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The first step of the evidence-based practice process is to evaluate a nursing practice environment to identify a nursing problem in the clinical area. When a nursing problem is discovered, the nurse researcher develops a clinical guiding question to address that nursing practice problem.

For this discussion question, you will create a clinical guiding question known as a PICOT question. The PICOT question must be relevant to a nursing practice problem (coordination of health care, assessment, education, patient support, trauma prevention, recovery, health screenings, etc.).

After reviewing the relevant topic materials:

1. Select a nursing practice problem of interest.
2. Develop a PICOT question using the template and example provided below.
3. Identify two articles, one qualitative and one quantitative, related to the problem of interest. Provide an APA-formatted reference for each article, and explain how each relates to your PICOT question. Be sure to identify which article is qualitative and which article is quantitative. These articles may be used in this week’s assignment.

PICOT question intervention format:

In_______________(Population), how does _______________ (Intervention) compared to _______________ (Comparison) affect _______________ (Outcome) within______________(Time, optional)?

Example: In critically ill patients in an Intensive Care Unit (ICU) (P), how do daily 2% chlorhexidine cloth baths (I) compared to daily disposable non-antimicrobial cloth baths (C) affect the incidence of health care-associated infections (HAIs) (O)?

Initial discussion question posts should be a minimum of 200 words and include at least two references cited using APA format.

The significance of composition and size of the sampling to be studied correlates to the size of the study and the representativeness of such study. The study size must be ethical and must be clearly stated. The protection of the participants must be outlined and detailed to protect its participants. Composition and size both are crucial to the research study to one is intended to present. Composition refers to the population being studied and its characteristics in contrast to the size which refers to the sample being researched and evaluated. Both composition and size play an important role in the research when producing a good outcome.

           The sample size for a study needs to be estimated at the time the study is proposed; too large a sample is unnecessary and unethical, and too small a sample is unscientific and unethical (Andrade, 2020). Studies in populations need to be done in sample sizing due to the inability to study a population as a whole, thus sampling sizing will provide a more accurate study. The necessary sample size can be calculated, using statistical software, based on certain assumptions. If no assumptions can be made, then an arbitrary sample size is set for a pilot study (Andrade, 2020). An appropriate sampling technique with the exact determination of sample size involves a very vigorous selection process, which is actually vital for any empirical research. It is obvious that these methodological decisions would greatly affect the internal and external validity and the overall generalizability of the study findings (Ahmed, 2024).

           In conclusion when choosing a composition and a sampling size for research it is imperative that it is done in an ethical manner, the sample size must take into consideration as well as the population and effect size, statistical power and confidence level must be present allowing room for error. Precise calculation of sample size is an important step in such research, knowing the factors affecting the study will also play an important part in the research. Sample size calculations require assumptions about expected means and standard deviations, or event risks, in different groups; or, upon expected effect sizes (Andrade, 2020).

References

Andrade C. (2020). Sample Size and its Importance in Research. Indian journal of psychological medicine, 42(1), 102–103. https://doi.org/10.4103/IJPSYM.IJPSYM_504_19

Bishop D. V. M. (2021). Using multiple outcomes in intervention studies: improving power while controlling type I errors. F1000Research, 10, 991. https://doi.org/10.12688/f1000research.73520.3

Buchholz, B.S.M.P.M.S. W. (2021). Research for Advanced Practice Nurses (4th ed.). Springer Publishing LLC. https://online.vitalsource.com/books/9780826151339

Sirwan Khalid Ahmed (2024). How to choose a sampling technique and determine sample size for research: A simplified guide for researchers, Oral Oncology Reports, Volume 12,100662, ISSN 2772-9060, https://doi.org/10.1016/j.oor.2024.100662.

 Create a concept map of a mental health diagnosis using one of the mental health scenario case studies presented in this section of the course. 

Pulmonary Function:
D.R. is a 27-year-old man, who presents to the nurse practitioner at the Family Care Clinic complaining of increasing SOB, wheezing, fatigue, cough, stuffy nose, watery eyes, and postnasal drainage—all of which began four days ago. Three days ago, he began monitoring his peak flow rates several times a day. His peak flow rates have ranged from 65-70% of his regular baseline with nighttime symptoms for 3 nights on the last week and often have been at the lower limit of that range in the morning. Three days ago, he also began to self-treat with frequent albuterol nebulizer therapy. He reports that usually his albuterol inhaler provides him with relief from his asthma symptoms, but this is no longer enough treatment for this asthmatic episode.

Case Study Questions

1. According to the case study information, how would you classify the severity of D.R. asthma attack?
2. Name the most common triggers for asthma in any given patients and specify in your answer which ones you consider applied to D.R. on the case study.
3. Based on your knowledge and your research, please explain the factors that might be the etiology of D.R. being an asthmatic patient.

