Nursing

PICOT Question and Search Strategy
Among the geriatric population at a long-term care facility, who are currently taking multiple medications due to chronic conditions or acute conditions, would review medications at each provider visit, fall, admission, or re-admission to reduce polypharmacy and its associated adverse reactions? You will formulate and write a clinical, administrative practice, public health policy, or program question that relates to your professional interests, and track and develop a search strategy based on that question. This assessment sets the stage for much of the writing you will complete in the course.
Competency 1: Address assessment purpose in a well-organized text, incorporating appropriate evidence and tone in grammatically sound sentences.
Compose well-developed paragraphs that address the assessment purpose.
Produce text with minimal grammar, usage, spelling, and mechanical errors.
Competency 3: Create a literature review that supports a possible intervention or process change.
Implement a search strategy for literature based on your PICOT question.
Competency 4: Obtain preceptor and practicum approval.
Propose a PICOT question that has an appropriate scope for a DNP project.
The assessments in this course must be completed in the order presented; subsequent assessments should be built on both your earlier work and your instructor’s feedback on earlier assessments. If you choose to submit assessments prematurely, without considering and integrating your instructor’s feedback, your assessment may be returned ungraded, resulting in your loss of an assessment attempt.
PICOT Question and Search Strategy
Formulate and write a clinical problem question that relates to your professional interests and could be used for a DNP doctoral project. Ideally, this question relates to an identified problem at your doctoral practice site.
The work you do in this assessment will assist you in crafting Part 2 of your Project Charter in NURS-FPX9100. Your PICOT question will help you to identify evidence-based strategies that you will use in your doctoral project.
Use this format for developing a PICOT question:
In ____________(P), how does __________(I) compared to desired state __________(C) affect the outcome __________(O) within __________(T).
Here is an example of a PICOT question: For medical units experiencing a high number of “failure to rescue” (P), will the development of a rapid response team (RRT) (I) compared to the current emergency alert system (code blue) (C) decrease the number of “failure to rescue” and ICU admissions (O) and unplanned admissions to the ICU (O) over a 12-week period (T)?
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Describe your search strategy and the results of your search in relation to the PICOT question. Think about these questions as you describe your search:
Which electronic databases did you use?
What were the key search terms used?
What type of literature was excluded?
How many articles or sources did your search yield?
How did you decide which sources to retain?
This assessment will be graded according to the following scoring guide criteria.
Propose a PICOT question that has an appropriate scope for a DNP project.
A DNP project of appropriate scope:
Can be completed in 8 to 12 weeks.
Is a quality improvement project or a process improvement project (i.e., is not “research”)?
Addresses a gap in practice, using an evidence-based intervention.
Implement a search for literature to support your argument.
Design a search strategy to support a problem question.
Compose well-developed paragraphs that address the assessment purpose.

Assignment 1: Supportive Psychotherapy Versus Interpersonal Psychotherapy
Although supportive psychotherapy and interpersonal psychotherapy share some similarities, these therapeutic approaches have many differences. When assessing clients and selecting therapies, it is important to recognize these differences and how they may impact your clients. For this Assignment, as you compare supportive and interpersonal psychotherapy, consider which therapeutic approach you might use with your clients.
Learning Objectives
Students will:
• Compare supportive psychotherapy and interpersonal psychotherapy
• Recommend therapeutic approaches for clients presenting for psychotherapy
To prepare:
• Review the media in this week’s Learning Resources.
• Reflect on supportive and interpersonal psychotherapeutic approaches.
The Assignment
In a 1- to 2-page paper, address the following:
• Briefly describe how supportive and interpersonal psychotherapies are similar.
• Explain at least three differences between these therapies. Include how these differences might impact your practice as a mental health counselor.
• Explain which therapeutic approach you might use with clients and why. Support your approach with evidence-based literature.
NOTE: THE CLIENTS SHOULD BE OLDER ADULTS FROM 52 YRS TO 99YRS.
Note: The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references.

Oppositional Defiant Disorder/ODD: Parent Guide
Using evidence-based research, design and develop a Parent Guide for your Pathophysiology
This assignment is a group assignment . I am only responsible for the Pathophysiology of Oppositional Defiant Disorder/ODD.
Only the Pathophysiology of Oppositional Defiant Disorder/ODD please.
Thanks

concept map
Please complete a Problem Based Care Plan and Concept Map for Post Partum Hemorrhage. I upload the template for the concept map and problem-based care plan.
Postpartum Hemorrhage Scenario
Patient:
Patty Noble Mrs. Patty Noble is a 42-year-old G5P4014 who was admitted in active labor at 38+2 weeks and just had a spontaneous vaginal delivery 30 minutes ago. The delivery was uncomplicated, and she had no lacerations. She is approximately 30 minutes postpartum and has just called out because she feels dizzy and has noticed more bleeding.
Patient Information:
? The patient has no significant past medical history.
? She has no known drug allergies.
? Her pregnancy was uncomplicated except for asymptomatic anemia with an H/H=10/30.3 and was on iron BID during her prenatal course.
Laboratory Data (On Admission):
? Hemoglobin: 10.5
? Hematocrit: 31.1
? WBC: 12,000
? Platelets: 218,000
Delivery Information:
? Measurement of cumulative blood loss (as quantitative as possible) from the delivery was 400cc.
? The placenta was inspected at the time of delivery and appeared to be intact per the delivery note.
? The vaginal vault and perineum was inspected; no lacerations were found
? The infant weighed 4220 grams.
? The patient has an IV line in place with oxytocin running.
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Solution
vbg
by Cole John
Submission date: 02-Mar-2022 05:41PM (UTC+0300)
Submission ID: 1774688903
File name: pati78.docx (15.85K)
Word count: 435
Character count: 2304
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ORIGINALITY REPORT
PRIMARY SOURCES
www.ncbi.nlm.nih.gov
Internet Source

Nursing Interview
Nurse Interview: Leader, Executive, or Manager
Nursing leaders work in a variety of positions: managers in hospitals, directors at various levels within clinical and non-clinical settings, executives within healthcare organizations, etc. For this assignment, students will conduct an interview to explore the characteristics and functions of nursing leaders. Students will then present their findings. The nursing leader must be an RN, have a BSN degree or higher, and be in a position of leadership.
