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Hi,

I completed my research with the answer above.  Please reviewed and correct my paper by tomorrow before 12:00pm.  Thanks.

Tim.

1) Minimum 8 full pages (Follow the 3 x 3 rule: minimum three paragraphs per part)

              Part 1: Minimum 1 page

              Part 2: minimum 1 page

              Part 3: minimum 1 page

              Part 4: minimum 1 page 

              Part 5: Minimum 1 page

              Part 6: minimum 1 page

              Part 7: minimum 1 page

              Part 8: minimum 1 page

Submit 1 document per part

2)¨******APA norms

          All paragraphs must be narrative and cited in the text- each paragraphs

          Bulleted responses are not accepted

          Dont write in the first person 

          Dont copy and pase the questions.

          Answer the question objectively, do not make introductions to your answers, answer it when you start the paragraph

         Submit 1 document per part

3)****************************** It will be verified by Turnitin (Identify the percentage of exact match of writing with any other resource on the internet and academic sources, including universities and data banks) 

********************************It will be verified by SafeAssign (Identify the percentage of similarity of writing with any other resource on the internet and academic sources, including universities and data banks)

4) Minimum 3 references per part not older than 5 years

5) Identify your answer with the numbers, according to the question.

Example:

Q 1. Nursing is XXXXX

Q 2. Health is XXXX

6) You must name the files according to the part you are answering: 

Example:

Part 1.doc 

Part 2.doc 

__________________________________________________________________________________

Part 1: 

 Topic: Infection control and prevention

Dissemination of EBP and research, such as presenting results at a conference or writing an article for a journal, is an important part of professional practice. 

Infection control and prevention

1. Identify one professional journal and one nursing or health care conference where you might present your project. 

2. Discuss why each of your choices is the best option for you to disseminate your new knowledge.

Part 2: 

 Topic: Infection control and prevention

1. Discuss why EBP is an essential component of the practice of a BSN-prepared RN. 

2. Identify two ways in which you will continue to integrate evidence into your practice and encourage it within your work environment. 

3. What obstacles could challenge this plan, and what steps will you take to minimize their impact?

Part 3: 

Case Study:

Richard is a 40-year-old man with a history of 4 weeks of cluster headache once each year. These began when he was 35 years old. His cluster periods occur in the fall. The cluster period begins slowly, increasing over 1 week, reaching a peak where Richard has two or three severe cluster attacks each day. They occur from 10 p.m. to 3 a.m. Each cluster headache lasts from 40 to 90 minutes, and the headaches are severe. The pain is always on the right side, with eye tearing and nasal congestion. 

Richard comes into our office 1 week into this fall’s cluster series. The headaches are increasing in intensity, and he is miserable with the pain.

Please complete the following questions: 

1. Describe Cluster Headache and its epidemiology.

2. What would be your goals for therapy for Richard? Give rationale with evidence from articles. 

 Part 4: Community Nursing

A neighbor, who is 3 months pregnant, asks to talk to you because she has felt tired for the last 2 days, has a headache, a rash, and does not feel like eating. You take her vital signs and find that she has a low-grade fever. She has recently traveled to an area where there is risk for Zika virus disease.

1. To what could your neighbor have been exposed

2. how could the exposure have occurred?

3. What advice would you give your neighbor?

Part  5: Crisis intervention 

 1. Discuss what is complicated grieving.

2.  Mention at least 3 clues for identifying complicated grief reaction and explain them. 

Part 6: Aging

When caring for older adults, it is important for the nurse to understand special considerations for medication use in the older population. 

1. List at least two considerations and education you would provide for following medication: Analgesics: Aspirin, acetaminophen and Diuretics: Thiazides, loop diuretics, potassium-sparing diuretics?

You are the nurse caring for an 82-year-old patient with a diagnosis of: Ineffective Breathing Pattern. 

2. List two (2) interventions for this diagnosis with supporting rational. +

Part 7

Clinical performance evaluation is subjective and involves the judgments of the evaluator. It is filtered by the evaluator’s perspective, values, and biases. With this in mind, 

1. select three clinical evaluation strategies that you believe are fair and accurate in order to measure student learning, and determine their competency and safety in the clinical setting.

2.  Explain your rationale for why you selected each of the strategies, and how they align with your personal philosophy of teaching.  

