cause coronary spasms (Rhoads & Wiggins Petersen, 2021). I would also ask the patient if she has a history of anxiety.

When conducting the physical assessment on this patient I would gather more objective data. I would assess the patient’s skin color, mucous membranes, and lips to assess for cyanosis or anemia. I would assess her skin temperature as well and check to see if she was diaphoretic. I would also assess the patient’s eyes and check for Xanthelasmas and any skin or nail changes, which may be present in a patient with angina (Zitkus, 2010). Changes in skin texture and hair distribution may also be present in peripheral vascular disease.

The diagnostic tests that I would order would be an electrocardiogram (ECG), a troponin I level, an X-Ray of the digestive system and chest, and an endoscopy. The ECG and troponin lab would be done to rule out any cardiac abnormalities or if the patient may have had a myocardial infarction, and this patient does not appear to be in acute cardiac distress. The other tests would be done to assess for a possible gastrointestinal cause for her chest pain. Non-cardiac chest pain can cause angina like pain in patients without heart disease.

Three differential diagnoses that I would give for this patient are Gastroesophageal reflux (GERD), esophageal motility disorders, and gastric ulcer. I believe that this chest pain is related to a gastrointestinal cause because gastrointestinal pain can be described as a burning sensation in the middle of the chest (Rhoads & Wiggins Petersen, 2021). However, thee diagnoses can only truly be made after ruling out any cardiac related chest pain, as cardiac related chest pain caused by a myocardial infarction may have similar symptoms (Frieling, 2018). GERD is a common cause of non-cardiac related chest pain, and it is attributed to up to 60% of non-cardiac chest pain diagnoses (Frieling, 2018).

References

Ayerbe, L., González, E., Gallo, V., Coleman, C. L., Wragg, A., & Robson, J. (2016). Clinical assessment of patients with chest pain; a systematic review of predictive tools. BMC cardiovascular disorders, 16, 18. https://doi.org/10.1186/s12872-016-0196-4

Frieling, T. (2018). Non-Cardiac Chest Pain. Visceral Medicine, 34, 92-96. doi: 10.1159/000486440

Rhoads, J., & Wiggins Petersen, S. (2021). Advanced Health Assessment and Diagnostic Reasoning. Burlington, MA: Jones and Bartlett Learning.

Zitkus, B. (2010). Assessing chest pain accurately. Nursing2010, 40, 1-6 doi: 10.1097/01.NURSE.0000389904.40627.35

Introduction and Alignment

This workshop provides additional instruction on integrated mental healthcare and is intended to expand the student’s comprehension of roles and responsibilities of the PMHNP while functioning as part of the larger interprofessional team. 

Upon completion of this assignment, you should be able to:

• Summarize duties and responsibilities of the PMHNP associated with the role of Consult-Liaison.
• Compose a brief case study or client scenario which incorporates the services of the PMHNP functioning as a Consult-Liaison.
• Compare specific tasks, duties, and responsibilities associated with the Consult-Liaison role as it pertains to inpatient and outpatient mental healthcare settings.

Resources

• Textbook: American Nurses Association (2014). Psychiatric Mental Health Nursing: Scope and Standards of Practice – pages 12-16; pages 36-37.
• Article: Sharrock, J. and Happell, B. (2002), The psychiatric consultation-liaison nurse: Thriving in a general hospital setting. International Journal of Mental Health Nursing, 11(1), 24–33. https://doi.org/10.1046/j.1440-0979.2002.00205.x

Instructions

1. Use the included resources and/or other articles you find in the Assignment 5.4 literature review.
2. Navigate to the threaded discussion and respond to the following:
   1. In 3-4 paragraphs, summarize the role of the PMHNP as a consult-liaison. Look at the role from both the inpatient and outpatient setting. How do the tasks, duties and responsibilities differ?
   2. Develop a case study or client scenario in which the PMHNP serves in the role of a consult-liaison.
3. Your initial post is due by the end of the fifth day of the workshop.
4. Read and respond to at least two of your classmates’ postings by the end of the workshop.

Select here to access the discussion topic.