Ensure the individual being interviewed has enough responsibility to be able to respond to the following questions. You will use these headings to organize and present your findings.
• Introduction
o Describe your education, nursing background, and current and previous positions.
• Leadership Style
o Describe the leadership style you identify with and most commonly use in your practice.
o How did you develop your leadership style?
o How has your leadership style evolved with experience?
• Future Planning
o How are you working towards sustainability for your practice setting in developing new nursing leaders?
o To what professional organizations do you belong?
o How are professional organizations impactful in developing nursing leaders?
• Current Issues and Trends
o Describe current challenges you are facing in nursing and healthcare (today and in the past 2-5 years.)
o How do these challenges impact your practice setting?
o Describe the impact of these challenges at the local, national, and global levels.
(For example, if staffing is a concern for the practice setting is it because of a local trend? Is this a tourist community in which the population fluctuates making finding and keeping qualified, dedicated staff a difficulty? Is this a challenge because this type of facility is impacted by local, national, or even global politics and economic circumstances?)
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Solution
Nurse Interview: Emergency Department Manager
Introduction
I started my nursing career by obtaining an associate degree in nursing. I began with an associate degree in nursing because the program took less time and allowed me to enter the workforce in a short time. After obtaining my associate degree, I was employed as a charge nurse in an emergency department of a healthcare facility. During the period I worked as a charge nurse, I pursued a Bachelor’s of Science degree in nursing to gain more in-depth education in my career. My employer helped me significantly to pursue my BSN degree by providing tuition reimbursement. After pursuing my education, I also completed and passed the National Council Licensure Examination NCLEX-RN and obtained my certification as a registered nurse. I also earned my state license to practice as a registered nurse.
As a registered nurse, my nursing background and primary role are to ensure that all the patients receive the direct and proper care they need in varying healthcare settings. As a registered nurse, my responsibilities, therefore, include identifying and assessing patients’ needs and then monitoring and implementing the patient’s treatment and medical plan.
Currently, I’m an emergency department manager in a large healthcare facility. As an emergency department manager, my main roles and responsibilities include promoting administrative and clinical efficiency in the emergency care department. As an emergency department manager, I’m actively involved in facilitating communication between different clinical personnel in the emergency department and ensuring that patients receive quality healthcare services within the budgetary parameters of the healthcare facility. As an emergency department manager, my main focus at the moment is on the administrative duties in the emergency department, which makes me spend a lot of time in the office as opposed to providing clinical services to patients.
Previously I worked as a charge nurse in the emergency room for five years. As a charge nurse in the emergency room, my roles and responsibilities included monitoring the vital signs of patients and being actively involved in creating medical records for patients. As a charge nurse, I’m normally in charge of supervising the nursing staff in the emergency room and monitoring their needs. As a charge nurse, my role also includes overseeing the admission of patients, transfers, and discharges. I also ensured compliance with safety and health regulations in the emergency room in my previous role as a charge nurse.
Leadership Style
As an emergency department manager, I would describe my leadership style as the transformational leadership style. As a transformational leader, I am always actively involved in motivating all the healthcare practitioners that work within the emergency department to take responsibility and ownership of their roles and to always perform beyond expectations (Gemeda & Lee, 2020). As a transformational leader, I rarely assign tasks to the healthcare practitioners who work in the emergency department but rather promote independence and innovation in the performance of duties. I developed my leadership style through extensive personal analysis and a lot of mentorships. Initially, I would have described my leadership style as democratic, especially when I was working as a charge nurse. However, my leadership style evolved to the transformational leadership style after pursuing a nursing leadership course that highlighted the advantages of the transformational leadership style.
Future planning
As an emergency department manager, I have helped in the development of a leadership mentorship program that aims at developing new nursing leaders in the department. Through the program, various leaders in the emergency department can nurture talented subordinates who are interested in leadership roles in the future.
Currently, I’m a member of the American Nurses Association (ANA). Professional nursing organizations such as ANA play a significant role in developing nursing leaders through mentorship, leadership seminars, workshops, and leadership proficiency programs. Professional nursing organizations also help nurse leaders network and collaborate and enhance their leadership skills.
Current Issues and Trends
The main challenge facing nursing and healthcare currently is inadequate staffing. As the population has continued to age, the demand for healthcare services has continued to increase, resulting in the stretching of healthcare resources, including human resources. Currently, there seems to be a significant mismatch between the demand for nurses and healthcare practitioners and the number of people who are pursuing the nursing career. The lack of adequate staff in healthcare facilities is therefore having a significant impact on the quality of healthcare services delivered to patients (Ashe, 2018).
In the emergency department, one of the central challenges that I experience currently is inadequate staffing. Most of the time, the emergency department is normally understaffed, which leads to the enforcement of mandatory overtime and heavy workloads among healthcare providers. The challenge of inadequate staffing in the emergency department contributes significantly to the problem of nurse burnout, absenteeism, and high turnover rates.
At the local level, the challenge of inadequate staffing in the emergency department seems to be fueled by an aging population that demands more health care services. On the other hand, on the national level, the trend of an aging population and the demand for health care services has not been met by the increasing number of people who are pursuing a nursing profession, resulting in a shortfall in the number of healthcare practitioners required. The aging population is also a global trend that has contributed significantly to the rising demand for health care services and inadequate staffing in healthcare facilities.
