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Assessing and Planning Care for an Elderly Person

In order to gain an insight into the world of elder adults, it is important to understand how they view themselves and the values they hold. Additionally, it is important to assess and determine his/her needs and establish appropriate interventions for this individual.

In a Microsoft Word document of 4-5 pages formatted in APA 7 style, you will discuss your interview of an older adult. You can use a friend, family member, or co-worker. The older adult must be age 65 years or older.

There are two parts to this assignment – the psychosocial interview component and the functional assessment.

Interview

Download the patient questionnaire (see attachment). Use this format to record the person’s responses.

• Include 2–3 questions of your own to get a complete picture of the older adult.

• Summarize your findings.

• Include the questionnaire with responses in the Appendix of your paper.

Assessment

After gaining permission, conduct a physical and mental functional assessment of the older adult you have chosen. Review your readings for the process of a functional assessment.

• Use the tools discussed this week to complete a comprehensive assessment of your patient. Search the Internet for resources on these tools.

o Tinetti Balance and Gait Evaluation

o Katz Index of Activities of Daily Living

o Assessment of Home Safety

o The Barthel Index

o Do not include a name on each tool, but do include professional or other designation, and age. Your name should also be identified on the tool.

 Include these tools in the Appendix.

• Based on your assessment:

o Compare and contrast the age-related changes of the older person you interviewed and assessed with those identified in this week’s reading assignment.

o Identify at least 4–6 preliminary issues.

o Identify three alterations in health that you would propose and describe them.

o Identify a minimum of three comprehensive interventions for each alteration.

o Integrate cultural considerations in your interventions.

On a separate references page, cite all sources using APA 7 format. Please note that the title and reference pages should not be included in the total page count of your paper.

Description

Review the PICO / Levels of Research rubric (see rubric attached)

Identify a nursing EBP or Research resource found by searching the internet. This article should be applicable to informatics (telehealth, EMR, Smart Cards, any other topic). Summarize the research article and findings. Is this a practice issue that is evidence-based and should be analyzed using PICO? Is this a non-clinical or research-based topic that should be evaluated using levels of research? Provide an overview of PICO or Levels of Research (whichever is appropriate for your article) and explain why they are used. Discuss how you used information literacy skills (PICO or levels of research evidence) to evaluate the healthcare information that you found.

This 2-page assignment should be submitted following APA format including title and reference pages.

Review: “You Tube: Safe at School” by the American Diabetes Association. With your knowledge of who needs to be trained, how would you use this series of 13 chapters to support your students with diabetes? Review Chapter 13 and discuss the legal implications of caring for your students with diabetes. 

Two different  papers same topic

 You should respond in a well-developed paragraph (300–350 words) integrating an evidence-based resource , Respectfully agree and disagree with your peers’ responses and explain your reasoning by including your rationales in your explanation .At Least 2 APA references each

Response 1 

The purpose of this discussion is to discuss and describe treatment for R.S. who is diagnosed with bacterial vaginosis. Identifying the specific goals of treatment for this patient is essential to care for R.S. The specific goal of the Metronidazole treatment is to resolve the signs and symptoms of infection (Vallerand & Sanoski. 2016). The length of time for complete resolution of the infection depends on the organism and site of infection Vallerand, A. & Sanoski, C. (2016). Moreover, other specific goal of  treatment is to relieve vaginal symptoms, and potentially decrease the risk of acquiring HIV and other sexually transmitted infections such as Chlamydia, trachomatis, Neisseria gonorrhea, and viral STIs (Coudray & Madhivanan. 2020).  The drug therapy this writer would prescribe is metronidazole because it will help to fight the signs and symptoms of infection in R.S. (Woo, Terri Moser, Robinson & Marylou. 2020). Metronidazole is the first pharmacological method to treat bacterial vaginosis (Woo, Terri Moser, Robinson & Marylou. 2020). This medication is indicated for anaerobic bacterial infection (Woo, Terri Moser, Robinson & Marylou. 2020). The metronidazole mechanism of action is disrupting DNA and protein synthesis in susceptible organisms (Vallerand & Sanoski. 2016).  This writer would prescribe Metronidazole as 500 mg orally twice daily for 7 days (Woo, Terri Moser, Robinson & Marylou. 2020).

