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I need someone who can answer quiz online questions emergency nursing

it is 10 question in 30 min

the quiz will start after 3 hours

Attention Wizard Kim       

Please pay attention to Week 8 Discussion: Quality indicators in Long-term care and Home health care.

 Please pay attention to learning resources for citations.

 Response 1

TC presents to urgent care with a right-shoulder pain 8/10 due to a work injury. The patient has no ROM in the effected shoulder and reports no neck pain. As a healthcare provider there are several things that need to be asked to understand this patient’s pain and pain management. How the injury occurred, if the pain gets better or worse with anything, how long has this pain been occurring for, and what type of pain is TC experiencing should be asked (Woo & Robinson, 2020). The patient should also be assessed for any depression or anxiety via a mental health screen for a history as well as to see if the pain is causing any changes in affect. A past medical history as well as a full physical exam should also be completed prior to making recommendations for pain management. Asking the patient if he is currently on any medications, specifically pain medications will be a useful tool to help decide what treatment will work best for this patient. In addition, allergies need to be considered.
The goal of pain management is to treat the pain but with the least adverse reactions possible (Woo & Robinson, 2020). The best way to accomplish this is to start with non-pharmaceutical management. Ice would be my first recommendation when the patient arrives. If upon assessment this patient has an injury that is affecting the muscle or tendon as most shoulder pain from work occurs from than ice can be put on the patient (Workers Injury Law and Advocacy Group, 2020). The patient’s pain being an 8 out of a 10 on the 0-10 scale however would alert me to give him at least an anti-inflammatory medication as well if not contradicted by information gathered during the history intake and physical examination. I would give TC 1,000mg of acetaminophen due to his high pain scale every 4 to 6 hours (Harvard Health, 2020). This patient may be asked for a urine sample as well for a tox screen to ensure there will be no medication contradictions as well as to assess if this patient is a drug seeker. If this were not sufficient for pain control and there were no other contradictions noted I would try a low dose of hydrocodone.
Instructions for TC would include to rest the shoulder and to ice the shoulder for 10-15 minutes at a time for the first day or two of the injury (Michigan Medicine, 2018). Instructions for acetaminophen include taking with some food to avoid GI upset as well as to not mix with alcohol or loop diuretics, beta-adrenergic blockers, or zidovudine medications (Woo & Robinson, 2020). If the patient were on one or more of these medications I would consider using a non-steroidal anti-inflammatory (NSAID) medication instead of acetaminophen such as Naprosyn. Also, the patient should not exceed the total daily maximum of 4,000mg per day as acetaminophen poisoning is common and dangerous (Woo & Robinson, 2020). Instructions for hydrocodone include not to take with alcohol or other opioid medication. Hydrocodone can cause respiratory distress, low blood pressure, altered mental status, nausea, vomiting, hallucinations, incoordination, constipation, and lethargy (Woo & Robinson, 2020). TC should be instructed not to drive while taking this medication. All opioid medications can become addictive as well so screening and education on this topic is also vital for TC. Lastly I would inform TC to follow-up with his provider and return to urgent care if symptoms get worse or new ones arise.
The DEA Drug Classification Schedule has five categories. Schedule one includes substances that are not for medical purposes or have not been legally endorsed for medical purposes and are highly abused when used such as heroin (DEA, 2020). Schedule two are also high risk for abuse however are used in a medical setting for example hydromorphone. Schedule three includes medications like Tylenol/Codeine which have a less risk of addictive abuse but still could be abused (DEA, 2020). Schedule four medications have a low risk for abuse and addiction as consequence of consumption and they include medications such as Ambien (DEA, 2020). And lastly, are schedule five drugs which do not contain the same narcotic properties as the other categories of drugs. This would include cough syrup and Lyrica (DEA, 2020).