Assessment Criteria

Criteria

Points

Question answered comprehensively

• Summarizes consult-liaison role for the PMHNP (20)
• Case study/client scenario fully shows PMHNP acting in a consult-liaison role (20) 

40

Student’s post adheres to APA guidelines, including references and citations, and proper style/grammar/punctuation/spelling

5

Responds to at least two peers’ posts by end of workshop

5

Total Points

50

When politics and medical science intersect, there can be much debate. Sometimes anecdotes or hearsay are misused as evidence to support a particular point. Despite these and other challenges, however, evidence-based approaches are increasingly used to inform health policy decision-making regarding causes of disease, intervention strategies, and issues impacting society. One example is the introduction of childhood vaccinations and the use of evidence-based arguments surrounding their safety.

In this Discussion, you will identify a recently proposed health policy and share your analysis of the evidence in support of this policy.

To Prepare:

• Review the Congress website provided in the Resources and identify one recent (within the past 5 years) proposed health policy. These are the resources provided ( congress.gov.(n.d.). Retrieved September 20, 2018,from https://www.congress.gov/

     Klein,K.J.,& Sorra, J.S. (1996). The challenge of innovation implementation. Academy of management Review, 21(4), 1055-1080.doi:10.5465/AMR.1996.9704071863

     Sacristan, J., & Dilla, T.D. (2015). No big data without small data: Learning health care systems begin and end with the individual patient. Journal of Evaluation in Clinical Practice, 21(6), 1014-1-17.

     Centers for Disease Control and Prevention (CDC). (n.d.). Step by step: Evaluating  violence and injury prevention policies: Brief 4: Evaluating policy implementation. Retrieved from https://www.cdc.gov?injury/pdfs/policy?Brief%204-a.pdf

• Review the health policy you identified and reflect on the background and development of this health policy.

 Post a description of the health policy you selected and a brief background for the problem or issue being addressed. Explain whether you believe there is an evidence base to support the proposed policy and explain why. Be specific and provide examples. 

( Please in discussion 1, I need at least 3 resources, APA format and 1 Page)

Discussion 2: The Role of the RN/APRN in Policy-Making

Word cloud generators have become popular tools for meetings and team-building events. Groups or teams are asked to use these applications to input words they feel best describe their team or their role. A “word cloud” is generated by the application that makes prominent the most-used terms, offering an image of the common thinking among participants of that role.

What types of words would you use to build a nursing word cloud? Empathetic, organized, hard-working, or advocate would all certainly apply. Would you add policy-maker to your list? Do you think it would be a very prominent component of the word cloud?

Nursing has become one of the largest professions in the world, and as such, nurses have the potential to influence policy and politics on a global scale. When nurses influence the politics that improve the delivery of healthcare, they are ultimately advocating for their patients. Hence, policy-making has become an increasingly popular term among nurses as they recognize a moral and professional obligation to be engaged in healthcare legislation.

To Prepare:

• Revisit the Congress.gov website provided in the Resources and consider the role of RNs and APRNs in policy-making. Here is the resources ( American Nurses Association (ANA). (n.d.). Advocacy. Retrieved September 20, 2018, from https://www.nursingworld.org/practice-policy/advocacy/
• Reflect on potential opportunities that may exist for RNs and APRNs to participate in the policy-making process.

 Post an explanation of at least two opportunities that exist for RNs and APRNs to actively participate in policy-making. Explain some of the challenges that these opportunities may present and describe how you might overcome these challenges. Finally, recommend two strategies you might make to better advocate for or communicate the existence of these opportunities to participate in policy-making. Be specific and provide examples. 

( 1 page for Discussion 2. APA format. 3 refences within past 5 years.)

They are two different papers. 

three page paper

apa format

references from the last 5 years

The benefits, concerns, and challenges of a systems approach offer the practice scholar several ways to view a health problem. Select a practice problem within your unique setting and consider the following.

• Describe the selected problem from two of the three systems levels (micro-, meso-, and macro).
• Explain how the outcomes of one system-level effect the other level?
• How are the systems approach beneficial in improving healthcare quality and safety?  

Instructions:

Use an APA style and a minimum of 200 words. Provide support from a minimum of at least three (3) scholarly sources. The scholarly source needs to be: 1) evidence-based, 2) scholarly in nature, 3) Sources should be no more than five years old (published within the last 5 year), and 4) an in-text citation. citations and references are included when information is summarized/synthesized and/or direct quotes are used, in which APA style standards apply. 

• Textbooks are not considered scholarly sources. 

• Wikipedia, Wikis, .com website or blogs should not be used.

What’s your Disease factor

What are the advantages of bringing community health nursing services close to where people live out their daily lives? What are the challenges?