References
Ashe, L. (2018). The importance of adequate staffing. Nursing Management, 49(12), 7. https://doi.org/10.1097/01.numa.0000549519.47901.4f
Gemeda, H. K., & Lee, J. (2020). Leadership styles, work engagement and outcomes among information and communications technology professionals: A cross-national study. Heliyon, 6(4), e03699. https://doi.org/10.1016/j.heliyon.2020.e03699

Normal delivery
Please complete a Problem Based Care Plan and Concept Map for Vaginal Delivery
I uploaded the example so follow that, please
A. SCENARIO LEARNING OBJECTIVES
Learning Outcomes
1. Utilize principles and care practices related to normal labor and delivery.
2. Implement critical thinking and clinical decision-making skills necessary to interpret data.
3. Integrate understanding of multiple dimensions of patient-family centered care.
4. Provide safe care to laboring patients, prioritizing and implementing interventions for mother and fetus.
Specific Learning Objectives
1. Accurately assess the laboring mother and estimate labor progress based on client responses.
2. Recognize normal fetal heart rate pattern.
3. Implement appropriate nursing interventions at this point in the labor process.
4. Communicate relevant patient information to team using SBAR tool.
5. Effectively communicate with client throughout simulation to keep informed and relieve anxiety.
6. Perform pain assessment and reassure patient realistically.
7. Engage family members to support patient in laboring process.
Critical Learner Actions
1. Identifies self and role to patient and family members.
2. Performs hand hygiene.
3. Identifies patient using 2 identifiers.
4. Prioritizes assessment for both mother and fetus.
5. Attaches fetal monitor.
6. Communicates calmly with patient and family members while implementing interventions.
7. Supports patient while primary nurse performs vaginal check to assess labor progress.
8. Recognizes signs of imminent delivery.
9. Reassesses mother and fetal heart tracing throughout.
10. Considers patient need for privacy and need for family support when making decisions about care.
B. PRE-SCENARIO LEARNER ACTIVITIES
Prerequisite Competencies
Knowledge Skills/ Attitudes
q Normal Labor and Delivery q General survey and focused assessment of newly
admitted patient in active labor
q Pain theory related to child birth q Recognition of and interventions for normal fetal
heart patterns
q Pharmacology of medications administered
during intra-partum period.
q Comfort measures for laboring patient including
family involvement
q Therapeutic communication with patient and
family
q Dimensions of patient-family centered care in
dealing with distressing situations
q SBAR communication with interprofessional
team.
q Non-medicinal measures to support patient in active
labor
D.Patient/Client Profile
Last name: Garcia First name: Leticia
Gender: Fe Age: 15 Ht: 5’2” Wt: 158# Code Status: Full
Spiritual Practice: Catholic Ethnicity: Puerto Rican Primary Language spoken:
English/Spanish
1. History of present illness
Chief Complaint: Excruciating abdominal pain.
Visiting from Florida visiting sister and in complete denial of pregnancy. Her parents are first generation Puerto Rican immigrants. Parents and sister are totally unaware she is pregnant. Because of her denial she has had no prenatal care. At her sister’s home at 0100 she begins to experience strong abdominal cramps. She does not tell her sister until 0700 and states she has a bad stomach ache. Her sister sees she is in a lot of pain and
immediately takes her to the nearest hospital.
Primary Medical Diagnosis Full term pregnancy
2. Review of Systems
CNS Alert, oriented, cooperative, fearful
Cardiovascular Regular sinus rhythm, no gallops, rubs or murmurs, apical clear, pulses +4 radial and
pedal
Pulmonary Clear to A&P
Renal/Hepatic Voiding clear urine, no hepatomegaly felt
Gastrointestinal Distended, full term pregnancy
Endocrine Full term pregnancy
Heme/Coag No bruising or bleeding noted
Musculoskeletal Moves all extremities well. Spine within normal limits
Integument Clear without abrasions
Developmental Hx Normal Hispanic teenager
Psychiatric Hx None reported
Social Hx Sexually active, no reported drug, smoking or alcohol history
Alternative/ Complementary Medicine Hx unknown
Medication allergies: None reported Reaction:
Food/other allergies: NKDA Reaction:
3. Current medications Drug Dose Route Frequency
4. Laboratory, Diagnostic Study Results
Na: 142 K: 4.2 Cl: 102 HCO3: 2622 BUN: Cr:
Ca: 9.3 Mg: 1.2 Phos: Glucose: HgA1C:
Hgb: 13 Hct: 36.8 Plt: 265 WBC: 5.2 ABO Blood Type:
PT: 11.5 PTT: 25 INR Troponin: BNP:
Ammonia: Amylase: Lipase: Albumin: Lactate:
ABG-pH: paO2: paCO2: HCO3/BE: SaO2:
VDRL: neg GBS: pending Herpes: neg HIV: neg Chlamydia: neg
CXR: ECG:
CT: MRI:
Other:
Due to the running out of space problem on the actual worksheet I have copied the statements here:
WHAT ASSESSMENT DATA DOES THE NURSE FIND AS PERTINENT (important) (RECOGNIZE CUES)?
Risk factors: Young age of 16, nulliparity, late prenatal care, lack of support system, underweight for current gestation.
Current problem: Hypertensive with BP 150/80 mm Hg, pedal edema. Labs: urine protein 400mg, Why is this significant? What does it tell you? Platelet 80,000, ALT 70 U/L, AST 90 U/L, Cr 12 mg/dL Again, what do these lab values tell you? Are they normal? (You have to know what the normal ranges are!)
What we would hope for in any care plan is Lab value x is normal, or abnormal. Thinking about a normal labor patient, we do a CBC on admission to the hospital for labor. Why? 1. Anemia is common in pregnancy 2. To know BASELINE values so we can see if there are major or concerning changes if there is a bleeding event (All women will lose at least a little blood with birth, as low as 100ml and as high as multiple liters in the case of hemorrhage-how did the blood loss affect them?) If Susie Lou has an admission HCT of 35, what does that tell you? (It tells me that it is a normal value, and she is well set to handle a typical amount of blood loss for birth). If Queen Jones has an admission Hct of 28, that raises several concerns. Is it part of a larger picture like HELLP? Has she been losing blood somehow, like placental bleeding?
For this case: Lab value of ALT 70 and AST 90 show elevated liver enzymes. We have a low platelet count of 80,000. The significance of these numbers is: this indicates the patient has developed HELLP syndrome (Hemolysis, Elevated Liver Enzymes, Low Platelets). The low platelet count also increases risk of bleeding and, while you may not know this as a student, due to this risk of bleeding the patient typically cannot get regional anesthesia (epidural or spinal) with a platelet count below 75k-100k depending on facility protocol and provider comfort level.
WHAT IS THE DISEASE PROCESS CAUSING THESE ASSESSMENT FINDINGS (ANALYZE CUES)?