Make sure the strategies that you selected include ways to evaluate students cognitive, psychomotor, and affective domains of learning.

Part 8

What is your position on assigning grades based on a curve (a relative scale)? Explain and defend your position.

Reply to this discussion (site sources if applicable)

Workplace Violence-Preventing and Improving the Outcomes 

     After discussing different aspects of change with my preceptor, we discovered ways to improve my evidence-based practice implementation. Developing an evidence-based change proposal can be challenging in any aspect. One financial aspect of preventing and managing workplace violence is hiring more security guards to be present in difficult situations. Also, having security guards that are properly trained to intervene and provide interventions to help hospital staff when needed with the use of restraints or the use of physically restraining a difficult patient that is causing disruption and health care staff are unable to safely care for the patient. Improving a quality aspect of workplace violence would be to decrease the rates of WPV, promote a safe working environment with signage and verbal reminders. Workplace violence can be in the form of verbal, confrontation, harassment, intimidation, and physical violence. All these forms of violence can cause harm emotionally and physically to nurses, physicians and other healthcare providers. Reporting of these incidents can help with collecting data and this data should be reported and analyzed by management teams for incident tracking. Due to the limited reporting of incidents, staff should be better trained and educated on the need for reporting (Alqahtani, Alsaleem & Qassem, 2020). With these quality improvements, we can create a safer healthcare organization. A clinical aspect of managing workplace violence in the workplace is ensuring proper training, real-life scenarios and providing a safe workplace environment free from potential hazards. Administration teams and management teams need to provide the proper training, in order for nurses to be better prepared for violence and how to handle each situation.  My implementation of creating a zero-tolerance for violence in the Emergency Department will help create a safer environment.  Nurses are constantly being abused physically and verbally and increasing awareness, reporting and training can hopefully help reduce the number of incidents.

Required Readings

Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.
Chapter 7, “Motivational Interviewing” (pp. 299–312)
Chapter 16, “Psychotherapeutic Approaches for Addictions and Related Disorders” (pp. 565–596)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Albrecht, U., Kirschner, N. E., & Grusser, S. M. (2007). Diagnostic instruments for behavioral addiction: An overview. German Medical Science Psycho-Social-Medicine, 4, 1–11. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2736529/

Fisher, M. A. (2016a). The ethical ABCs of conditional confidentiality. In Confidentiality limits in psychotherapy: Ethics checklists for mental health professionals (pp. 13–25). Washington, DC: American Psychological Association. doi:10.1037/14860-002.

To prepare:

• Review this week’s Learning Resources and consider the insights they provide.
• Review the Levy Family video Episodes 1 through 5.

The Assignment

In a 2- to 3-page paper, address the following:

• After watching Episode 1, describe:
  • What is Mr. Levy’s perception of the problem?
  • What is Mrs. Levy’s perception of the problem?
  • What can be some of the implications of the problem on the family as a whole?
• After watching Episode 2, describe:
  • What did you think of Mr. Levy’s social worker’s ideas?
  • What were your thoughts of her supervisor’s questions about her suggested therapies and his advice to Mr. Levy’s supervisor?
• After watching Episode 3, discuss the following:
  • What were your thoughts about the way Mr. Levy’s therapist responded to what Mr. Levy had to say?
  • What were your impressions of how the therapist worked with Mr. Levy? What did you think about the therapy session as a whole?
  • Informed by your knowledge of pathophysiology, explain the physiology of deep breathing (a common technique that we use in helping clients to manage anxiety). Explain how changing breathing mechanics can alter blood chemistry.
  • Describe the therapeutic approach his therapist selected. Would you use exposure therapy with Mr. Levy? Why or why not? What evidence exists to support the use of exposure therapy (or the therapeutic approach you would consider if you disagree with exposure therapy)?
• In Episode 4, Mr. Levy tells a very difficult story about Kurt, his platoon officer.
  • Discuss how you would have responded to this revelation.
  • Describe how this information would inform your therapeutic approach. What would you say/do next?
• In Episode 5, Mr. Levy’s therapist is having issues with his story.
  • Imagine that you were providing supervision to this therapist, how would you respond to her concerns?
• Support your approach with evidence-based literature.

