Describe a time when you recognized your values had an impact on your decision. How might this affect clinical reasoning at the bedside?  

It is necessary for an RN-BSN-prepared nurse to demonstrate an enhanced understanding of the pathophysiological processes of disease, the clinical manifestations and treatment protocols, and how they affect clients across the life span.

Evaluate the Health History and Medical Information for Mr. C., presented below.

Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below.

Health History and Medical Information

Health History

Mr. C., a 32-year-old single male, is seeking information at the outpatient center regarding possible bariatric surgery for his obesity. He currently works at a catalog telephone center. He reports that he has always been heavy, even as a small child, gaining approximately 100 pounds in the last 2-3 years. Previous medical evaluations have not indicated any metabolic diseases, but he says he has sleep apnea and high blood pressure, which he tries to control by restricting dietary sodium. Mr. C. reports increasing shortness of breath with activity, swollen ankles, and pruritus over the last 6 months.

Objective Data:

1. Height: 68 inches; weight 134.5 kg
2. BP: 172/98, HR 88, RR 26
3. 3+ pitting edema bilateral feet and ankles
4. Fasting blood glucose: 146 mg/dL
5. Total cholesterol: 250 mg/dL
6. Triglycerides: 312 mg/dL
7. HDL: 30 mg/dL
8. Serum creatinine 1.8 mg/dL
9. BUN 32 mg/dl

Critical Thinking Essay

In 750-1,000 words, critically evaluate Mr. C.’s potential diagnosis and intervention(s). Include the following:

1. Describe the clinical manifestations present in Mr. C.
2. Describe the potential health risks for obesity that are of concern for Mr. C. Discuss whether bariatric surgery is an appropriate intervention.
3. Assess each of Mr. C.’s functional health patterns using the information given. Discuss at least five actual or potential problems can you identify from the functional health patterns and provide the rationale for each. (Functional health patterns include health-perception, health-management, nutritional, metabolic, elimination, activity-exercise, sleep-rest, cognitive-perceptual, self-perception/self-concept, role-relationship, sexuality/reproductive, coping-stress tolerance.)
4. Explain the staging of end-stage renal disease (ESRD) and contributing factors to consider.
5. Consider ESRD prevention and health promotion opportunities. Describe what type of patient education should be provided to Mr. C. for prevention of future events, health restoration, and avoidance of deterioration of renal status.
6. Explain the type of resources available for ESRD patients for nonacute care and the type of multidisciplinary approach that would be beneficial for these patients. Consider aspects such as devices, transportation, living conditions, return-to-employment issues.

You are required to cite to a minimum of three sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.

Prepare this assignment according to the guidelines found in the APA Style Guide, An abstract is not required. 

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. 

Instructions for Discussion Replies to 3 DQS

DO NOT JUST REPEAT SAME INFORMATION, DO NOT JUST SAY I AGREE OR THINGS LIKE THAT. YOU NEED TO ADD NEW INFORMATION TO DISCUSSION.

1- Each reply should be at least 200 words.

2- Minimum One Peer reviewed/scholarly reference ( NO MAYO CLINIC/ AHA)

3- APA 6th edition style needs to be followed.

4- Each response should have reference at the end of each reply

5- Reference should be within last 4 years

Discussion Topic

1. Discussion # 4 : Challenges of the interview of the ARNP initial post due this week

Listed below are the three most challenging interview questions you may experience during the interview process. To fully prepare the student for his or her future interview, please provide a clear and concise answer as to how you as the APRN will answer each interview question.

What is your biggest Weakness?

Describe how you resolved conflict with a co-worker or patient?

Tell me about yourself? 

On your initial threat and peer response develops this topic and include current scholarly articles as your reference.

The Omnibus Budget Reconciliation Act (OBRA), also known as the Nursing Home Reform Act of 1987, has dramatically improved the quality of care in the nursing home over the last twenty years by setting forth federal standards of how care should be provided to residents. 

This Act is interpreted with the U.S. Code of Federal Regulations (42 CFR Part 483). Such improvements include less use of antipsychotic drugs, a reduction in chemical and physical restraint use, and a reduction in inappropriate use of indwelling urinary catheters.

Mandates

The quality of care mandates contained within OBRA, and the regulations, require that a nursing home must provide services and activities to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident in accordance with a written plan of care. 

In order to participate in Medicare and Medicaid programs, nursing homes must be in compliance with the federal requirements for nursing homes.

The mandates of OBRA are regarded in the nursing home setting to represent minimum accepted standards of care. The failure of a nursing home to comply with the OBRA quality of care mandates in caring for a resident represents a failure to exercise the degree of reasonable care and skill that should be expected.

Penalties

The Indiana State Department of Health is responsible for ensuring that nursing homes follow these mandates through the state survey process. The Department of Health and Human Services (DHHS) and the states may apply penalties against nursing homes for failure to meet the minimum standard of care as defined in the OBRA regulations. 