Pre-Eclampsia/HELLP syndrome
(Discuss pathophys in the DESCRIBE DISEASE PROCESS AFFECTING PATIENT (Include Pathophysiology of Disease Process) section
WHAT IS THE MAIN PROBLEM WITH THE PATIENT THE NURSE CAN TREAT (PRIORITIZE HYPOTHESES)? Another way to think of it is what do I as the nurse have control over?
This one is a bit tricky. You can’t really do anything about the fact that the patient has HELLP syndrome. What you can do is MANAGE RISK factors (hypertensive crisis, eclamptic seizures, falls, etc.) by:
Treating her with medication as ordered to control BP
Reducing risk of seizure by administering Magnesium sulfate as ordered, providing safety with padded rails, etc.
Lack of knowledge is a problem for all patients who need to learn about their disease process or condition. What should they alert the nurse/staff about? What do they need to do or avoid? What side effects could medication cause?
WHAT IS THE GOAL FOR THE PATIENT (GENERATE SOLUTIONS & TAKE ACTION)? CREATE SPECIFIC, MEASURABLE, ACHIEVABLE, REALISTIC, AND TIMETABLE (SMART) OUTCOMES.
Think safety. Think best outcome. For this patient that would be:
Pt will remain free of injury (covers fall and seizure) by the end of shift.
Pt will remain normotensive by end of shift
Pt will have adequate urine output of 30ml/hr or more by end of shift
WHAT INTERVENTIONS WILL THE NURSE IMPLEMENT WHEN CARING FOR THIS PATIENT (GENERATE SOLUTIONS & TAKE ACTION)? INCLUDE THE EVIDENCE/(RATIONALE). LIST INTERVENTIONS IN ORDER OF PRIORITY. INCLUDE COLLABORATIVE AND NURSE?INITIATED INTERVENTIONS
Evidence means citing where you got the knowledge from-your textbook? A website? An article?
What is the priority? Go back to RISK FACTORS/PROBLEMS
What is the worst-case scenario with elevated BP? >Stroke
So…we want to control patient’s blood pressure-how can nurses do this?
Interventions:
Create a calm, quiet environment
Have the patient rest in bed
Monitor BP (and other vitals) hourly, or per protocol/orders
Give blood pressure medication as ordered by provider, especially if patient becomes severely hypertensive (160/110) she will require additional prn IV med.
Rationale for controlling BP: Hypertension results from biochemical changes that cause vasoconstriction and vasospasm. A sharp increase in BP indicate progression of preeclampsia and increase risk of stroke.
What is the worst case scenario with Pre-Eclampsia? >That the patient become eclamptic (starts having seizures).
So, nurse will:
Monitor patient for worsening symptoms such as headache, visual changes, epigastric pain, hyperreflexia, presence of clonus. Monitor lab value trends regularly.
Educate patient to report new or worsening headache, visual changes, epigastric pain, and to call staff for assistance if getting out of bed.
Minimize the likelihood of seizure by giving a CNS depressant, Magnesium sulfate, as ordered.
We know that preeclampsia is a multi-organ disorder (pathophys). How do I know if her liver is OK? Lab values, absence of RUQ pain. How do I know if her kidneys are ok? Monitoring urine output and lab values for kidneys (proteinuria, creatinine, BUN, etc.)
Connect interventions to rationale, for example:
Monitor I&O per protocol (or provider orders). Rationale: Oliguria can indicate hypovolemia and renal hypoperfusion
How is the problem, the pre-eclampsia, affecting the unseen patient, the baby? How is the fetus tolerating being in the uterus right now? We need to see baby on the monitor to know that.
Intervention: Assess the fetal heart rate pattern with continuous monitoring. If there are signs of hypoxia, alert provider. (Would move to delivery)
Don’t forget about the emotional and psycho-social aspect, such as having this condition can cause anxiety.
Or with pre-term labor, patient could be experiencing anxiety about delivering early.
Patient (in any scenario) also needs knowledge about the healthcare team’s concerns and management plan. Intervention: Educate patient and family about …
Intervention: Prepare the patient and family for cesarean delivery if indicated due to the progression of preeclampsia or determined by the healthcare provider
Rationale: Fetal and placental delivery ceases the progression of preeclampsia. Failed induction and/or attempt for vaginal delivery will lead to cesarean section.
HOW WILL THE NURSE EVALUATE THE PATIENT’S RESPONSE (EVALUATE OUTCOMES)? AND WHAT WAS THE PATIENT’S RESPONSE TO THE INTERVENTIONS? Another way to think about it is, were the goals met in the time frame you specified? Then your interventions were effective!
Pt’s blood pressure remained less than 160/110 throughout the shift
Pt did not experience worsening HA, visual changes, or epigastric pain
DTR’s were within normal limits without change
Urine output adequate
Pt remained free of injury
Fetal tracing does not show signs of hypoxia
WHAT OTHER PROBLEMS COULD THE NURSE LINK TO THIS PATIENT PROBLEM?
I am not sure if what they are asking is what other health conditions could happen as a result of the patient having the main problem?
Pulmonary edema, Hypertensive crisis, Seizures (eclampsia), Retinal detachment, Stroke, Abruptio placentae, Thrombocytopenia, Acute renal failure, Preterm labor, Intrauterine growth restriction. (Lippincott Advisor Diseases and Conditions).
DESCRIBE DISEASE PROCESS AFFECTING PATIENT (Include Pathophysiology of Disease Process)
In preeclampsia and eclampsia, placental hypoperfusion, hypoxia, and ischemia develop due to: failure of maternal uterine spiral arteries to undergo remodeling in the first trimester; release of factors that affect maternal vascular endothelial function; systemic vasospasm; leukocyte activation; coagulation system activation. Talk about why patient would have edema, proteinuria, affects multiple organs, visual changes are due to retinal edema, etc. CONNECT pathophys to assessment findings/typical presentation with this condition/what you are watching out for
Diagnostic Tests:
Kidney function test – urine protein 400mg. Cr 12 mg/dL.
• CBC – Platelet 80,000, Hgb 14 g/dl
• Liver function test – ALT 70 U/L, AST 90 U/L
In addition to tests already performed, what other tests do you think might be needed?
PATIENT INFORMATION
INCLUDING PRIORITY PATIENT PROBLEM(S)
· Pt is age 16 (why is that significant?