Fluid, Electrolyte and Acid-Base Homeostasis:
Ms. Brown is a 70-year-old woman with type 2 diabetes mellitus who has been too ill to get out of bed for 2 days. She has had a severe cough and has been unable to eat or drink during this time. On admission, her laboratory values show the following:

• Serum glucose 412 mg/dL
• Serum sodium (Na+) 156 mEq/L
• Serum potassium (K+) 5.6 mEq/L
• Serum chloride (Cl–) 115 mEq/L
• Arterial blood gases (ABGs): pH 7.30; PaCO2 32 mmHg; PaO2 70 mmHg; HCO3– 20 mEq/L

Case Study Questions

1. Based on Ms. Brown admission’s laboratory values, could you determine what type of water and electrolyte imbalance does she has?
2. Describe the signs and symptoms to the different types of water imbalance and described clinical manifestation she might exhibit with the potassium level she has.
3. In the specific case presented which would be the most appropriate treatment for Ms. Brown and why?
4. What the ABGs from Ms. Brown indicate regarding her acid-base imbalance?
5. Based on your readings and your research define and describe Anion Gaps and its clinical significance.

Submission Instructions:

• You must complete both case studies
• Your initial post should be at least 500 words per case study, formatted and cited in current APA style with support from at least 2 academic sources. 

J.C is an 82-year-old white man who was evaluated by GI specialist due to abdominal discomfort, loss of appetite, weight lost, weakness and occasional nausea.

Past Medical History (PMH):
Patient is Diabetic, controlled with Metformin 500 mg by mouth twice a day, Lantus 15 units SC bedtime. Hypertensive, controlled with Olmesartan 20 mg by mouth once a day. Atrial Fibrillation, controlled with Rivaroxaban 15 mg by mouth once a day and bisoprolol 10 mg by mouth once a day.

Labs:
Hb 12.7 g/dl; Hct 38.8% WBC 8.2; Glycemia 74mg/dl; Creatinine 0.8 mg/dl; BUN 9.8 mg/dl; AST 21 U/L ALT 17 U/L; Bil T 1.90 mg/dl; Ind 0.69 mg/dl; Dir 1.21 mg/dl.

Diagnostic test:
Endoscopic Ultrasound of the Pancreas. Solid mass in the head of pancreas 4 cms, infiltrating Wirsung duct. The solid mass impress to infiltrate the superior mesenteric vein. Perilesional node is detected, 1.5 cms, metastatic aspect. Fine needle aspiration (FNA) biopsy: Ductal adenocarcinoma.

Case study questions:

1. Please name the potential most common sites for metastasis on J.C and why?
2. What are tumor cell markers and why tumor cell markers are ordered for a patient with pancreatic cancer?
3. Based on the case study described, proceed to classify the tumor based on the TNM Stage classification. Why this classification important?
4. Discussed characteristic of malignant tumors regarding it cells, growth and ability to spread.
5. Describe the carcinogenesis phase when a tumor metastasizes.
6. Choose the tissue level that is affected on the patient discussed above: Epithelial, Connective, Muscle or Neural. Support your answer. 

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. You don’t need to make a presentation page.

Bb week 2 po

 Identify one vulnerable population within a selected community. Explore current literature and related data to understand better the variables that place this population at risk for health concerns and health disparities. Analyze national health directives, such as Healthy People 2030 or another national initiative, to determine the correlation to the vulnerable population’s needs/risks/disparities.

1. Create a concept map, either neatly drawn by hand or using Microsoft Word, that portrays each element and its relationships. 
2. Download the Concept Map Summary templateLinks to an external site.Open this document with ReadSpeaker docReader to answer the questions related to the concept map scenario. Use of this template is required. If the template is not used, a 10% deduction will be applied. See the rubric. Save the template and include your name in the file name. 
3. Follow APA grammar, spelling, word usage, and punctuation rules consistent with formal, scholarly writing. 
4. Use APA in-text citations and complete references to support your writing.  
5. Use no more than one short direct quote (15 words or less). 
6. Refrain from using first person within this assignment. 
7. Abide by Chamberlain University’s academic integrity policy.  
8. Submit the Concept Map and the Concept Map Summary template to the Week 2 Assignment Dropbox. 

Include the Following Sections (detailed criteria listed below and in the grading rubric)

Concept Map

1. Using a concept map format, identify the following elements:
   1. vulnerable population
   2. the variables that place the population at risk
   3. the identified health risk or disparity to which the population is susceptible
   4. the relationships between the elements

Concept Map Summary

1. Describe the elements on the Concept Map and include the following.  
   1. Provide a succinct description of the vulnerable population identified.
   2. Discuss a minimum of three variables that place the population at risk.
   3. Describe the identified health risk(s) or disparity the population is at risk of experiencing.
   4. Explain how the Concept Map portrays the relationships between each element presented.
   5. Provide an in-text citation from one scholarly source to support your writing.
2. Intervention Proposal
   1. Identify one national population health goal or objective that relates to the identified risk or disparity, such as Healthy People 2030 or another national initiative
   2. Propose one strategy for the advanced practice nurse to collaborate at the local, state, or national levels to advocate for the health of the vulnerable population and advance the identified Healthy People 2030 goal or objective
   3. Identify the stakeholders with whom the advanced practice nurse could collaborate.
   4. Provide an in-text citation from two scholarly sources to support your writing. 

Create a Venn diagram showing the major factors contributing to the obesity epidemic in the United States.

You must include at least two academic sources, formatted and cited according to current APA standards.

Review the rubric to determine how your assignment will be graded.

Your assignment will be checked for plagiarism through Turnitin. Check your results, make any necessary corrections, and resubmit a revised copy if the system identifies any issues.