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#1

Clinical Practice Guideline

1.       

Title: Vascular access

Date of publication: June 2021

Organization or author:  Registered Nurses’ Association of Ontario (RNAO)

Purpose: To provide all healthcare workers, mainly nurses, with evidence-based recommendations and resources to insert, assess, and maintain vascular access in all infants, pediatric, and adult populations.

Two major clinical recommendations:

–              To implement specialists for vascular access or a team to support the insertion and management of the vascular access device.

–               To provide comprehensive health teaching to the person or family/caregivers about their vascular access device.

2.         

Yes, the recommendations were based on substantial evidence.  According to the data, using Vascular access specialist teams (VASTs) could minimize issues and increase the likelihood of successful VAD insertion attempts. Most of the research focused on managing and inserting CVADs, especially PICCs. The management and insertion of PVADs became the main topics of the subsequent study.

According to evidence, comprehensive health education may lower hospital readmission rates and problems. Compared to baseline or control groups, most studies found that individuals receiving health education experienced fewer difficulties. For example, three studies showed a decrease in the incidence of occlusion and a drop in CLABSI rates. In one study, the education group experienced less clotting than the control group. One study compared hospital readmission rates for CLABSI before and after family members were taught a CVAD care class. After a month of follow-up, there were no hospital readmissions for CLABSI.

These recommendations will help me care for my patients by educating each parent about their baby’s IV access and ensuring that each IV access is maintained well to prevent infections and CLABSIs. A clinical practice guideline (CPG) is a set of recommendations for healthcare providers based on an extensive review of existing research to optimize patient care for particular conditions. A research study is an organized inquiry intended to produce new knowledge about a topic by gathering and analyzing data, frequently to test a hypothesis or assess an innovative approach.

RNAO  (2021) Vascular access https://rnao.ca/bpg/guidelines/Vascular_Access

#2

Title: Aggression Assessment Clinical Practice Guideline
Publication: 2023
Organization: Emergency Nurses Association (ENA)
Purpose: Recommended to help identify patients at risk of becoming violent based on a systematic review and critical literature analysis.
Recommendation 1: All patients should be routinely screened for aggression risk upon arrival at the emergency department. 
Recommendation 2: The use of de-escalation techniques as the first-line intervention for managing aggression. 

The clinical practice guideline (CPG) recommended by the ENA, for assessing aggression in emergency department patients is based on a systematic review and critical analysis of the literature, which suggests a high level of evidence and provides clear recommendations for using validated tools. One tool is the Broset Violence Checklist (BVC), to identify those at risk of violence (ENA, 2023). By using validated tools to identify patients at risk of violence, healthcare providers can implement appropriate interventions early, potentially preventing violent incidents (ENA, 2023). This approach enhances patient care and safety for both healthcare providers and patients.  A CPG, like the one discussed here, is a systematically developed statement to assist healthcare provider and patient decisions about appropriate healthcare for specific clinical circumstances. It is based on a comprehensive review of the current evidence and provides practical recommendations for clinical practice (Melnyk & Fineout-Overhold, 2023). A research study is a scientific investigation designed to answer specific questions about a particular aspect of healthcare, such as the effectiveness of a treatment or the accuracy of a diagnostic test (Melnyk & Fineout-Overhold, 2023). The results of multiple research studies are often used to develop a CPG.

Emergency Nurses Association (2023). Clinical practice guidlines. https://www.ena.org/enau/practice-resource-libraryLinks to an external site.

Melnyk, B. M., & Fineout-Overhold, E. (2023). Evidence-Based Practice in Nursing & Healthcare (5th ed.). Lippincott Williams & Wilkins.

NOTE: Cite at least 2 scholarly references published within the last 2-3 years.   

Deliverable Length: 5-7 pgs  not including the title, abstract, and reference pgs

Description

Since the enactment of the Affordable Care Act, there have been several lawsuits in the federal courts, and some have made their way to the Supreme Court. Not all of these cases are accepted for appeal by the Supreme Court and thus are settled at the appellate court. Analyze a recent appellant court case related to a healthcare legal case. If possible, find a case in your own federal appellate court. Discuss your answers to the following questions:

• In what court did this case originate? What is the law at issue in this case?
• What are the arguments supporting the law, and what are the arguments to overturn the law?
• Discuss the effect of this court case on healthcare delivery or operations. For example, will patient care be changed?
• How will the operations of a healthcare organization or health insurance company be changed?

SEE FILE

APA 7th edition references PER ANSWER within the last 5 years. Graduate level answer.

Assignment Objectives:

For this assignment, you will appraise a clinical practice guideline (CPG).  The purpose of this assignment is to acquaint you with a clinical practice guideline as well as the appraisal process to determine the feasibility of the CPG.

Assignment Instructions: 

Read/Review the clinical practice guideline provided below:

• Practice Guidelines for Psychiatric Evaluation of Adults Download Practice Guidelines for Psychiatric Evaluation of AdultsOpen this document with ReadSpeaker docReader This guideline may also be helpful to you as you move through the program as you will have many opportunities to evaluate adults with psychiatric needs.  

You will appraise the clinical practice guideline using the AGREE II Tool Download AGREE II Tool for evaluating Clinical Practice Guidelines.  You must download the document to your computer, save it, and then open the document.  You should then be able to type in the comment section for each of the items to provide your responses.  You will not be able to type in the document if you just download it here without saving it first.  Here is the user’s guide for the AGREE II Tool Download user’s guide for the AGREE II Tool  Beginning on page 11 of the guide, you will find a detailed explanation of the purpose for each section of the tool, an overview of how to score that section, as well as where to locate this information in your CPG.  

A rationale and “answer” must be provided for each item in the comment section so that we can “see” how you formulated your response to that section.