Adolescent developmental phase, need to understand care needs and how you would approach differently/teach differently).
· Pt has only her mom for support
· Pt is hypertensive with BP 150/80
· Diagnosed with pre-eclampsia (based on VS and diagnostic tests)
· She is under weight for her current gestation.
· Risk for seizure
ASSESSMENT FINDINGS
Many of you listed data from the case study such as: BP 150/80 mm Hg, pedal edema, urine protein 400mg, Platelet 80,000, ALT 70 U/L, AST 90 U/L, Cr 12 mg/dL
These are not assessment findings, except the BP and pedal edema. This is data from the chart. How do you interpret what you find on physical exam and interviewing? Make the connection!
Assessment is lung sounds-crackles? Could indicate fluid overload. Deep Tendon Reflexes and Clonus-exaggerated reflexes or positive clonus? getting closer to seizing
RUQ pain? Liver is being affected by disease process
PLAN OF CARE/INTERVENTIONS
Another way to think of this is-what will I spend my shift doing? What am I most concerned about for this patient? How will I know if the patient’s condition is getting worse? What will I monitor? What risks will I work to avoid?
Assess Vital Signs hourly per protocol/orders
Assess DTR and clonus q 4 hours per protocol/orders
Administer antihypertensives and magnesium sulfate as ordered
Educate patient about symptoms to report
Monitor I&O hourly (strict I and O)
Monitor for worsening symptoms
Continuous fetal monitoring
Quiet room with dim lighting, safety….
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Solution
What assessment data does the nurse find as pertinent (important) (recognize cues)?
Risk factors: Laticia Garcia, a 15-year-old female, has not received prenatal care due to pregnancy denial, current weight 158lbs, which is slightly lower, nulliparity, and sexually active.
Current problem: The patient complains of excruciating abdominal pain has a distended abdomen. Lab results includes Na: 142, K: 4.2, Plt: 265, Hgb: 13, Cl: 102, Mg: 1.2, and WBC: 5.2. The majority of the lab results are within the normal range, therefore eliminating the possibility of infections or systemic diseases. For example, WBC: 5.2 is within the normal range; therefore, it is unlikely that the patient has any infections. The Mg:1.2 is, however, slightly lower than the normal range of 1.8, which suggests the possibility of a health condition; however, since other parameters are within the normal range, it is less likely that the patient has an underlying condition. The distended abdomen and excruciating pain suggest the possibility of a pregnancy, which can explain the slightly lower mg levels since the patient has not had prenatal care (Liu & Zhang, 2021).
What is the disease process causing these assessment findings?
Full-term pregnancy: The primary diagnosis for this patient is a full-term pregnancy which is not a health condition; rather, it is a normal biological condition that results in the birth of a child. A full-term pregnancy is defined as a pregnancy where the baby is born between 39 weeks 0 days to 40 weeks 6 days. The excruciating abdominal pain experienced by the patient is labor pains. At the end of a pregnancy, uterus contractions occur to push the baby out, leading to pain as the muscles tighten. At the end of pregnancy, the body will start to produce hormones such as prostaglandin, which increases the sensitivity to other hormones. Oxytocin contributes to contractions that facilitate the expulsion of the fetus, relaxin, and Beta-endorphins facilitate stretching of the cervix and relief from pain, respectively (Tripp, 2021).
What is the main problem with the patient the nurse can treat?
Pain management relief measures will be necessary for this patient. The care provider should initiate natural pain relief measures such as patterned breathing, movement, and position changes. Medications can also be used to manage the pain. The patient is in denial of pregnancy; therefore, care provider should inform the patient and the family members of the pregnancy status and explain to the patient that she is pregnant and that it is due for delivery, which should explain the excruciating abdominal pain (Nanji & Carvalho, 2020).
What is the goal for the patient outcomes?
The patient and the family members will be aware of her pregnancy status.
The patient will experience pain relief during the delivery process.
The patient will have a natural birth with minimal complications.
What interventions will the nurse implement when caring for this patient
Assess the patient’s psychological readiness; it is important to ensure that the patient is psychologically aware and ready for the birth process, including the actions that are necessary to have a safe delivery, dangers and risks associated with the birth process, and the impact the delivery process will have on her physically and emotionally.
Allow and encourage the patient to be active: research has shown that assuming upright positions during labor is effective in preventing complications associated with delivery.
Assess the patient’s vital signs and those of the fetus; this will assist in detecting any abnormalities early enough to prevent complications.
Conduct patient education on the delivery process and after delivery care practices; patient education will ensure that the patient is aware of the delivery process and can identify abnormalities such as excessive pain; it will also equip her with the necessary skills and knowledge to handle emergencies (Nanji & Carvalho, 2020).
How will the nurse evaluate the patient’s response?
The patient will report a decreased level/severity of labor pains.
The patient will exhibit increased awareness concerning her pregnancy and the necessary measures to be taken in the event of an emergency.
The patient will maintain normal vital signs as well as the fetus.
What other problems could the nurse link to this patient problem?
Some of the conditions that can cause excruciating abdominal pain include organ rupture, including appendicitis, kidney stones and infections, irritable bowel syndrome, urinary tract infection, and intestinal obstruction.
References
Liu, G. L., & Zhang, N. Z. (2021). Routine blood tests in early pregnancy: their development and value in the early diagnosis of gestational diabetes mellitus. Clin. Exp. Obstet. Gynecol, 48(2), 228-233. http://venus-pro-bucket.s3.amazonaws.com/journal/CEOG/48/2/10.31083/j.ceog.2021.02.2273/CEOG2273.pdf
Nanji, J. A., & Carvalho, B. (2020). Pain management during labor and vaginal birth. Best Practice & Research Clinical Obstetrics & Gynaecology, 67, 100-112. https://www.sciencedirect.com/science/article/abs/pii/S1521693420300432
Tripp, R. (2021). Physiology of pregnancy. Emergency Medical Services: Clinical Practice and Systems Oversight, 1, 343-349. https://onlinelibrary.wiley.com/doi/abs/10.1002/9781119756279.ch41

PHN 652 -TOPIC 4 DQ 2-Public Health Nursing Assessments
QUESTION -TOPIC 4 DQ 2
When writing a community health needs assessment report, the public health nurse will need to include micro, meso, and macro levels of assessment. What is the difference between these levels of assessment? Why is it necessary to use all levels of assessment when writing a community health needs assessment report? What would be the impact of not including all three levels of assessment in a community health needs assessment report?