Analysis of a Pertinent Healthcare Issue (lack of access to healthcare)

Develop a 3- to 4-page paper, written to your organization’s leadership team, addressing your selected national healthcare issue/stressor and how it is impacting your work setting. Be sure to address the following:

• Describe the national healthcare issue/stressor you selected and its impact on your organization. Use organizational data to quantify the impact (if necessary, seek assistance from leadership or appropriate stakeholders in your organization).
• Provide a brief summary of the two articles you reviewed from outside resources on the national healthcare issue/stressor. Explain how the healthcare issue/stressor is being addressed in other organizations.
• Summarize the strategies used to address the organizational impact of national healthcare issues/stressors presented in the scholarly resources you selected. Explain how they may impact your organization both positively and negatively. Be specific and provide examples.

  Reply in a well-developed paragraph (300-350 words) to each Response , integrating an evidence-based resources.  Respectfully agree and disagree with your peers’ responses and explain your reasoning by including your rationales in your explanation. 

Response 1

The purpose of this week’s discussion post is to describe two diagnoses and the medications used for their symptoms. This week I will be focusing on migraines and insomnia. Both conditions are neurological by nature and have negative effects on people’s lives. They interfere with activities of daily living as well as mental and physical health.
Migraines are defined as either a classic migraine that has momentary focal symptoms-with aura or a common migraine that has specific symptoms- without aura (Woo & Robinson, 2020). Although the exact catalyst for migraines is not clear there are various theories that help to navigate the course of treatment. Some theories include heightened brain activity from genetics, intracranial vasodilation, and a sensitivity to trigeminovascular systems which causes alterations in structure and function (Woo & Robinson, 2020). Treatment course depends on if migraines are acute or chronic and if the patient has success with preventing or aborting symptoms. One drug class used for acute/abortive migraines are analgesics (Woo & Robinson, 2020). Aspirin and Naprosyn are often used as first line recommendations for acute migraines. It was found that the use of high dose aspirin (900-1,300mg) was successful in aborting, as well as preventing, the symptoms of an acute migraine attack without associated nausea (Alpert, 2020). Aspirin helps alleviate symptoms by interfering with prostaglandins and platelet activity as well as possibly effecting the serotonin activity (Woo & Robinson, 2020). Of course, high doses of aspirin have a long list of warning to teach the patient. Gastrointestinal bleeding, ulcers, and discomfort should be educated and reported. Aspirin is also contradicted in pregnancy, children, prior to surgeries, with any active bleeds or ulcers, and caution with hepatic dysfunction (Woo & Robinson, 2020). The patient should report any signs of bleeding, dizziness, hearing issues, or new pain. The use of aspirin should also be avoided if taking anticoagulants, antihypertensives, NSAIDs, and glucocorticoids (Woo & Robinson, 2020). Naprosyn or naproxen is the other analgesic that is used for the treatment of migraines. Naproxen is used for menstrual specific migraines as well and is contradicted in the last trimester of pregnancy (Woo & Robinson, 2020). Caution should be taken with naproxen with comorbidities such as kidney disease, ulcers, and gastritis. This medication has similar side effects and interactions as aspirin. Gastrointestinal bleeds being the most common. Medication interactions include antihypertensive, antithrombotic, antidepressants, and corticosteroids (Cooney et al., 2015). Being a COX inhibitor, naproxen works for migraines by decreasing pain and inflammation.
Another drug class utilized for migraines are beta blockers. One beta blocker used for migraines include propranolol which is a beta-1 and beta-2 antagonist. This drug works by preventing chronic migraines from occurring and the exact reason how is not clear, but it is believed it is from effecting the catecholaminergic system and brain serotonin receptors (Linde & Rossnagel, 2017). This medication would begin with a 3 month trial and be reassessed every 6 months (Woo & Robinson, 2020). Propranolol can cause a decrease in heart rate as well as respiratory distress so should be avoided in patients with underlying respiratory illnesses or preexisting heart conditions such as bradycardia. Adverse drug reactions include lethargy and depression (Woo & Robinson, 2020). These drugs should also be used in caution with diabetics and be tapered. Another beta blocker that acts only on the beta-1 receptor is metoprolol. Metoprolol is selective for beta-1 so cardiac comorbidities should try alternative methods as this can cause more issues such as bradycardia (Woo & Robinson, 2020). This drug also has many drug interactions because it is metabolized through CYP450.
Insomnia is difficulty falling or remaining asleep which consequently results in a decrease in ability to function during the daytime (Krystal et al., 2019). There are many causes of insomnia including medication reactions, hormone imbalances, mental illness, diabetes, chronic pain, and stress. Because the pathology of insomnia is multifaceted there are numerous medications recommended depending on the cause. One medication group are benzodiazepines. Benzodiazepines work by targeting the GABA receptors which induce sedation and a disease in anxiety (Krystal et al., 2019). Alprazolam or Xanax is known as one of the short-acting benzodiazepines used for insomnia. Another long-acting benzodiazepine utilized is clonazepam. Both medications have the same mechanism of action as stated above. And there are similar interactions as well. All benzodiazepines are CNS-depressants and can cause dependency (Woo & Robinson, 2020). Xanax has a higher prevalence of this than that of a long-acting medication such as clonazepam. These medications can cause respiratory depression, cardiac rates to slow, dizziness, altered mental status, hypotension, or depression (Woo & Robinson, 2020). Clonazepam has a side effect of increased salivation. These medications should not be taken with other depressants or digoxin (Woo & Robinson, 2020).
The other class of medications that is utilized for insomnia are antidepressants. Trazadone is one of the most used antidepressants for insomnia and is no longer used as much for depression (Jaffer et al., 2017). Trazadone is a serotonin antagonist and reuptake inhibitors (SARI) and interferes with the serotonin receptor as well as the histamine 1, and alpha receptors (Jaffer et al., 2017). The main side effects of this medication are sedation, headaches, dizziness, and tolerance. Less commonly trazadone can cause dry mouth, hypotension, QT prolongation, suicidal ideation, and hallucinations (Shin, 2020). Caution should be taken with MAOIs, triptans, TCA, and fentanyl. This drug is also metabolized by the liver and kidneys so those functions should be monitored (Shin, 2020). Another antidepressant that can be used for insomnia treatment is sertraline (Zoloft). This medication is in the selective serotonin reuptake inhibitors (SSRIs) class of antidepressants and works by inhibiting the serotonin reuptake which increases serotonin levels (Singh, 2020). This mediation has a lot of side effects including fainting, GI upset, perspiration, xerostomia, altered mental status, hallucinations, sexual dysfunctions, and drowsiness (Singh, 2020). There is also an increased risk for bleeds, prolonged QT intervals, suicide ideation, and should be taken in caution with elderly populations (Singh, 2020). Because of all these risks this would not be a first line choice for an off-label use such as insomnia but does benefit certain people. 