Response 2

The treatment plan for pain has been a much-discussed topic with different opinions that may have pharmacological companies and government agencies at odds of how to treat pain in this country. The one thing everyone agrees is that pain is “real” and affects millions of people worldwide with ineffective treatment for different reasons. According to Woo (2020), pain can be defined as the duration of the pain is either acute or chronic and the source of the pain. The attempt by large corporations in the late 1990’s to treat pain resulted in millions of people dying of an overdose or with addiction that has cost millions of dollars in healthcare treatments (CDC, 2020). In this case study, there are a few things to consider.

        TC comes to the clinic due to a work-injury with an 8 out of 10 pain and is unable to do ROM to the shoulder. The first action that this clinician would take is to assess the patient’s shoulder, his skin, and also take a detailed history of medications, and allergies. After identifying TC’S home medications, if any, and allergies, this prescriber prescribes a fast-acting opioid medication to help with the pain such as morphine. The next step would be sending TC to do an X-Ray and possible follow-up with orthopedic.

        While treating TC for acute pain with opioid morphine is important to understand that this treatment option would be just until his pain is controlled and the necessary X-rays and other tests are obtained. Understanding that the inflammatory process has started the moment the injury occurred as a body’s defense mechanism and healing process (Roma et al., 2020). In this situation, an anti-inflammatory, NSAIDs such as Ibuprofen could be prescribed to control his pain, if there were no fracture noted. The use of an NSAID would decrease the need to use an opioid which is associated with chemical dependency (Woo, 2020). Also, a topical agent could be prescribed in adjunction with the NSAID to help in the treatment of the pain. By prescribing the Lidocaine patch to be applied to the site would help in the control of pain with continuous therapy.

        The teaching to TC would include following the instructions from the orthopedics. Take medications as prescribed. When taking NSAIDS make sure to take with food and a full glass of water and stay up for at least 30 minutes to prevent any GI disturbance, do not take any other medication that is not approved by the clinician, and report to the clinician if the pain is at a comfortable level. Educate TC to report to the clinician if the pain is increasing and the injury is not getting any better to contact the clinician and not to initiate any home remedies without first consulting a prescriber.

        The classification of medication according to the US Drug Enforcement Administration (DEA) drug classification scheduled is to guide prescribers into prescribing drugs. It is designed to regulate the manufacturing, distribution, and dispensing of medications classified as “controlled” (Woo, 2020). The schedule is bound to follow those rules. It is divided into five categories. Scheduled I is drugs that are not prescribed for medical use and have a high potential for abuse, for example, heroin, LSD, marijuana, ecstasy, methaqualone, and peyote (DEA, 2020). In the scheduled II are drugs with high potential for abuse, and may lead to psychological or physical dependency, some examples are Vicodin, Dilaudid, Demerol, OxyContin, Fentanyl, Dexedrine, Adderall, and Ritalin (DEA, 2020). In the scheduled III comes drugs with moderate potential for abuse which are Tylenol with codeine, ketamine, anabolic steroids, and testosterone (DEA, 2020). In Scheduled IV are drugs with low potential for abuse or dependence, some are Xanax, Soma, Darvon, Darvocet, Valium, Talwin, Ambien, and Tramadol (DEA, 2020). Lastly, comes the schedule V which are drugs with low potential for abuse, and contains preparations with a limited quantity of certain narcotics. It is mostly used as an antidiarrheal, antitussive, and analgesic needs, some examples are Robitussin AC, Lomotil, Motofen, Lyrica, and Parepectolin (DEA, 2020). This classification is an important tool for the prescriber to follow and understand how each medication is used and the level of addiction that it can have in patients.

 Respond with a  well-developed paragraph (300–350 words to each peer), integrating an evidence-based resource that is different than the one used for the initial post.

Respectfully agree and disagree with your peers’ responses and explain your reasoning by including your rationales in your explanation.
 

After reading chapters seven (7) and eight (8), choose one of the following conditions and discuss the implications and potential solutions nurses can offer to the older adult.

when writing your weekly discussions: – A minimum of three paragraphs per DQ. Each paragraph should have a minimum of three sentences.

All answers or discussions comments submitted must be in APA format according to Publication Manual American Psychological Association (APA) (6th ed.) 2009 ISBN: 978-1-4338-0561-5

Discussions must have a minimum of two references, not older than 2015.

