Think about the evidence, concepts, and/or theories (evidence) learned throughout this program and your nurse executive specialization.

Analyze a problem, issue, or situation that you have observed during your practicum experience.

Using a minimum of three peer-reviewed sources of evidence, consider what you have observed within the context of your specialty using appropriate concepts, principles, and theories. Give special attention to observed events that vary from the scholarly literature.

Including personal communications from leaders in health care administration is acceptable; however, this does not replace the requirement for three peer-reviewed sources of evidence.

Determine the degree to which the problem, situation, or issue was addressed in a manner consistent with the theory, concepts, and principles detailed in the evidence.

Given the various evidence-based approaches that can be used in addressing the observed problem, situation, or issue, think about a plan for approaching the matter differently.

 Discuss the tenets of nursing’s metaparadigm. Identify personal philosophy of nursing. 

Your paper should include the following:

– Discuss personal philosophy of nursing.
– Articulate changes in personal philosophy over time.
– Discuss factors that impacted change in personal philosophy of nursing.

Submission Instructions:

• The paper is to be clear and concise and students will lose points for improper grammar, punctuation and misspelling.
• The paper should be formatted per current APA and 3-5 pages in length, excluding the title, abstract and references page. Incorporate a minimum of 3 current (published within last five years) scholarly journal articles or primary legal sources (statutes, court opinions) within your work.

Main Post

Pharmacokinetics and Pharmacodynamics

As advanced practice nurses it is important that we understand pharmacokinetics and pharmacodynamics when caring for our patients. There are many factors to consider when prescribing medications because not one person is the same. Pharmacokinetics is the study of drug movement throughout the body, and has four basic processes: absorption, distribution, metabolism, and excretion (Rosenthal, 2021, p 13). Pharmacodynamics is the study of the biochemical and physiologic effects of drugs on the body and the molecular mechanisms by which those effects are produced (Rosenthal, 2021, p 22). In my experience I can not pinpoint one specific scenario in which pharmacokinetic and pharmacodynamic factors altered an anticipated response to a drug but multiple scenarios.

I can think of things to consider when prescribing medications like their medical history, medications they take, whether prescribed or over the counter, compliance, genetics, age, race, and family history. Other things to consider is the patients liver function and renal function, which affect the drugs absorption and excretion rate. One class of drugs that comes to mind are chemotherapy medications. Not everyone has the same outcome with chemotherapeutic agents when treating cancers. Another class of medications are psychotropic medications, some psych medications work better for others and do not work at all for some. And one of the most common ailments hypertension, antihypertensive drugs that work for some and not others. Immunosuppressed, CHF, renal failure, liver failure patients and patients with multiple ailments on multiple medications, all have to be prescribed medications carefully because of possible polypharmacy and drug interactions. A-fib patients prescribed coumadin needing their PT/INR checked to make sure their coumadin is therapeutic, educating them not to eat green leafy vegetables or drink grapefruit juice.

A patient’s genetics may play a role in whether the medication prescribed is going to work or not. It became evident in the 60’s that therapeutic doses of psychotropic medications vary markedly from person to person, with some patients failing to respond despite treatment with high dosages (Lerer, 2004, p158). Among many factors that may influence the drug response, hepatic function, and drug metabolism ae of great importance for nearly all medications used in psychiatry and even more importantly patient compliance with medication use (Lerer, 2004, p158). The CYP2D6 genetic polymorphism was discovered in late 1970’s and represents one of the most intensively studied monogenic variations in drug metabolism, approx. 7% of Caucasians are poor metabolizers of CYP2D6 substrates while the rest are considered as extensive metabolizers (Lerer, 2004, p160). CYP2D6 enzyme has particular significance for clinical psychiatry as it is involved in clearance of many psychotropic drugs such as tricyclic, antidepressants, selective serotonin reuptake inhibitors, classical antipsychotics, some atypical antipsychotics, drugs of abuse and codeine (Lerer, 2004, p160). In patients who rapid metabolize and have multiple copies of CYP2D6, conventional dose titration may cause delays in therapeutic response and lead to prolonged inpatient hospitalization. It is important to know our patient’s, do lab work according to the drugs being prescribed and refer our patients to specialty physicians if necessary.

                Another consideration is gender when prescribing medications. Research shows that women have different absorption due to lower gastric pH and longer gastrointestinal transit, lower P-glycoprotein expression, different body fat percentage than men, and that estrogen in women can affect drug metabolizing enzymes (Pierzchlinska, 2018, p 117). All of the topics discussed are why it is so important to develop an individualized care plan for each patient to provide the best care possible. The care plan should include goals of therapy, interventions, and follow up evaluation of treatment outcomes. Well rounded individualized treatment plans specific for each patient allow patients to establish trusting relationships with their providers.

Reference

Lerer, B. (2004). Pharmacogenetics of psychotropic drugs. (electronic source). Cambridge University Press.