Response 2

 A seizure is a transient disruption in brain electrical function which are classified differently (McCance, Huether & Rote,2014). Seizures happen when two events occur in a group of neurons. A burst of action is produced by depolarization of the neuron caused by extracellular calcium that opens the sodium channel, which generates repetition (McCance, Huether & Rote,2014). The firing increases and the amplitude becomes greater. The discharge goes to the neurons surrounding and spreads through corticocortical synapses (McCance, Huether&Rote,2014). The firing will spread through pathways to areas in the brain like the basal ganglia, thalamus, and the brainstem, which comes to a tonic phase of muscle contraction and increased muscle tone , and loss of consciousness( McCance,Huether &Rote,2014). There are different types of seizures, they are classified by symptoms and site of origin. Seizures can be initiated due to hypoglycemia, fatigue, emotional and physical stress, lack of sleep, hyponatremia, environmental stimuli, stimulants, alcohol withdrawal, hyperventilation, or blinking lights (McCance, Huether &Rote,2014). Epilepsy is a diagnosis for when seizures continue to reoccur for no known reason, the cause cannot be found (McCance, Huether & Rote,2014).
The three major drug classes of antiepileptic drugs to treat seizures are hydantoins, iminostilbenes, and succinimides (Woo& Robinson,2016).
Examples of hydantoins are phenytoin or Dilantin (mostly used), ethotoin or peganone, and fosphenytoin or cerebyx. These drugs work by stabilizing electrical discharge in the brain by effecting the influx of sodium into the neuron during depolarization, which slows the spread and disruption in electrical function (Woo & Robinson,2016). The rate is usually oral, and these medications are absorbed slowly in the small intestine but enters the brain quickly. These medications are good because levels can be measured for a therapeutical goal of 10-20mcg/ml. When administering hydantoins iv, they must be administered with caution and not too fast because it can cause cardiovascular reactions. Patients should not be prescribed iv if they have sinus bradycardia, sinoatrial block, second- and third-degree blocks, and must be used in caution with patients who have liver disease or renal disease (Woo & Robinson,2016). Side effects of hydantoins are agitation, confusion, dizziness, ataxia, headache, drowsiness, nausea, vomiting, anorexia. Patients should be educated to take exactly as prescribed and not to miss any doses. Patients should not stop this medication abruptly. Patients should be advised that their urine may change in color to pink or red, or reddish brown and not to be alarmed (Woo & Robinson,29016).
Examples of iminostilbenes are carbamazepine or Tegretol, oxcarbazepine or Trileptal and treat epilepsy, bipolar disorder, and some neuralgias (Woo & Robinson,2016). These medications depress transmission in the nucleus of the thalamus, slowing the spread of abnormal activity (Woo & Robinson,2016). Carbamazepine can decrease WBC’s and depress bone marrow leading to leukopenia, thrombocytopenia, and aplastic anemia (Woo & Robinson,2016). CBC should be monitored closely. Side effects of Carbamazepine include thyroid function impairment, and hepatic damage. LFT and TSH should be monitored closely. Most common side effects include, dizziness, diplopia, fatigue, nausea (Woo & Robinson,2016). When patients are prescribed carbamazepine, they should be taught to report sore throat, bruising, and fever. The medication can cause fatigue so they should be on alert to be careful as these medications can be sedating (Woo & Robinson,2016).