Part (1)  After discussion with your preceptor, name one financial aspect, one quality aspect, and one clinical aspect that needs to be taken into account for developing the evidence-based change proposal. Explain how your proposal will, directly and indirectly, impact each of the aspects.

Part {11}  Now that you have completed a series of assignments that have led you into the active project planning and development stage for your project, briefly describe your proposed solution to address the problem, issue, suggestion, initiative, or educational need and how it has changed since you first envisioned it. What led to your current perspective and direction?

 Identify a population to assess and develop an evidence-based, primary care health promotion recommendations to deliver in their own communities (Ex: Hispanics-Diabetes, Africanamericans and Prostate Cancer,etc). 

Data-Based Changes

Write an word essay addressing each of the following points/questions. Be sure to completely answer all the questions for each number item. There should be three sections, one for each item number below, as well the introduction (heading is the title of the essay) and conclusion paragraphs. Separate each section in your paper with a clear heading that allows your professor to know which bullet you are addressing in that section of your paper. Support your ideas with at least three (3) scholarly citations using APA citations in your essay. Make sure to reference the citations using the APA writing style for the essay. The cover page and reference page do not count towards the minimum word amount. Review the rubric criteria for this assignment.

1. Identify one aspect of big data and data mining that is interesting to you. Explain the concept and how it might bring value to healthcare. 
2. Describe the concept of continuity planning. If you were the director or manager for your current workplace, describe the preparedness program you would recommend.
3. Locate an article discussing the use of informatics in healthcare education of the general public or of nursing students. Discuss the benefits and drawbacks to using technology in this situation and recommendations from the author. Do you feel this use of technology is a viable method of educating (the public or nursing students)? Why or why not?

Assignment Expectations

Length: 500 words per essay prompt/section (1500 total for this assignment)

Structure: Include a title page and reference page in APA style. These do not count towards the minimal word amount for this assignment. All APA Papers should include an introduction and conclusion. 

References: Use the appropriate APA style in-text citations and references for all resources utilized to answer the questions. Include at least three (3) scholarly sources to support your claims.

Rubric: This assignment uses a rubric for scoring. Please review it as part of your assignment preparation and again prior to submission to ensure you have addressed its criteria at the highest level.

Format: Save your assignment as a Microsoft Word document (.doc or .docx) or a PDF document 

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2 REFERENCES

Personality disorders refer to a group of mental illnesses that involve enduring patterns of thoughts, feelings, and behaviors that are not healthy which significantly and adversely affect how an individual functions in work, relationships, and various aspects of life.  According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), personality disorders fall into 10 distinct types: paranoid, schizoid, schizotypal, antisocial, borderline, histrionic, narcissistic, avoidant, dependent, and obsessive-compulsive. The DSM-5 further divides PDs into three categories of clusters.  Cluster A: schizoid, schizotypal, paranoid the client may have odd or eccentric behaviors.  Cluster B borderline, histrionic, antisocial, narcissistic with dramatic behaviors.  Cluster C avoidant, dependent, obsessive-compulsive which includes anxious and fearful behaviors (American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 2013). 

This paper will discuss Narcissistic personality disorder a cluster B disorder.  A narcissistic personality disorder is characterized by a persistent pattern of grandiosity, fantasies of unlimited power or importance, and the need for admiration or special treatment. The client with NPD may experience significant psychological distress related to interpersonal conflict and functional impairment. Research has shown that core features of the NPD are associated with a poor prognosis in therapy, slow progress to behavioral change, premature patient-initiated termination, and negative therapeutic alliance (Dixon-Gordon et al., 2015).  A narcissistic personality disorder is prevalent, highly comorbid with other disorders, and associated with significant functional impairment and psychosocial disability.  NPD is a challenging clinical syndrome, variable presentation, difficult to treat, and often exists with co-occurring disorders which further complicates treatment.  

