Nursing

Legislation Grid and testimony advocacy statement
Assignment: Legislation Grid and Testimony/Advocacy Statement
As a nurse, how often have you thought to yourself, If I had anything to do about it, things would work a little differently? Increasingly, nurses are beginning to realize that they do, in fact, have a role and a voice.
Many nurses encounter daily experiences that motivate them to take on an advocacy role in hopes of impacting policies, laws, or regulations that impact healthcare issues of interest. Of course, doing so means entering the less familiar world of policy and politics. While many nurses do not initially feel prepared to operate in this space effectively, the reward is the opportunity to shape and influence future health policy.
To Prepare:
Select a bill that has been proposed (not one that has been enacted) using the congressional websites provided in the Learning Resources.
The Assignment: (1- to 2-page Legislation Grid; 1-page Legislation Testimony/Advocacy Statement)
Be sure to add a title page, an introduction, purpose statement, and a conclusion. This is an APA paper.
Part 1: Legislation Grid
Based on the health-related bill (proposed, not enacted) you selected, complete the Legislation Grid Template. Be sure to address the following:
Determine the legislative intent of the bill you have reviewed.
Identify the proponents/opponents of the bill.
Identify the target populations addressed by the bill.
Where in the process is the bill currently? Is it in hearings or committees?
Part 2: Legislation Testimony/Advocacy Statement
Based on the health-related bill you selected, develop a 1-page Legislation Testimony/Advocacy Statement that addresses the following:
Advocate a position for the bill you selected and write testimony in support of your position.
Describe how you would address the opponent to your position. Be specific and provide examples.
At least 2 outside resources and 2-3 course specific resources are used.
Excellent
Federal and State Legislation
Part 1: Legislation Grid
Based on the health-related bill you selected, complete the Legislation Grid Template. Be sure to address the following:
• Determine the legislative intent of the bill you have reviewed.
• Identify the proponents/opponents of the bill.
• Identify the target populations addressed by the bill.
• Where in the process is the bill currently? Is it in hearings or committees?
32 (32%) – 35 (35%)
The response clearly and accurately summarizes in detail the legislative intent of the health-related bill.
The response accurately identifies in detail the proponents and opponents of the health-related bill.
The response accurately identifies in detail the populations targeted by the health-related bill.
The response clearly and thoroughly describes in detail the current status of the health-related bill.
Advocating for Legislation
Part 2: Legislation Testimony/Advocacy Statement
Based on the health-related bill you selected, develop a 1-page Legislation Testimony/Advocacy Statement that addresses the following:
• Advocate a position for the bill you selected and write testimony in support of your position.
• Describe how you would address the opponent to your position. Be specific and provide examples.
45 (45%) – 50 (50%)
Testimony clearly and thoroughly provides statements that fully justifies a position for a health-related bill.
Response provides a detailed, thorough, and logical explanation of how to address opponents to the position for the health-related bill and includes one or more clear and accurate supporting examples.
A complete, detailed, and specific synthesis of two outside resources is provided. The response fully integrates at least 2 outside resources and 2-3 course specific resources that fully supports the responses provided.
Written Expression and Formatting – Paragraph Development and Organization:
Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided which delineates all required criteria.
5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity.
A clear and comprehensive purpose statement, introduction, and conclusion is provided which delineates all required criteria.
Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation
5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors.
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list. 5 (5%) – 5 (5%)
Uses correct APA format with no errors.
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Solution
Legislation Grid and Testimony Advocacy Statement
Introduction
Nurses form the largest section of health care professionals and as part of the system, they are responsible for developing policies that promote work and environmental safety. The legislation process is an integral step in developing policies that govern professionalism. Nurses need to develop legislation skills to champion professional development and eradicate concerns that contribute to the drawbacks within the health care system (Lasater et al, 2021).
For instance, workplace violence is a significant challenge that affects approximately 43% of health care professionals annually. It causes physical injuries, high turnovers, and psychological trauma, and related mental health disorders such as post-traumatic stress disorder and depression (Mento et al, 2020). This paper expounds on a bill in the United States legislation body related to health care using a legislation grid.
Legislation Grid
Health-related Bill Name Workplace Violence Prevention for Health Care and Social Service Workers Act
Bill Number H.R.1195
Description The bill proposes that the department of labor should address workplace violence in social service, health care, and other sectors. The labor department will issue standard measures on occupational safety and health that require employers to protect all employees from workplace-related violence (Congress.gov. (n.d.). The standards developed will apply to employers in the health, social service, and other sectors that perform activities related to health and social service. The bill is at the introduction state at the senate.