Such penalties may include fines, appointment of administrative consultants to run the nursing home while deficiencies are remedied, and even closure of a nursing home.

• Residents must be assessed to identify their medical problems and their abilities to perform basic self-care activities. The DHHS established a uniform data set, referred to as the minimum data set (MDS), to document this assessment.
• The nursing home is responsible for the safety of each resident. This includes being responsible for orders written by the resident’s primary physician or other medical provider. If the physician writes an order that does not comply with the federal regulations, the nursing home is responsible for making sure the physician changes such order. The mere presence of a physician’s inappropriately written order does not absolve the nursing home of responsibility in providing safe care.
• Provide services that will enhance each resident’s quality of life to its fullest (42 CFR §483.15).
• Maintain the dignity and respect of each resident (42 CFR §483.15).
• Develop a comprehensive care plan for each resident (42 CFR §483.20).
• Conduct a comprehensive and accurate assessment of each resident’s overall health upon admission and at each required interval (42 CFR §483.20).
• Prevent a decline in activity of daily living (ADL) activities, including the ability to eat, toilet, bathe and walk. Staff must provide for ADL care when necessary (42 CFR §483.25).
• Prevent the development of pressure sores, and if a resident has pressure sores, provide the necessary treatment and services to promote healing, prevent infection, and prevent new sores from developing (42 CFR §483.25).
• Provide appropriate care to those who have urinary incontinence and restore bladder function if possible. This also includes only using urinary catheters when appropriate as outlined in the regulations to prevent adverse consequences related to such use (42 CFR §483.25).
• Prevent accidents, including falls, accidental poisonings and other incidents that could cause injuries (42 CFR §483.25).
• Maintain adequate nutrition to prevent unnecessary weight loss (42 CFR §483.25).
• Provide each resident with sufficient fluid intake to prevent dehydration (42 CFR §483.25).
• Ensure that residents are free from significant medication errors (42 CFR §483.25).
• Have sufficient nursing staff (42 CFR §483.30).
• Ensure that each resident’s rights to choose activities, schedules, and health care are maintained (42 CFR §483.40).
• Provide pharmaceutical (medication) services to appropriately meet the physical and psychological needs of each resident (42 CFR §483.60).
• Maintain accurate, complete, and easily accessible clinical records for each resident (42 CFR §483.75).

CASE STUDY: Mrs. J is repeatedly asking for a nurse; other patients are complaining, and you simply cannot be available to Mrs. J for long periods.  Considering the setting and the OBRA guidelines, what would you do to manage the situation?

In order to formulate your evidence-based practice (EBP), you need to assess your organization. In this assignment, you will be responsible for setting the stage for EBP. This assignment is conducted in two parts: an organizational cultural and readiness assessment and the proposal/problem statement and literature review, which you completed in NUR-550.

Section A: Organizational Culture and Readiness Assessment

It is essential to understand the culture of the organization in order to begin assessing its readiness for EBP implementation. Select an appropriate organizational culture survey tool and use this instrument to assess the organization’s readiness.

1. Develop an analysis of 250 words from the results of the survey, addressing your organization’s readiness level, possible project barriers and facilitators, and how to integrate clinical inquiry, providing strategies that strengthen the organization’s weaker areas.
2. Make sure to include the rationale for the survey category scores that were significantly high and low, incorporating details or examples. Explain how to integrate clinical inquiry into the organization.
3. Submit a summary of your results. The actual survey results do not need to be included.

Section B: Proposal/Problem Statement and Literature Review

In NUR-550, you developed a PICOT statement and literature review for a population quality initiative. In 500-750 words, include the following:

1. Refine your PICOT into a proposal or problem statement.
2. Provide a summary of the research you conducted to support your PICOT, including subjects, methods, key findings, and limitations.

P: The lower SES population diagnosed with diabetes type 2.

I: Analysis of the current SES barrier health disparities impedes the provision of quality health care facilities.

C: Promoting equality in the provision of health care procedures to patients with diabetes from the lower SES population.

O: Deliver improved quality of healthcare to the lower SES population to attain the healthy people goal 2020.

This research shows health disparities and determinants regarding those individuals who have diabetes. This PICO is modifiable and open to exploring.

 My PICO was based on the Socioeconomic Status (SES) and geographical location. the disparities in the health care system, with a specific focus on SES and how it affects the access and availability of quality care. In general, the SES can be classified by one’s education, earnings, and occupation. They live in rural and undeveloped regions where there is a lack of medical support, education, and job. Health disparities place a tremendous strain on the community of health care and on culture. Evidence shows that lower SES is associated with the increased health disparities in diabetes patients among U.S. populations. In addition, the collection of data and information among high-risk diabetes groups is appropriate to tackle the health problem in the United States. I provided an intervention that utilized appropriate financing and donation programs would encourage health interventions from distinct ethnic and racial groups to treat diagnosed patients. People have different beliefs and attitudes about individuals with diabetes. Diabetes incidence is different among the various ethnic groups. Appropriate projects need to be developed to eliminate lower SES health disparities.(Healthy People 2020, 2018) 

General Guidelines:

You are required to cite three to five sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

Note: After submitting the assignment, you will receive feedback from the instructor. Use this feedback to make revisions for your final paper submission. This will be a continuous process throughout the course for each section.