How to Read the Guideline to Complete the Critique Assignment

The guideline that you are being asked to review contains many sections within the overall document.  Pages 1-3 and 145-148 decribe the process for developing the entire document.  Pages 3-7 provide a list of key recommendations found within the individual sections of the document for immediate access. This is followed by the references for the document (a complete reference list is on pages 150-162).  Beginning on page 9, you will find an indepth discussion of each of the different components of the guideline.  Each section is laid out in the same manner:  

• Guideline Statements:  This is where you will find a summary of the recommendations made based on the review of hte literature
• Rationale:  This section provides a rationale for the development of that specific guideline as well as a discussion of the strength of the evidence identified for this guideline.  
• Potential Benefits and Harms:  This section provides a discussion of the benefits and harms associated with using or not using these recommendations.  There may also be a discussion of the need for future research in this area.
• Implementation:  This section provides a discussion of how to use these recommendations in practice.  Other resources that can be used to enhace the assessment of this section are also provided.  Barriers to implementation of the guideline are also discussed.

Typically, a clinical practice guideline will be one document that contains recommendations for practice for one particular subject.  Since the psychiatric evaluation contains many components, the guideline you are asked to review contains several “mini” guidelines which make up the overall guideline for the “Psychiatric Evaluation of Adults.”  You will use the information on pages 1-9 and 145-148 to answer the majority of the critique items in Domains 1-3 of the AGREE II tool. 

To answer items 11 and 12 in Domain 3 and the items in Domains 4-5, you will choose ONE of the guidelines to follow through the Guidelines and Implementation section, the Review of Available Evidence section. and the Quality Measurement Considerations section of the CPG.  For example, if you choose to do an indepth review of Guideline III:  Assessment of Suicide Risk, you will look on pages 18-23, 57-65, and 139-140 to answer the specific questions about that guideline.  

The selected disease process is cirrhosis which is a liver disease that occurs when scar tissue replaces healthy tissue preventing the organ from working normally. An injured tissue is replaced by a scar, known as fibrosis which often takes months or years of ongoing injury. The underlying pathophysiological mechanism of cirrhosis is the development of scar tissue that leads to the replacement of normal liver parenchyma causing blockage of portal blood flow and disruption of normal liver function. When fibrosis reaches a point where distortion of the hepatic vasculature occurs, it is called cirrhosis (Jagdish et al., 2023). If the damage continues, panlobular cirrhosis may occur. The cellular mechanisms responsible for cirrhosis are similar irrespective of the type of initial insult and the injury site within the liver lobule. The clinical manifestation observed in Bayani’s case that could be explained by the pathophysiological mechanisms of cirrhosis is foul-smelling urine. This is due to the liver’s inability to filter waste products effectively leading to a build-up of ammonia in the blood causing a strong, ammonia-like odor in the urine.

The clinical manifestations of cirrhosis depend on the advancement of the disease. The common early signs and symptoms are fatigue, loss of appetite, nausea, weight loss, itchy skin, and upper abdominal pain (Wu et al., 2024). The later signs and symptoms related to portal hypertension and declining liver function are vomiting blood, disruption in the menstrual cycle, jaundice, gallstones, dark-colored pee or stool, edema, blood in the stool, low urine output, shortness of breath, ascites and digestive difficulties. In Bayani’s case, the clinical manifestations that can partially support a diagnosis of cirrhosis are foul-smelling urine, abdominal pain which is caused by a buildup of fluid in the abdomen (ascites), and mild confusion which occurs when a damaged liver cannot properly filter toxins causing them to build up in the brain leading to cognitive changes.

The diagnostic tests that would be most appropriate for investigating a diagnosis of cirrhosis in Bayani’s case are physical examination, blood tests, imaging tests, and liver biopsy. A physical examination focuses on checking the medical history of Bayani, and the signs and symptoms related to cirrhosis. The blood tests for the disease include CBC, liver tests, and viral infection tests. For instance, liver tests can measure liver products like enzymes, proteins, and bilirubin levels in the blood to confirm cirrhosis. Imaging tests include MRI, CT scan, and abdominal ultrasound that show detailed images of the size, shape, and texture of the liver to confirm cirrhosis (Wu et al., 2024). A liver biopsy is a small procedure that involves taking a sample of the liver for examination to diagnose cirrhosis. Type 2 diabetes is a condition that causes high blood sugar levels because the body does not produce adequate insulin. In Bayani’s case, the clinical manifestations that can partially support the diagnosis of type 2 diabetes are mild confusion often known as brain fog, abdominal pain, frequent water drinking and urination, and foul-smelling urine due to the production of ketones excreted in the urine.

References

Jagdish, R. K., Roy, A., Kumar, K., Premkumar, M., Sharma, M., Rao, P. N., Reddy, D. N., & Kulkarni, A. V. (2023). Pathophysiology and management of liver cirrhosis: From Portal hypertension to acute-on-chronic liver failure. Frontiers in Medicine, 10. https://doi.org/10.3389/fmed.2023.1060073Links to an external site.

Wu, Z., Chen, L., Chen, J., & Chen, C. (2024). Management of liver cirrhosis and its complications. Liver Cirrhosis and Its Complications – Advances in Diagnosis and Management. https://doi.org/10.5772/intechopen.1005466Links to an external site.

Describe your clinical experience for this week.

MUST BE ON PEDIATRIC PATIENT 

• Did you face any challenges, any success? If so, what were they?
• Describe the assessment of a patient, detailing the signs and symptoms (S&S), assessment, plan of care, and at least 3 possible differential diagnosis with rationales.
• Mention the health promotion intervention for this patient.
• What did you learn from this week’s clinical experience that can beneficial for you as an advanced practice nurse?
• Support your plan of care with the current peer-reviewed research guideline.

Submission Instructions:

• Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.