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Solution
Community Health Needs Assessment Report
A community health needs assessment report is a document that acts as a guideline for the health practitioners to enhance quality care among the community members. The reports entail all the information necessary for implementing a health program that can enhance quality care and improve the population’s health status based on factors such as hygiene, nutrition, and poverty levels. The reports must be written coherently by ensuring that all the information has been captured on all three levels of assessments: micro, meso, and micro levels.
Levels of Assessment
Micro, macro, and meso levels are essential in community health needs assessment reports. They identify the most effective areas that the public health nurse must adhere to while implementing the health program with its team. The levels of assessment enable the health team to assess and gather informative data regarding the community problem. Micro levels focus on evaluating individuals’ perspectives and views (Jilke et al.). Macro examines the community’s external and internal environment to gather information on any influences, while meso focuses on community groups of various kinds within the community. All three levels are interrelated, thus improving the community needs assessment report (Sawatzky et al., 2021).
Importance of the Levels
The three levels are essential when writing a community health needs assessment report because they give information that can help in decision-making. Information gathered through these levels can also be used in implementing community health policies to help solve the problem affecting the community members (Sawatzky et al., 2021).
Impact of not using the Levels
Community need assessment reports with no inclusion of the three levels of assessment can lead to a lack of conclusive results. For instance, gathering data at the community level is only effective when conducted at individual levels on community groups. These levels have community members who are more familiar and conversant with their communities. Therefore, without focusing on the levels, conducting the assessment can be complicated and hectic because it might be biased too because of focusing on a specific category of the population and not necessarily considering the influential factors that can lead to the community health problems (Sawatzky et al., 2021).
References
Jilke, S., Olsen, A. L., Resh, W., & Siddiki, S. Analytic Frameworks for Micro-, Meso-, and Macro-Level Public Administration. https://www.maxwell.syr.edu/minnowbrook/about/analytic-frameworks-for-micro-meso-and-macro-level-public-administration/
Sawatzky, R., Kwon, J. Y., Barclay, R., Chauhan, C., Frank, L., van den Hout, W. B., … & Sprangers, M. A. (2021). Implications of response shift for micro-, meso-, and macro-level healthcare decision-making using results of patient-reported outcome measures. Quality of Life Research, 1-15. https://link.springer.com/article/10.1007/s11136-021-02766-9

application of theory to research
this is a professional paper in which headings, full sentences, paragraphs, correct grammar and punctuation, and correct citation of sources are required.
Application of Theory to Research:
Find two published, original sources in which researchers used the theory as a framework, and/or the concept of interest to support their research. These articles must have been published within the past 10 years. Discuss how those researchers utilized the theory (and/or the concept of interest) to support their research. Include in the discussion of each study the purpose of the study, how the researchers used the theory in their study, how the researchers used the concept of interest in their study, and how the researchers theoretically and operationally defined the concept of interest.
Style & Format:
The paper will be written using APA standards. The paper will include a title page (using specified format), 2-3 pages of text, and a reference list. It will be double-spaced, written in 12-point Times New Roman font, and have 1-inch margins. Professional and orderly presentation of ideas (precision, clarity, format, headings, grammar, spelling, & punctuation) with appropriate citation of sources in text and reference list is required. Up to 0.5 points will be deducted for each type of grammar, spelling, punctuation, or format error.
Submission Instructions:
Only primary sources and empirical research articles are to be used for this assignment. Secondary sources such as, textbooks, literature reviews, systematic reviews, dissertations and concept analyses are NOT to be used. All articles in the application of theory to research section of the paper must be written within the past 10 years.
Submit the paper as a Word document.
You must also submit/upload copies of the 2 Research articles you used for the assignment.
As such, you will submit 3 documents for this assignment. Your paper, as a Word document, and research article #1 and #2. The research articles only can be uploaded in PDF format.
Rubric
Module 3 Assignment: Application of Theory to Research
This criterion is linked to a Learning OutcomeResearch Study #1&2
QUANTITATIVE research study Brief discussion of how researchers operationally defined the concept of interest (20 pts) OR QUALITATIVE research study Identify the type of guide used for the study (interview, observation, etc.) Brief discussion of the themes derived from the study (20 pts) MIXED METHOD STUDY: graded for either quantitative or qualitative portion of the study
20 pts
Clear, correct discussion operational definition (20 pts) OR Identified the guide correctly and clear correct discussion of the themes (20 pts)
15 pts
Correct, limited discussion of operational definition (15 pts) OR Identified the guide correctly and limited discussion of the themes (15 pts)
10 pts
Identified definition without discussion (10 pts) OR Identified the guide without discussion of the themes (10 pts)
5 pts
Incorrect operational definition (5 pts) OR Incorrect identification of the guide used for the study and omitted discussion of the themes (5 pts)
0 pts
No operational definition (0 pts) OR No guide and no discussion of the themes (0 pts)
This criterion is linked to a Learning OutcomeAPA Style & Format (10 pts) Style includes: Professional and orderly presentation of ideas (precision and clarity). Grammar, spelling and punctuation. Minimal use of direct quotes (1-2 max.) Format includes: Proper use of title page (using specified format), spacing, font, margins, and headings. Appropriate citation of sources in text and reference list. A minimum of 2 references are required. Up to 0.5 points will be deducted for each type of grammar, spelling, punctuation, or format error. Up to two points will be deducted for poor headings /insufficient headings/formatting
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Solution
Transcendent pluralism is a middle-range theory that proposes that most of the contemporary social challenges that harm human health are due to ecological and human devaluation, and by advancing dignity, healing can be achieved. The theory focuses on the development of human dignity through nonviolent social transformation among diverse people in relationships. Some of the two articles that have utilized this theory as their framework include, “Peace Through a Healing Transformation of Human Dignity Possibilities and Dilemmas in Global Health and Peace.” The study focused on discussing challenges within the health and peace paradigm using the Israeli-Palestinian conflict. The researcher first explained the relationship between health and peace and then utilized the Israeli-Palestinian conflict to show how the middle-range theory can be used to overcome the violence, promoting peace and health, through health-related peace initiatives. The researcher conducted the study with the Israeli-Palestinian group, Combatants for Peace, which was begun by Palestinians who had been formerly involved in the violence by had changed and now renounced violence. He utilized transcendent pluralism to guide his study with combatants for peace groups to help him understand how the group members decided to change from violence to nonviolence and the impact of the decision on the group. The theory focuses on the human spirits as those that evolve, and mutually transformative relationships between diverse populations can be used to ensure the fulfillment of human dignity. Peace, which was an important concept of interest in the study, was defined as a “dynamic state of genuine human relationship with self and others that maximizes human dignity through good will.” The genuine encounter also emerged and was defined as critical reflection by either a group or an individual commitment to action and respectful dialogue. Human dignity was defined as the value in the personhood of a person. The study findings revealed that the combatants for peace had a genuine encounter, leading to their change from violence to nonviolence (Perry, 2013).