Metronidazole has parameters for monitoring the success of the therapy. This writer will assess the patient R.S. for signs of infection by monitoring the vitals signs, the appearance of discharge, and the white blood cell count (Vallerand & Sanoski. 2016). This assessment will  occur at the beginning of and throughout therapy (Vallerand & Sanoski. 2016).  Additionally, this writer will obtain specimens for culture and sensitivity before therapy and at the end of the therapy (Vallerand & Sanoski. 2016). Patient education is a crucial component of the prescribed treatment. This writer will instruct the patient to take medication as direction and even when feeling better (Vallerand & Sanoski. 2016). This writer will also instruct the patient that metronidazole may be taken with meals or a snack to decrease GI irritation (Woo, Terri Moser, Robinson & Marylou. 2020). More importantly, this writer will instruct and educate patient to avoid alcohol beverages during therapy and for 48 hours after completing it (Woo, Terri Moser, Robinson & Marylou. 2020). Similarly, this writer will instruct patient to abstain from sexual contact or use condoms for seven days after therapy begins (Woo, Terri Moser, Robinson & Marylou. 2020). Lastly, this will advise the patient to consult health care professional if no improvement in a few days or if signs and symptoms of superinfection (black, furry overgrowth on tongue; vaginal itching or discharge; loose or foul-smelling stools) develop (Vallerand & Sanoski. 2016). Metronidazole has several adverse effects. If the patient has seizures or stevens-johnson syndrome while taking this medication this writer would change the medication (Vallerand & Sanoski. 2016). One drug-drug interaction occurs with alcohol (Vallerand & Sanoski. 2016). Disulfram-like reaction may occur with alcohol ingestion (Vallerand & Sanoski. 2016).

Bacterial vaginosis has two treatment options. If the patient does not show signs of improvement with metronidazole. The second choice therapy is clindamycin: oral preparations or intravaginal ovules. Clindamycin would be prescribed to the patient as 300 mg orally twice daily for 7 days (Petrina, Cosentino, Rabe & Hillier. 2017). Clindamycin is the second line of treatment because the medication is an anti-infective used to treat symptomatic women (Vallerand & Sanoski. 2016). Alternative methods to help treat bacterial vaginosis are yogurt, probiotics, or boric acid (Falconi‐McCahill. 2019). Lifestyle management should be recommended for R.S. This writer will educate patients that many of the infections treated with metronidazole are due to sexual transmission (Woo, Terri Moser, Robinson & Marylou. 2020). This writer will advise R.S. the route of transmission and promote refraining from activity until the treatment is complete (Woo, Terri Moser, Robinson & Marylou. 2020). 

Response 2

  Some conditions may affect the client in the community which can make the client feel embarrassed to seek medical attention, but it can be as dangerous as any other health condition when treatment is not delivered promptly and those conditions are associated with sexually transmitted diseases (STD). It can be situations when the person may also infect the partner and both may need treatment. In the discussion board this week R.S. is a 32 years old female which has been having a vaginal discharge for the past month and only have one partner and has been diagnosed with Bacterial Vaginosis. Although Bacterial vaginosis is not considered a sexually transmitted infection the reason for occurrence is associated with multiple sex partners, douching, unprotected intercourse, and the decrease amount of natural flora (Woo, 2020). This condition is caused primarily due to a replacement of the normal flora which is acidic at pH 4.5 to an overgrowth of anaerobic organisms such as Prevotella spp., Mobiluncus spp., Gardnerella vaginalis, or Mycoplasma hominis (Woo, 2020). These organisms tend to grow in a less acidic environment, as presented by the case study were R.S. pH is 5.5 during microscopic examination.

        The main goal of treatment for this condition is to make the symptoms subside before it morphs into something more serious. The first-line treatment is usually initiated with metronidazole 0.75% gel applied vaginally for five days (Allen, 2020). By initiating this therapy, the patient will also monitor itself and follow up with the prescriber whether the treatment is being effective. This type of condition may reoccur on multiple occasions and is important for the patient to seek the prescriber if the condition reoccurs where a different treatment option may be needed. The reason for choosing this treatment option is that it is the least amount of time and can have a better effect since is applied to the site. However, the patient needs to take some precautions during therapy such as do not consume alcohol during and at least three days after the completion of treatment due to the risk for disulfiram-like reactions (Woo, 2020). The patient should also report any burning, stinging, or change in taste which are rare symptoms, but it should be reported while in this therapy (Mayo clinic, 2020). The prescriber should seek a different treatment or add therapy if this first-line treatment is not being effective.