Bells Palsy
Bell’s palsy is the most common cause of acute spontaneous peripheral facial paralysis which is unilateral. Common symptoms include the eyebrow sagging, inability to close the eye, and drooping at the affected corner of the mouth, which is drawn to the unaffected side (Ronthal & Greenstein,2020). The etiology of Bells Palsy remains unknown (McCance, Huether & Rote,2014). Bells Palsy could be caused by herpes simplex reactivation in facial cranial nerve VII (McCance, Huether & Rote,2014).
Treatment for Bells Palsy includes short term oral glucocorticoid. Prednisone 60 mg daily x 5 days followed by a 5-day taper of 10mg per day until completed is recommended (Ronthal & Greenstein,2020). Glucocorticoids inhibit the immune and inflammatory by their actions at several sites (Woo & Robinson,2916). When using short term patient may experience insomnia, mood swings and dyspepsia (Ronthal & Greenstein,2020). If a patient has diabetes, they should be educated that the patient will experience hyperglycemia (Ronthal & Greenstein,2020). In severe cases of Bells Palsy, the patient face will be asymmetric at rest, no motion to forehead, and incomplete closure of the eye (Ronthal & Greenstein,2020). With severe cases it is recommend to co -administer anti-viral medication valacyclovir with prednisone. It is unclear if anti-viral therapy adds benefit with new onset bells palsy. It is not recommended to treat with anti-viral medication alone (Ronthal & Greenstein,2020). Mild cases of Bells Palsy should be treated with prednisone alone. Mild case consists of normal facial symmetry at rest and slight weakness noted in face (Ronthal & Greenstein,2020).
Valacyclovir is rapidly converted to acyclovir after administration, the mechanism of action is the same as acyclovir. It is active against the herpes simplex virus. It distributes to areas in the brain, the lung, herpetic lesions, saliva, semen, and kidney (Woo & Robinson,2016). Renal failure has been reported, use with caution in patients with kidney disease. Thrombotic thrombocytopenic purpura has been reported. There are few side effects with acyclovir, but some include headache, rash, and nausea vomiting (Woo & Robinson,2016). Education includes should be taken at the earliest sign of disease; medication should be taken with plenty of fluids to maintain hydration to help avoid renal failure (Woo & Robinson,2016).

Submit a summary of six of your articles on the discussion board. Discuss one strength and one weakness for each of these six articles on why the article may or may not provide sufficient evidence for your practice change.

This week you have learned about common GI disorders in the Adult and Geriatric patient. For the purpose of this discussion select one of the following GI disorders and provide the following in your initial post:

• Common Signs and symptoms seen
• Screening assessment tools
• Recommended diagnostic tests (if any)
• Treatment plans both pharmacologic and non-pharmacologic based on current clinical practice guidelines

GI disorders:

• GERD
• Peptic Ulcer Disease
• Diverticulitis

My Topic Is Corneal & Retinal Disorders