The study “Expanding Humanitarian Global Health Capacity for the Human Good”
aimed to understand how the health providers decided to engage in humanitarian global health care and analyze their experiences before deployment, during, and after return to the United States. The researchers adopted transcendent pluralism middle-range theory to guide the initial study and secondary data analysis. The theory was used to elucidate the need for a transformative approach in humanitarian capacity building. The participants were guided into self-reflection experiences, judgments, and understanding about their experiences and actions as carried forth into personal actions. The method also explored participants’ personal development and the meaning they associated with the experiences and choices. The theory of transcendent pluralism holds that most of the problems in society are rooted in human devaluation, and they negatively impact health, and thus to advance human value/dignity, transformative healing is required in the global culture. In this study, the researchers defined human dignity as the value of personhood. Personhood was defined as the unique wholeness of a human being consisting of intrinsic and developmental value that can attain fulfillment if consciously developed at goodwill. In this paper, human dignity consisted of two aspects: the good of being, which is the unique value of human life by just existence, and the good of becoming attained through fulfilling human potential. Humanitarian global health care provides an opportunity to advance human dignity (Perry & Ojemeni, 2016).
References
Perry, D. J., & Ojemeni, M. T. (2016). Expanding Humanitarian Global Health Capacity for the Human Good. Global Health Governance, 10(2). http://blogs.shu.edu/ghg/files/2016/10/Fall-2016-Issue-1.pdf#page=107
Perry, D. J. (2013). Peace through a healing transformation of human dignity: Possibilities and dilemmas in global health and peace. Advances in Nursing Science, 36(3), 171-185. https://afcfp.org/wp-content/uploads/2017/07/Peace-through-a-Healing-Transformation-of-Human-Dignity.-For-Ed-purposes-only.pdf

Nurse patient ratio and how it impacts patient care
This is a literature review paper. I have the articles already and I will upload it as document.
Literature Review
Introduction
Nursing is one of the most important services in the healthcare system delivered through professional nurses. The nurses play an essential part in patient care, including diagnosis, drug prescription, self-care education, guidance, psychiatric care, and assistance for coordinated care. In delivering the various services for the patient’s wellbeing, the nurse-patient ratio highly impacts the timeliness and quality of care, among other aspects of care. An increased ratio of nurses to patients reduces the amount of work per nurse and thus provides for timely care and reduced nurse burnout, which is also associated with poor quality of healthcare services (Cho et al., 2017). The research aims to establish the impact of inadequate nurse-patient ratio on the quality of care, which is hypothesized to have an inversely proportional relationship. This paper will review two research articles on the impact of the nurse-patient ratio on the quality of care and the wellbeing of the nurse practitioners.
Methods
The search for the articles was done on the Google Search Engine and the “Google Scholar” database to acquire the relevant research articles for the research. The main search keywords include “patient-nurse ratio,” “impact of a nurse shortage,” and “nurse shortage and quality of care.” The search provided a list of numerous articles relevant to the topic of study on the impact of nurse shortage on the quality of care. The articles included in the literature review are those aged five years and below (From 2017 to 2021). This ensured that the articles chosen were the most recent with relevant content. The articles also included for the literature review are research articles and not personal opinions.
Identified Articles
There are two main articles registered for literature review after the search from the online database. The two articles include Chen et al. (2019) and Driscoll et al. (2018).
Chen et al. (2019)
The research study aimed to investigate the effects of the patient-nurse ratio on the nurses’ intention to leave and considering the mediation roles of burnout and job dissatisfaction. The authors wanted to establish whether the ratio affects the nurses’ view towards the nursing profession, leads to underlying stress and job dissatisfaction. The quantitative study analyzed cross-sectional surveys on the average daily patient-nurse ratios (ADPNR), personal burnout of the nurses, client-related burnout, intention to leave, and job dissatisfaction, among other aspects. The study conducted for 1409 full-time RNs in the medical and surgical wards indicated a relationship between the ADPNR levels and the intention to leave the nursing job, mediated by the factors of personal burnout, job dissatisfaction, and client-related burnout. According to the results, high ADPNRs predicted high client-related burnout, personal burnout, and job dissatisfaction that contributed to the nurses’ intention to leave the workplace or the nursing profession. The research concluded that an increased patient-nurse ratio induces high levels of personal burnout, dissatisfaction, and client-related burnout that eventually increase the nurses’ intention to leave their job.
Driscoll et al. (2018)
Driscoll et al. (2018) identified the lack of an optimal number of nurses in acute care hospitals for high-quality delivery of services. The purpose of the systematic review and meta-analysis examination was to examine the association between the nurse staffing levels and the nurse-sensitive outcomes in the acute specialist units. The research included articles published between 2006 and 2017 from nine electronic databases. The articles considered for the study were cross-sectional, utilizing large administrative databases. According to the research article, higher staffing levels were associated with reduced medication errors, mortality rates, restraint use, ulcers, hospital-acquired infections, pneumonia, higher use of aspirin, and timeliness in care for the percutaneous coronary complications. These results generally indicated that the increased ratio of nurses to the patients reduced the strains leading to a positive patient outcome. The study concluded that nurse-to-patient ratios highly influence patient outcomes, especially on key quality indicators such as timeliness of care, mortality rates, and risks to HAIs.