        Although there is a different option that someone may take this writer would prescribe clindamycin 300mg twice daily for 7 days as second-line therapy. The reason for prescribing an oral medication is that it would act quickly and have a more systemic action instead of continuing with the topical option. Besides, it could only be that the patient did not have a useful treatment with the clotrimazole cream due to not following the treatment correctly which can affect the overall treatment. By reading the literature this writer did not found many over-the-counter (OTC) treatment options while treating this condition. The most mentioned OTC was the introduction of probiotics as an adjunct therapy with the antibiotic, but there was no convincing data that attest to its efficacy (Ellington, & Saccomano, 2020). However, while taking antibiotics such as clindamycin, taking a probiotic can decrease the chances of damaging the intestinal natural flora, in this situation it may not help with the current bacterial vaginosis, but it will protect the natural flora which implies that it may be a good reason to take a probiotic while on antibiotic therapy. The main dietary recommendation while taking clindamycin is not to take grapefruit juice together. Clindamycin is a CYP3A4 substrate and grapefruit juice is a strong inhibitor of this substrate, which implies that while taking Clindamycin R.S. should avoid grapefruit juice (WellRx, 2020).Other education factors can help this patient prevent reoccurrences such as limiting sexual partners, using condoms, improving hygiene with sharing sex toys, and the avoidance of douching (Ellington, K., & Saccomano, S. J. (2020). Overall, educating the patient to take/administer the medication as prescribed. Communicate with the prescriber any adverse effects are also an important recommendation to be made while treating the patient in the community.

RUBRIC:

 Discussion Question Rubric – 100 PointsCriteriaExemplary
Exceeds ExpectationsAdvanced
Meets ExpectationsIntermediate
Needs ImprovementNovice
InadequateTotal PointsQuality of Initial PostProvides clear examples supported by course content and references.

Cites three or more references, using at least one new scholarly resource that was not provided in the course materials.

All instruction requirements noted.

40 pointsComponents are accurate and thoroughly represented, with explanations and application of knowledge to include evidence-based practice, ethics, theory, and/or role. Synthesizes course content using course materials and scholarly resources to support importantpoints.

Meets all requirements within the discussion instructions.

Cites two references.

35 pointsComponents are accurate and mostly represented primarily with definitions and summarization. Ideas may be overstated, with minimal contribution to the subject matter. Minimal application to evidence-based practice, theory, or role development. Synthesis of course content is present but missing depth and/or development.

Is missing one component/requirement of the discussion instructions.

Cites one reference, or references do not clearly support content.

Most instruction requirements are noted.

31 pointsAbsent application to evidence-based practice, theory, or role development. Synthesis of course content is superficial.

Demonstrates incomplete understanding of content and/or inadequate preparation.

No references cited.

Missing several instruction requirements.

Submits post late.

27 points40Peer Response PostOffers both supportive and alternative viewpoints to the discussion, using two or more scholarly references per peer post. Post provides additional value to the conversation.

All instruction requirements noted.

40 pointsEvidence of further synthesis of course content. Provides clarification and new information or insight related to the content of the peer’s post.

Response is supported by course content and a minimum of one scholarly reference per each peer post.

All instruction requirements noted.

35 pointsLacks clarification or new information. Scholarly reference supports the content in the peer post without adding new information or insight.

Missing reference from one peer post.

Partially followed instructions regarding number of reply posts.

Most instruction requirements are noted.

31 pointsPost is primarily a summation of peer’s post without further synthesis of course content.

Demonstrates incomplete understanding of content and/or inadequate preparation.

Did not follow instructions regarding number of reply posts.

Missing reference from peer posts.

Missing several instruction requirements.

Submits post late.

27 points40Frequency of DistributionInitial post and peer post(s) made on multiple separate days.

All instruction requirements noted.

10 pointsInitial post and peer post(s) made on multiple separate days.

8 pointsMinimum of two post options (initial and/or peer) made on separate days.

7 pointsAll posts made on same day.

Submission demonstrates inadequate preparation.

No post submitted.

6 points10OrganizationWell-organized content with a clear and complex purpose statement and content argument. Writing is concise with a logical flow of ideas.

5 pointsOrganized content with an informative purpose statement, supportive content, and summary statement. Argument content is developed with minimal issues in content flow.

4 pointsPoor organization and flow of ideas distract from content. Narrative is difficult to follow and frequently causes reader to reread work.

Purpose statement is noted.

3 pointsIllogical flow of ideas. Prose rambles. Purpose statement is unclear or missing.

Demonstrates incomplete understanding of content and/or inadequate preparation.

No purpose statement.

Submits assignment late.

2 points5APA, Grammar, and SpellingCorrect APA formatting with no errors.

The writer correctly identifies reading audience, as demonstrated by appropriate language (avoids jargon and simplifies complex concepts appropriately).

Writing is concise, in active voice, and avoids awkward transitions and overuse of conjunctions.

There are no spelling, punctuation, or word-usage errors.