You are caring for a 6 year old female patient name Rita in the hospital.  She is 2 hours post-op from acute appendicitis.  She had a laparoscopic appendectomy. She is sleepy but arousable and can answer short questions. 

Her last set of vital signs are:

b/p 100/68, p 90, r 26, t 98.1, sats 96%.  

Her vitals 30 minutes before that were:

b/p 120/79, p 74 r 20, t 98.3, sats 99%.  

You check her abdomen and there are 4 well approximated incisions on her abdomen, closed with surgical glue.  One incision on her lower left quadrant appears to be swollen and appears to have some red drainage seeping from under the surgical glue.  Rita is moaning and grimacing with her eyes closed in the bed.  

She has a 20g IV in her left forearm and is running LR at 100ml/hr, she has 02 at 2l/m via NC in place. She has an indwelling Foley catheter and you have drained 40ml of urine in the 2 hours she has been in your care.

Rita’s mom and dad are anxiously sitting in her room, asking questions regarding her recovery from surgery and when she will be discharged.

1. What are your thoughts regarding Rita’s condition? Is she progressing normally post operatively?
2. What is your priority in regard to her condition?
3. Is Rita giving you cause to worry? If yes, what do you anticipate happening?
4. What nursing diagnosis would you apply to Rita? To her family

 THIS IS NOTAN EASSAY IT IS AN ASSIGNMENT

Present a case study of a patient with suspected anemia. The patient may have a chief complaint of fatigue, dizziness, or failure to thrive (choose one). Include the following in the case study:

1. Identifying data
2. Chief complaint (CC)
3. History of present illness (HPI)
4. Review of systems (ROS)
5. Pertinent medications or allergies
6. Physical exam
7. Screening tools
8. Assessment, including differential diagnoses and any pitfalls of which one must be aware

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 assignment, you will create a clinical guiding question know as a PICOT question. The PICOT question must be relevant to a nursing practice problem. To support your PICOT question, identify six supporting peer-revised research articles, as indicated below. The PICOT question and six peer-reviewed research articles you choose will be utilized for subsequent assignments.

Use the “Literature Evaluation Table” to complete this assignment.

1. Select a nursing practice problem of interest to use as the focus of your research. Start with the patient population and identify a clinical problem or issue that arises from the patient population. In 200–250 words, provide a summary of the clinical issue.
2. Following the PICOT format, write a PICOT question in your selected nursing practice problem area of interest. The PICOT question should be applicable to your proposed capstone project (the project students must complete during their final course in the RN-BSN program of study).
3. The PICOT question will provide a framework for your capstone project.
4. Conduct a literature search to locate six research articles focused on your selected nursing practice problem of interest. This literature search should include three quantitative and three qualitative peer-reviewed research articles to support your nursing practice problem.

Note: To assist in your search, remove the words qualitative and quantitative and include words that narrow or broaden your main topic. For example: Search for diabetes and pediatric and dialysis. To determine what research design was used in the articles the search produced, review the abstract and the methods section of the article. The author will provide a description of data collection using qualitative or quantitative methods. Systematic Reviews, Literature Reviews, and Metanalysis articles are good resources and provide a strong level of evidence but are not considered primary research articles.  Therefore, they should not be included in this assignment.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center

Literature Evaluation Table

Student Name: 

Summary of Clinical Issue (200-250 words):

PICOT Question:

Criteria

Article 1

Article 2

Article 3

 APA-Formatted   Article Citation with Permalink

How   Does the Article Relate to the PICOT Question?

Quantitative,   Qualitative (How do you know?)

Purpose   Statement

Research   Question

Outcome

Setting   

(Where   did the study take place?) 

Sample

Method

 Key   Findings of the Study

Recommendations   of the Researche Criteria

Article 4

Article 5

Article 6

 APA-Formatted   Article Citation with Permalink

How   Does the Article Relate to the PICOT Question?

Quantitative,   Qualitative (How do you know?)

Purpose   Statement

Research   Question

Outcome

Setting   

(Where   did the study take place?) 

Sample

Method

Key   Findings of the Study

Recommendations   of the Researcher

Write a 1 page reflection analyzing the COVID situation. 

– Include an introduction.

– Include a section called “Your Thoughts” explaining the history of the virus in our country, what caused the situation and out country’s response. How have different points of view included factual reports, inductive inferences, and evaluative judgement. Define these terms. 

– Include a conclusion explaining how perceptions and beliefs of others influence awareness of our “lenses”. 

APA style