Results
The results of the two research articles indicated a positive relationship between the number of nurse practitioners in a healthcare environment, their workload, and the quality of services delivered. Chen et al. (2019) sought to establish the intent to leave among the nurses due to high patient-nurse levels, while Driscoll et al. (2018) sought to establish the impact of nurse-patient ratios on the patient outcome. The two studies focus on establishing the impact of high patient-nurse ratios in the delivery of healthcare services by the nurses, which can be measured on both the healthcare providers and the patients. The two studies conducted meta-analytic reviews on other previous studies for the quality conclusion. The quantitative studies obtained cross-sectional articles, which are effective for analyzing the situation of the nursing environment. The studies had limitations that would affect their reliability. Driscoll et al. (2018) established that some studies combined patients from special units and those from non-special units, thus weakening the findings. Chen et al. (2019) cited limitations of the study, such as the unidentified worker-survival effect since even on standardized ADPNR, the nurses indicated different responses to burnout, work dissatisfaction, and intention to leave, thus affecting the conclusively of the findings.
Conclusion
In conclusion, the two articles are relevant and provide conclusive findings supporting the reduction of nurse shortage in increasing the nurse-patient ratio, which is associated with poor quality of services. Apart from the low nurse-patient ratio causing poor patient outcomes, the issue also affects the wellbeing of the nurses, who should be emotionally, physically, and psychologically stable while delivering patient care. Healthcare institutions should thus consider increasing the ratio of nurses to patients to increase the patient care outcome and reduce adverse effects such as high rates of nurse burnout, work dissatisfaction, untimely care, and intention to leave.
References
Chen, Y. C., Guo, Y. L., Chin, W. S., Cheng, N. Y., Ho, J. J., & Shiao, J. S. (2019). Patient-Nurse Ratio is Related to Nurses’ Intention to Leave Their Job through Mediating Factors of Burnout and Job Dissatisfaction. International journal of environmental research and public health, 16(23), 4801. https://doi-org.libraryaccess.elpaso.ttuhsc.edu/10.3390/ijerph16234801
Cho, S. H., Mark, B. A., Knafl, G., Chang, H. E., & Yoon, H. J. (2017). Relationships between nurse staffing and patients’ experiences, and the mediating effects of missed nursing care. Journal of Nursing Scholarship, 49(3), 347-355
Driscoll, A., Grant, M. J., Carroll, D., Dalton, S., Deaton, C., Jones, I., Lehwaldt, D., McKee, G., Munyombwe, T., & Astin, F. (2018). The effect of nurse-to-patient ratios on nurse-sensitive patient outcomes in acute specialist units: a systematic review and meta-analysis. European journal of cardiovascular nursing: journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology, 17(1), 6–22. https://doi.org/10.1177/1474515117721561
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Solution
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Reflection of home health care
2 y/o female s/p heart transplant 2019, chronic RF, pulmonary vein stenosis, speech & developmental delay; tracheostomy, Trilogy ventilator, G-tube feedings
1. Reflect on what you thought in-home care nurses did what is the benefit
2. Discuss in depth the primary disease conditions present in the child. Name the disease process and give a description of the disease. Then discuss the types of assessments and care that were involved in the nursing care of this child. *This should be a two + paragraphs. *(ie: paragraph 1: student with asthma, what is asthma, what did you watch for, how did you help a flare-up, how well did the student care for self? What did you find interesting? Have you cared for this previously?)
3. Reflect on what the nurses did during clinical shift? How home care nurses different from hospital?
4. Discuss anything that interesting, or exciting that taking care of one child at home than hospital.
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Solution
Case Scenario
In-home care is an essential care program that ensures regular monitoring of the patients’ health and prevents health adversities. The nurses in the home-care program provide essential services such as diaper changing, feeding, medication administration, and performing essential health monitoring indicators such as blood pressure, respiratory rate, heart rate, and lung sounds. The activities done by the nurses for the child were of great benefit to the child in controlling the chronicity of the disease, ensuring health improvement through feeding, and providing company for psychological wellness.
The patient’s primary disease is asthma. The child is regularly coughing with difficulties in breathing due to constricted airway. The child produces wheezing sounds while breathing, especially during the night and cold weather. Asthma is a pulmonary disease that affects the breathing system and is caused by a viral infection in the breathing system. The virus infects the airways, especially the bronchi and the lungs. The inflammation causes an abnormal accumulation of inflamed cells in the airways, thus blocking the airways for free passage of air (King et al., 2018). This causes the constrictive breathing problem known as asthma.
There are various assessments that nurses conduct in diagnosing asthma in a patient. One of the assessments is the respiratory rate. Children with asthmatic or breathing problems have a higher respiratory rate than normal children. The pulse rate is another assessment measure that increases with constricted breathing. According to Turner (2018), asthma is characterized by a pulse rate above 100 bpm. The breathing patterns are also assessed. Asthma is associated with noisy and difficult breathing, and thus nurses should listen to the breathing sounds. Oxygen saturation is low for patients with asthma exacerbations and thus should be assessed in the diagnostic and monitoring process for asthma.
From the clinical shift experience, home care nurses provide highly patient-centered care in homes compared to hospitals. The nurses can closely monitor the patients medically and psychologically in ensuring that the patients. Timeliness in delivering the medications is an outstanding benefit of the home care program. One of the most interesting aspects of home care nurses is having a daily plan of medication and feeding for the child, which is rarely visible in hospital nursing care.
References
King, G. G., James, A., Harkness, L., & Wark, P. A. (2018). Pathophysiology of severe asthma: We’ve only just started. Respirology, 23(3), 262–271. https://doi.org/10.1111/resp.13251
Turner, A. O. J. F. W. (2018). Acute Asthma and Other Recurrent Wheezing Disorders in Children. Clinical Evidence Handbook – American Family Physician. https://www.aafp.org/afp/2013/0715/p130.html#:%7E:text=Moderate%20acute%20asthma%20is%20characterized,years)%20or%2030%20to%2040