5 pointsCorrect and consistent APA formatting of references and cites all references used. No more than two unique APA errors.

The writer demonstrates correct usage of formal English language in sentence construction. Variation in sentence structure and word usage promotes readability.

There are minimal to no grammar, punctuation, or word-usage errors.

4 pointsThree to four unique APA formatting errors.

The writer occasionally uses awkward sentence construction or overuses/inappropriately uses complex sentence structure. Problems with word usage (evidence of incorrect use of thesaurus) and punctuation persist, often causing some difficulties with grammar. Some words, transitional phrases, and conjunctions are overused.

Multiple grammar, punctuation, or word usage errors.

3 pointsFive or more unique formatting errors or no attempt to format in APA.

The writer demonstrates limited understanding of formal written language use; writing is colloquial (conforms to spoken language).

The writer struggles with limited vocabulary and has difficulty conveying meaning such that only the broadest, most general messages are presented.

Grammar and punctuation are consistently incorrect. Spelling errors are numerous.

Submits assignment late.

2 points5Total Points100 

Reply 1

Clinical nurse leaders play an important role in managing quality measures and setting policy thus involves dealing with fiscal responsibility and being answerable for the overall quality of patient care delivery, patient satisfaction and organization outcomes (McBride, 2019). Nonetheless, CNL role is coordinated to collaborate work with other professional teams. Education requirement for nurse leaders based on practice skills. In masters nurses get to improve care, quality and safety of patients, team working is highly encouraged in leadership.

A good leader should have the following trait; integrity, critical thinking, communication skills. Integrity is central in making a nurse leader (McBride, 2019). Integrity help nurses to make sound decisions regarding patients’ treatment plans and safety (Harris, Roussel & Thomas, 2016). Furthermore, effective leadership in nursing practice requires high level of integrity. Due to increased multidisciplinary collaboration, critical thinking skill is very important. Interdisciplinary alliance makes critical thinking an important skill for nurse leaders. Moreover, communication in leadership is key since it helps promote team spirit or teamwork translating to better care outcome.

References

McBride, A. B. (Ed.). (2019). The growth and development of nurse leaders. Springer Publishing Company.

Harris, J. L., Roussel, L. A., & Thomas, T. (2016). Initiating and sustaining the clinical nurse leader role. Jones & Bartlett Learning.

reply 2

According to Dwight Eisenhower as quoted by Mind tool blog (n d) leadership is defined as the art of bringing another person to do something that you want done because he/she wants to do it. Nurses occupy different leadership positions in the healthcare industry and I want to discuss about Nurse Managers. Nurse managers are typically Advanced Practice Nurses who has at least BSN but many hospitals require completion of Master’s degree or current enrollment in a Master’s program, also some nurse managers find it helpful to obtain Masters in Business Administration (MBA). Nurse managers are also called Nurse Administrators (Nurse org, 2020)

Essential responsibilities of a nurse managers include administrative meetings, working with new employees, serving in different committees throughout the hospital, interviewing and hiring of new nurses, acting as a liaison between hospital management and employees, collaborating with medical employees, managing unit budget, handling of disciplinary actions to those who have erred, ensuring that the mission of the hospital is maintained by the employees, set work schedules, oversee patient care, etc.(nurse org, 2020)

Leadership traits are those personal traits needed to be successful as a nurse manager include, advocacy, to speak up for her employees and the patients, should be able to participate in patients care and also in management meetings, he/she should be supportive of her staff and should also be mature in her judgement, strong communication skill is a trait that a nurse manager should possess, he/she should be able to communicate the hospital decision to her employees and also communicate her employee’s concerns to the hospital management (Duquesne, blog, 2017). The leadership style that I feel will make the nurse manager to succeed in his/her job Is the transformational style. Transformational leadership is a leadership style that can inspire positive changes in those who follow. Transformational leaders are generally energetic, enthusiastic, and passionate. Not only are these leaders concerned and involved in the process; they are also focused on ensuring that every nurse under her car becomes the best nurse they can ever be and also be successful in their nursing career. (Cherry, 2020). In order to succeed, a nurse leader should have qualities like listening, flexibility, organized. Be a problem solver, leadership skill, analytical ability, empathetic, confidence, decisiveness, confidence, etc. (nurse org, 2020)

                                                                                    References

Cherry, K. (2020) Transformational leadership. Very well mind. Retrieved from https://www.verywellmind.com/what-is-transformational-leadership-2795313

Duquesne University blog, (2017) Nurse manager: leading the Nurse profession into the future. Retrieved from https://onlinenursing.duq.edu/blog/roles-nurse-manager-leading-nursing-profession-future/#:~:text=Nurse%20managers%20are%20responsible%20for,and%20make%20decisions%20about%20personnel.