Federal or State? Federal
Legislative Intent The main initiative of introducing this bill is to protect employees in health care and social service from workplace violence. The department of labor takes the initiative of developing a standard of occupational health and safety that provides this kind of protection to employees in the identified sectors.
Proponents/ Opponents Proponents:
This bill is primarily sponsored by Rep. Courtney, Joe who initiated it on 02/22/2021 (Congress.gov. (n.d.). It is also cosponsored by 145 representatives, 139 who are democrats and 6 republicans that include Rep. Scott, Robert C. “Bobby, Bacon, Don Rep. Adams, Alma S., Rep. Young, Don, Rep. Khanna, Ro, Rep. Fitzpatrick, Brian K., Rep. Cole, Tom, Rep. Bonamici, Suzanne, Rep. Castro, Joaquin, Rep. Wild, Susan, Rep. DeSaulnier, Rep. Moore, Gwen, Rep. Trahan, Lori, Rep. Sherman, Brad, Rep. Garcia, Jesus G. “Chuy”, Rep. Van Drew, Jefferson, Rep. Hastings, Alcee, Rep. Maloney, Carolyn B, Rep. Larson, John B, Rep. Schakowsky, Janice, Rep. Morelle, Joseph D, Rep. Hayes, Jahana, Rep. Foster, Bill, Rep. Mrvan, Frank J, Rep. Clark, Katherine M, Del. Norton, Eleanor Holmes, Del. Sablan, Gregorio Kilili Camacho, Rep. DeLauro, Rosa L, Rep. Thompson, Bennie G, Rep. Welch, Peter, Rep. Dean, Madeleine, Rep. Doyle, Michael F, Rep. Barragan, Nanette Diaz, Rep. Blunt Rochester, Lisa, Rep. Casten, Sean, Rep. Moulton, and Seth.
Opponents:
This bill has not received any opponents to its current stage; rather some amendments have been proposed to enhance its effectiveness on the target population (United States Senate. (n.d.).
Target Population The bill targets the department of labor that is responsible for developing standards for occupational safety and health for preventing workplace violence. It also targets employers who are responsible for implementing the standard measures that will ensure employees are safe from workplace violence (Congress.gov. (n.d.). Finally, it targets employees in the health care and social service sectors who may be at risk of workplace violence.
Status of the bill (Is it in hearings or committees?) The bill has passed the house. In the previous action, the bill was read twice after being received in the senate and referred to the health, education, labor, and pensions committees in the senate (United States Senate. (n.d.).
General Notes/Comments
The bill proposes a crucial concept of workplace safety for workers in health care and social service industries. Any form of workplace violence impacts negatively on the performance of every employee. Cheung et al, (2017), states that workplace violence is associated with physical injuries, fatalities, psychological traumas, increasing the risk of depression and post-traumatic stress disorder PTSD, increasing job dissatisfaction, and high turnovers. High turnover increases shortages at work and causes a significant financial burden to the health care organizations..
PART II: Advocacy Statement
Health care providers across the US are at a high risk of violence-related injuries compared to other professions. Statistics indicate an increasing trend in workplace violence among health care workers in recent years. Approximately 43.1% of employees in health care sectors experience violence at their place annually (Park, et al, 2018).
This violence can be in form of criminal intentions, client-on-worker, worker-on-worker, and personal relationships. According to, Liu et al, (2019), the most common of violence includes verbal abuse which accounts for 53.5% of all the cases, physical abuse (16%), bullying (14%), sexual abuse (5%), and racial harassment (3%)
For instance, a newly employed nurse who is a primary nurse to a patient with urinary incontinence following spinal injury inserts a urinary catheter but accidentally forgets to balloon it. He notices the mistake after the patient has already wet the bed. The patients ring the bell and the nurse responds.
She starts to verbally abuse the nurse and suggests that she should not serve anymore because she is black and does not understand her duties. The patients tell the nurse to stop touching her and let another fix the catheter and take care of her for the remainder of the day. The following morning the same nurse resigns from the facility. Such a bill identifies a solving such racial and verbal abuse amicably.
Therefore the introduction of this bill marks a crucial step in attempts to address this challenge that impacts negatively on the quality of health care delivery in hospitals. A reduction in workplace violence is expected to promote job satisfaction and retention, reduce mental health disorders caused by psychological trauma, and the general quality of health delivery among health care professionals and social service workers.