Pierzchlinska, A., & Bialecka, M. (2018). An introduction to gender differences in neurological treatment. Aktualnosci Neurologiczne, 18(3), 117-122. https://doi-org.ezp.waldenulibrary.org/10.15557/AN.2018.0016

Rosenthal, L.D., & Burchum, J.R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier

link to the video: https://youtu.be/aUJD3sGppUo

View the persuasive speech, Graham Hill: Why I Am A Weekday Vegetarian. Based on the video, respond to the following questions in your post:

• What is the speaker’s topic?
• Who is the speaker’s target audience? How do you know?
• What is the speaker’s thesis?
• How did the speaker use logos?
• How did the speaker use ethos?
• How did the speaker use pathos?
• What other persuasive techniques did the speaker use?
• Did the speaker use visual aids? If so, how did these help persuade you?
• What defective persuasion did the speaker use?
• Did the speaker persuade you to listen to their point? Why or why not?

inculde biochemistry, background introduction, cause, sympotms, diagnosis treatment, prevention, and control incl;ude figures charts, pictures etc

Module 9 Assignment: Persuasive Ethics Research Paper Due November 15, 2020!

This is the paper mentioned in week 3.

Your persuasive paper is due this week.  Please pick a topic, and write a 5 page persuasive paper. 5 pages is approximately 2500 words. It is your responsibility to submit a 5 page paper. That does not include the cover page and references page. Shorter or longer papers will get a significant grade reduction. Please don’t write about abortion, the death penalty, mercy killing or stem cells. Please use at least 2 ethical theories to analyze your position. Please use at least 3 outside resources. Please use the APA citation method. Include in text citations and a references page. 

Submit your paper as an MSWord or .rtf file through the link below.

For this Discussion, you create and post a graphic model depicting your theoretical foundation for research. Your colleagues will offer interpretations of your model to help you identify sources of confusion that need to be addressed.

To prepare

• Review the elements you have been developing throughout this course. Consider the following:
  • How would you show the relationships between and among major concepts? For example, how would you illustrate antecedents and consequences?
  • Is there some aspect of the existing framework/theory you selected in Week 6 that you would like to incorporate in your graphic model? If so, what modifications would you make for it to be appropriate for your research purposes?
  • How would you use your graphic model to support and/or express your research questions or hypotheses?
• Create a graphic model of the theoretical foundation for your research. Your model may include pictures, symbols, and words or short phrases.

Note: Per the Assignment instructions, you may include narrative to accompany your graphic model in your Theoretical Foundation for Research Paper (which is due by Day 7 of Week 10). However, for this Discussion, share only your graphic representation. Your colleagues should view your graphic model without the narrative and share their interpretations of your visual representation to help you identify potential sources of confusion.

By Day 3

Post your graphic model.

Read a selection of your colleagues’ postings.

By Day 5

Respond to at least two of your colleagues, conveying your interpretation of each colleague’s model. (Respond to at least one colleague who has not yet received a response.)

By Day 7

Respond to each interpretation of your model by clarifying misconceptions and expanding upon the graphic presented. (For the Assignment, you should make adjustments to your model to address these misconceptions.)

Assignment: Evidence-Based Project, Part 5: Recommending an Evidence-Based Practice Change

The collection of evidence is an activity that occurs with an endgame in mind. For example, law enforcement professionals collect evidence to support a decision to charge those accused of criminal activity. Similarly, evidence-based healthcare practitioners collect evidence to support decisions in pursuit of specific healthcare outcomes.

In this Assignment, you will identify an issue or opportunity for change within your healthcare organization and propose an idea for a change in practice supported by an EBP approach.

To Prepare:

• Reflect on the four peer-reviewed articles you critically appraised in Module 4, related to your clinical topic of interest and PICOT.
• Reflect on your current healthcare organization and think about potential opportunities for evidence-based change, using your topic of interest and PICOT as the basis for your reflection.

The Assignment: (Evidence-Based Project)

Part 5: Recommending an Evidence-Based Practice Change

Create an 8- to 9-slide PowerPoint presentation in which you do the following:

• Briefly describe your healthcare organization, including its culture and readiness for change. (You may opt to keep various elements of this anonymous, such as your company name.)
• Describe the current problem or opportunity for change. Include in this description the circumstances surrounding the need for change, the scope of the issue, the stakeholders involved, and the risks associated with change implementation in general.
• Propose an evidence-based idea for a change in practice using an EBP approach to decision making. Note that you may find further research needs to be conducted if sufficient evidence is not discovered.
• Describe your plan for knowledge transfer of this change, including knowledge creation, dissemination, and organizational adoption and implementation.
• Describe the measurable outcomes you hope to achieve with the implementation of this evidence-based change.
• Be sure to provide APA citations of the supporting evidence-based peer reviewed articles you selected to support your thinking.
• Add a lessons learned section that includes the following:
  • A summary of the critical appraisal of the peer-reviewed articles you previously submitted
  • An explanation about what you learned from completing the Evaluation Table within the Critical Appraisal Tool Worksheet Template (1-3 slides)

• Describe long-term control and quick relief treatment options for the asthma patient from your practice as well as the impact these drugs might have on your patient.
• Explain the stepwise approach to asthma treatment and management for your patient.
• Explain how stepwise management assists health care providers and patients in gaining and maintaining control of the disease. Be specific.

5 pages