Nurse.org (2020) Nurse manager. Retrieved from https://nurse.org/resources/nurse-manager/

Mindtool (n d). What is leadership. Retrieved from https://www.mindtools.com/pages/article/newLDR_41.htm

For this assignment, you will locate two research studies related to the topic and PICOT questions that you developed in Week 2. The articles must be current (within the last five years), and one article must be quantitative, and one article must be qualitative. (The topic I used in week 2 was Juvenile Idiopathic Arthritis.)

Article choice is very important, therefore:

• Articles used for this assignment cannot be used for the other assignments. The selected articles should be original research studies. Review articles, concept analysis, meta-analysis, meta-synthesis, integrative review, and systemic review articles should not be used.
• Mixed-methods studies should not be used.

There are two parts to this assignment.

Part 1: Complete a Rapid Critical Appraisal Checklist

• Select one each: qualitative and quantitative research articles.
• Create a Rapid Critical Appraisal Checklist for the two research articles (one column per article).
• Complete with brief, concise, summarized information.

Part II: Write a summary (one- to two- pages)

• Identify differences between quantitative and qualitative designs and research methods.
• Use current APA Style for your summary paper and to cite your sources.
• Submit the checklist and summary.

  $5 for anyone who good in nursing paper can do this discussion response due by 12/9/2020 @5pm on eastern time. Exmple is provided. 

 Medicare or Medicaid – which has greater impact in Florida? 

Above is the answer of 2 peer.  I need a response for them

PEER 1

Medicare and Medicaid are the greatest insurance programs run by the government. However, they are operated and funded by different parts of the government and primarily serve different groups. Medicare is run by the federal government and mainly provide health coverage to individual aged 65 years and above and those with disability. Medicaid entails collaboration between the state and federal government and provides health coverage to low-income. However, there are those how meet dual eligible criteria. Therefore, as a state and federal-run program Medicaid has greater effects on state governments. State governments co-fund the program and are expected to match federal funding.

From modest beginnings in 1965, Medicaid has grown significantly from $5.3 billion four decades ago, to $449 billion in 2013. In Florida, Medicaid expenditures have grown by 33% between 2012 and 2016. In 2016, the combined state and federal spending on Medicaid increased by 22%. Over these years, the federal government has provided between 55% and 60% of Medicaid funding. During the same time, Medicaid has growth to more than 75% of the Medicare expenditure and its share of national health expenditure has almost doubled. Following the passage of the Affordable Care Act, 2010, states were requested to expand their Medicaid program (Sutter, 2016). According to Ward (2020), the expansion of the Medicaid program has met significant resistant because of its presumed impact on state budgets. Florida is one of the states that have failed to expand its Medicaid plan under the Affordable Care Act. Some stakeholders argue that expanding the illegibility criteria is likely to have significant fiscal implications. Florida is among the states with the highest personal healthcare spending, ranking 5th nationwide. According to Buettgens (2018), the growing Medicaid expenditure are not necessarily driven by increased coverage, but also by changing medical needs, changes in demographics, and other factors affecting consumption of health care services. The debate on the cost implications of expanding Medicaid are likely to persist, but is evident that more Americans have health insurance. 

PEER2 

More often individuals tend not to understand the difference between Medicare in addition to Medicaid. Regardless of them providing assistance to the senior citizens as well as the disabled ones in catering for most of the expenses that are health-related. Medicare is basically a type of health insurance for the people who are disabled, senior or anyone who is known to be suffering from a failure of the kidney which is considered to be permanent. Additionally, it is financed via the contributions of tax security which is contrary to the Medicaid (Hu and Mortensen, 2018).

Florida Medicaid is basically a program that depends on the necessities with benefits which is determined by an individual’s financial in addition to their medical position. It basically provides medical insurance to individuals who are considered to have low incomes in addition to the ones who are disabled. It is a nationwide program which is funded jointly by the federal government in addition to the states. The eligibility of Medicaid, administration in addition to benefits tends to be under the states’ management which are within the guidelines of the federal.

Medicaid basically is known for having an impact which is great within the Florida state in comparison to the Medicare program. It does not provide healthcare which is direct, contrary to that, it pays the nursing homes, hospitals, health plans, physicians in addition to other various caregivers particularly for the services that are covered as well as the ones that have been delivered to the eligible patients. In Florida State it is compulsory for an individual to have a Medicaid so that they can benefit from the healthcare (Munnich and Richards, 2020).