Conclusion
The bill proposed by Rep. Courtney, Joe addresses an important concept of work safety and health that directly affect employees in all industries. Health care professionals are likely to experience more violence than employees in other industries. All forms of violence impacts work negatively either due to physical injuries and or psychological traumas that may cause PTSD or depression.
Workers may also experience job dissatisfaction causing them to leave which in turn leads to high turnover rates. High turnovers increase shortages, increases financial burden, decrease the quality of service delivery, and increase morbidity and mortality in health.
References
Cheung, T., Lee, P. H., & Yip, P. S. (2017). Workplace violence toward physicians and nurses: prevalence and correlates in Macau. International journal of environmental research and public health, 14(8), 879.
Congress.gov. (n.d.). Retrieved September 9, 2021, from https://www.congress.gov/.
Lasater, K. B., Aiken, L. H., Sloane, D. M., French, R., Anusiewicz, C. V., Martin, B., … & McHugh, M. D. (2021). Is Hospital Nurse Staffing Legislation in the Public’s Interest?: An Observational Study in New York State. Medical care, 59(5), 444.
Liu, J., Gan, Y., Jiang, H., Li, L., Dwyer, R., Lu, K., … & Lu, Z. (2019). Prevalence of workplace violence against healthcare workers: a systematic review and meta-analysis. Occupational and environmental medicine, 76(12), 927-937.
Mento, C., Silvestri, M. C., Bruno, A., Muscatello, M. R. A., Cedro, C., Pandolfo, G., & Zoccali, R. A. (2020). Workplace violence against healthcare professionals: A systematic review. Aggression and violent behavior, 51, 101381.
Park, H. W. (2018). Preventing workplace violence against healthcare workers. Journal of the Korean Medical Association, 61(5), 292-296.
United States Senate. (n.d.). Retrieved September 9, 2021, from https://www.senate.gov/

Professional Capstone and Practicum Reflective Journal – Topic 2
Assessment Description Students are required to submit weekly journal entries throughout the course. These reflective narratives help students identify important learning events that happen throughout the course and the practicum. In each week’s entry, students should reflect on the personal knowledge and skills gained. Write a reflection journal (250-300 words) to outline what has been discovered about your professional practice, personal strengths and weaknesses, and additional resources that could be introduced in a given situation to influence optimal outcomes.
Each week there will be a specific focus to use in your reflection. Integrate leadership and inquiry into the current practice. Please make sure to address all areas in your writing. Topic Focus: Interprofessional Collaboration While APA style is not required for the body of this assignment, solid academic writing is expected. 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. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

NURS 6512: Advanced Health Assessment and Diagnostic Reasoning
Week 8: SOAP NOTE- Assessing Musculoskeletal Pain
Your Discussion post should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style Discussion posting format.
Please POST a SOAP Episodic/FOCUS note ONLY!
Refer to the Episodic/Focused SOAP Template I provided below
Remember that all Episodic/Focused SOAP notes have specific data included in every patient case.
With regard to the case study you were assigned:
Consider what history would be necessary to collect from the patient in the case study you were assigned.
Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
Identify at least fivepossible conditions that may be considered in a differential diagnosis for the patient.
Utilize at least 3 scholarly, peer reviewed sources.
Utilize SafeAssign Drafts to obtain originality report before final submission.
Post an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient’s differential diagnosis and justify why you selected each.
Case Study: Back Pain
A 42-year-old male reports pain in his lower back for the past month. The pain sometimes radiates to his left leg. In determining the cause of the back pain, based on your knowledge of anatomy, what nerve roots might be involved? How would you test for each of them? What other symptoms need to be explored? What are your differential diagnoses for acute low back pain? Consider the possible origins using the Agency for Healthcare Research and Quality (AHRQ) guidelines as a framework. What physical examination will you perform? What special maneuvers will you perform?
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Comprehensive SOAP Exemplar
Purpose: To demonstrate what each section of the SOAP note should include. Remember that Nurse Practitioners treat patients in a holistic manner and your SOAP note should reflect that premise.
Patient Initials: _______ Age: _______ Gender: _______
SUBJECTIVE DATA:
Chief Complaint (CC): Coughing up phlegm and fever
History of Present Illness (HPI): Eddie Myers is a 58 year old African American male who presents today with a productive cough x 3 days, fever, muscle aches, loss of taste and smell for the last three days. He reported that the “cold feels like it is descending into his chest and he can’t eat much”. The cough is nagging and productive. He brought in a few paper towels with expectorated phlegm – yellow/green in color. He has associated symptoms of dyspnea of exertion and fatigue. His Tmax was reported to be 100.3, last night. He has been taking Tylenol 325mg about every 6 hours and the fever breaks, but returns after the medication wears off. He rated the severity of her symptom discomfort at 8/10.