Therapeutic Approach

 Due to the complexity of identifying and treating NPD and the absence of expertise or resources for longer-term treatment of personality disorders, some specific approaches and techniques can be implemented to improve general clinical management of patients with the disorder.  There are no FDA-approved treatments for NPD, or any other personality disorder and clinicians use psychotherapy but the personality disorder is a challenging condition to treat (Dixon-Gordon et al., 2015).  Treatments for narcissistic personality disorder current treatment recommendations are based on clinical experience and theoretical formulations. Psychodynamic formulations have led to an increase in various treatment approaches, and case reports suggest that these treatments can be effective for some clients.  The recommended psychotherapies included: mentalization-based therapy, transference focused psychotherapy, and schema-focused psychotherapy. Each of these treatments targets psychological capacities thought to underlie and organize descriptive features of narcissistic personality disorder(Caligor et al., 2015).  However, medication may be used when clients with NPD have severe symptoms that compromise their safety. Medications include mood stabilizers or antidepressants for significant affective instability; mood stabilizer or antipsychotic for impulsive anger and aggression; or an antipsychotic for cognitive-perceptual disturbances such as paranoid thoughts, hallucination-like symptoms, depersonalization (Caligor et al., 2015).   Also, medication may be prescribed to treat co-occurring conditions, such as mood and anxiety disorders.  Clients with NPD tend to report being extra sensitive to side effects, which can cause them to stop taking their medication.  A strong therapeutic alliance has been linked to treatment success in clients with PDs. 

As the PMHNP providing care to a client with NPD, the diagnosis must be shared with the client.  This is an important part of informed consent.  In providing care for an NPD client it is imperative to discuss the etiology, clinical manifestations, course of illness, and treatment options.  Withholding diagnostic information may cause problems by focusing on comorbid conditions like depression or anxiety which the client may respond poorly to treatment.  Hence, if the narcissistic problems are not also addressed then the psychotherapies and medications to address depression and anxiety may be ineffective, lead to clinical worsening, and contribute to high drop out rates for NPD clients (Dixon-Gordon et al., 2011).      

In conclusion client with NPD are difficult to treat based on symptoms are closely linked to other psychosocial disorders and comorbid disorders. Also, treatment for NPD can be difficult for the client and therapist due to the frustration of the therapeutic progress.  NPD is an often misunderstood mental condition where a person acts arrogantly, lacks empathy, needs constant attention and admiration, and has an inflated sense of self.  There is still considerable research that needs to be done regarding the treatment of personality disorders. However, research suggests there is hope for the future in making significant changes in the psychosocial treatment for clients with personality disorders (Dixon-Gordon et al., 2011).  The PMHNP must be knowledgeable of available evidence-based practice, and well-trained to treat clients suffering from personality disorders.   Evidence has shown that PDs are treatable disorders.   The therapeutic alliance is an essential ingredient in all successful doctor-patient interactions, it is especially important when treating a narcissist. Patients with narcissistic traits commonly terminate treatment with medical providers after incidents that providers perceive as harmless misunderstandings.  Increased awareness of the clinician’s feelings when treating these patients will allow the clinician to better recognize the presence of narcissistic traits. This awareness, coupled with an improved understanding of what drives narcissistic behavior, will allow practitioners to manage these patients more effectively in a variety of medical settings.

References

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). (2013). American Psychiatric Association.

Caligor, E., Levy, K. N., & Yeomans, F. E. (2015). Narcissistic personality disorder: Diagnostic and clinical challenges. American Journal of Psychiatry, 172(5), 415–422. https://doi.org/10.1176/appi.ajp.2014.14060723

Dixon-Gordon, K. L., Turner, B. J., & Chapman, A. L. (2011). Psychotherapy for personality disorders. International Review of Psychiatry, 23(3), 282–302. https://doi.org/10.3109/09540261.2011.586992

Dixon-Gordon, K. L., Whalen, D. J., Layden, B. K., & Chapman, A. L. (2015). A systematic review of personality disorders and health outcomes. Canadian Psychology/Psychologie canadienne, 56(2), 168–190. https://doi.org/10.1037/cap0000024