Medications:
Norvasc 10mg daily
Combivent 2 puffs every 6 hours as needed
Advair 500/50 daily
Singulair 10mg daily
Over the counter Tylenol 325mg as needed
Over the counter Benefiber
Flonase 1 spray each night as needed for allergic rhinitis symptoms
Allergies:
Sulfa drugs – rash
Cipro-headache
Past Medical History (PMH):
Asthma
Hypertension
Osteopenia
Allergic rhinitis
Prostate Cancer
Past Surgical History (PSH):
Cholecystectomy 1994
Prostatectomy 1986
Sexual/Reproductive History:
Heterosexual
Personal/Social History:
He has never smoked
Dipped tobacco for 25 years, no longer dipping
Denied ETOH or illicit drug use.
Immunization History:
Covid Vaccine #1 3/2/2021 #2 4/2/2021 Moderna
Influenza Vaccination 10/3/2020
PNV 9/18/2018
Tdap 8/22/2017
Shingles 3/22/2016
Significant Family History:
One sister – with diabetes, dx at age 65
One brother–with prostate CA, dx at age 62. He has 2 daughters, both in 30’s, healthy, living in nearby neighborhood.
Lifestyle:
He works FT as Xray Tech; widowed x 8 years; lives in the city, moderate crime area, with good public transportation. He is a college grad, owns his home and financially stable.
He has a primary care nurse practitioner provider and goes for annual and routine care twice annually and as needed for episodic care. He has medical insurance but often asks for drug samples for cost savings. He has a healthy diet and eating pattern. There are resources and community groups in his area at the senior center but he does not attend. He enjoys golf and walking. He has a good support system composed of family and friends.
Review of Systems:
General: + fatigue since the illness started; + fever, no chills or night sweats; no recent weight gains of losses of significance.
HEENT: no changes in vision or hearing; he does wear glasses and his last eye exam was 6 months ago. He reported no history of glaucoma, diplopia, floaters, excessive tearing or photophobia. He does have bilateral small cataracts that are being followed by his ophthalmologist. He has had no recent ear infections, tinnitus, or discharge from the ears. He reported no sense of smell. He has not had any episodes of epistaxis. He does not have a history of nasal polyps or recent sinus infection. He has history of allergic rhinitis that is seasonal. His last dental exam was 1/2020. He denied ulceration, lesions, gingivitis, gum bleeding, and has no dental appliances. He has had no difficulty chewing or swallowing.
Neck: Denies pain, injury, or history of disc disease or compression..
Breasts:. Denies history of lesions, masses or rashes.
Respiratory: + cough and sputum production; denied hemoptysis, no difficulty breathing at rest; + dyspnea on exertion; he has history of asthma and community acquired pneumonia 2015. Last PPD was 2015. Last CXR – 1 month ago.
CV: denies chest discomfort, palpitations, history of murmur; no history of arrhythmias, orthopnea, paroxysmal nocturnal dyspnea, edema, or claudication. Date of last ECG/cardiac work up is unknown by patient.
GI: denies nausea or vomiting, reflux controlled, Denies abd pain, no changes in bowel/bladder pattern. He uses fiber as a daily laxative to prevent constipation.
GU: denies change in her urinary pattern, dysuria, or incontinence. He is heterosexual. No denies history of STD’s or HPV. He is sexually active with his long time girlfriend of 4 years.
MS: he denies arthralgia/myalgia, no arthritis, gout or limitation in her range of motion by report. denies history of trauma or fractures.
Psych: denies history of anxiety or depression. No sleep disturbance, delusions or mental health history. He denied suicidal/homicidal history.
Neuro: denies syncopal episodes or dizziness, no paresthesia, head aches. denies change in memory or thinking patterns; no twitches or abnormal movements; denies history of gait disturbance or problems with coordination. denies falls or seizure history.
Integument/Heme/Lymph: denies rashes, itching, or bruising. She uses lotion to prevent dry skin. He denies history of skin cancer or lesion removal. She has no bleeding disorders, clotting difficulties or history of transfusions.
Endocrine: He denies polyuria/polyphagia/polydipsia. Denies fatigue, heat or cold intolerances, shedding of hair, unintentional weight gain or weight loss.
Allergic/Immunologic: He has hx of allergic rhinitis, but no known immune deficiencies. His last HIV test was 2 years ago.
OBJECTIVE DATA
Physical Exam:
Vital signs: B/P 144/98, left arm, sitting, regular cuff; P 90 and regular; T 99.9 Orally; RR 16; non-labored; Wt: 221 lbs; Ht: 5’5; BMI 36.78
General: A&O x3, NAD, appears mildly uncomfortable
HEENT: PERRLA, EOMI, oronasopharynx is clear
Neck: Carotids no bruit, jvd or thyromegally
Chest/Lungs: Lungs pos wheezing, pos for scattered rhonchi
Heart/Peripheral Vascular: RRR without murmur, rub or gallop; pulses+2 bilat pedal and +2 radial
ABD: nabs x 4, no organomegaly; mild suprapubic tenderness – diffuse – no rebound
Genital/Rectal: pt declined for this exam
Musculoskeletal: symmetric muscle development – some age related atrophy; muscle strengths 5/5 all groups.
Neuro: CN II – XII grossly intact, DTR’s intact
Skin/Lymph Nodes: No edema, clubbing, or cyanosis; no palpable nodes
Diagnostics/Lab Tests and Results:
CBC – WBC 15,000 with + left shift
SAO2 – 98%
Covid PCR-neg
Influenza- neg
Radiology:
CXR – cardiomegaly with air trapping and increased AP diameter
ECG
Normal sinus rhythm
Spirometry- FEV1 65%
Assessment:
Differential Diagnosis (DDx):
Asthmatic exacerbation, moderate
Pulmonary Embolism
Lung Cancer
Primary Diagnoses:
1.) Asthmatic Exacerbation, moderate
PLAN: [This section is not required for the assignments in this course, but will be required for future courses.]
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Week 8: Assessing Musculoskeletal Pain
Assessing Musculoskeletal Pain
Patient Initials: S.K Age: 42 years old Gender: Male
SUBJECTIVE DATA:
Chief Complaint (CC): “Pain in my lower back for the past one month”
History of Present Illness (HPI): S.K is a 42-year-old Caucasian male patient who reported to the clinic with pain in his lower back that had lasted for about a month. he reports that the pain radiates to his left leg sometimes. The patient reports that the pain is worse when working, and is less disturbing when resting. He has been taking ibuprofen which he claims to provide minimal relief.
Location: lower back
Onset: about a month ago
Character: constant and sharp pain radiating to the left leg
Associated signs and symptoms: None
Timing: When handling strenuous work
Exacerbating/ relieving factors: Any movement worsens the pain. Resting and Ibuprofen provides minimal relief.
Severity: 7/10 on a pain scale
Medications:
Ibuprofen 800mg PO PRN for the back pain
Allergies:
No known environmental, food, or drug allergies.
Past Medical History (PMH):
Denies any history of a serious medical diagnosis
Past Surgical History (PSH):
Denies ever undergoing any surgical procedure in the past.
Sexual/Reproductive History:
Heterosexual
Personal/Social History:
Married with 3 children
Works in a book store downtown.
Has never smoked tobacco or marijuana.
Confirms taking 2 to 3 beers occasionally when with friends.
Immunization History:
Flu shot 17/2/2022
Covid Vaccine #1 2/1/2021 #2 3/1/2021 Moderna
All other immunization up to date
Significant Family History:
Mother- with HTN and DM
Father- with gout and kidney disease
Maternal grandmother- with kidney disease
Maternal grandfather- died from a stroke
Paternal grandmother- with COPD
Paternal grandfather with CAD, HTN, and COPD.
He has 2 daughters and one son who are all healthy with no significant health complications.
Lifestyle:
The patient works in a bookstore downtown. He is happily married to a junior school teacher with 3 children. They live on the outskirts of the city in a 3 bedroom apartment in a safe neighborhood. The means of transport is good, with easily accessible fresh water and healthcare services.
He tried as much as possible to eat a healthy diet together with his family. He walks the dog every evening for about a kilometer as a form of exercise. Uses seat belts when in the car, with safety equipment such as a first-aid kit available in their home. He is a strong church member and socializes with his friends mostly over the weekend.
Review of Systems:
General: No recent changes in body weight. Complains of pain in his lower back. Denies constipation, fatigue, chills, fever, or generalized body weakness.
HEENT: Head: No signs of trauma or headache reported. Eyes: Denies blurred vision, use of corrective lenses, excessive tearing, or redness. Ears: No tinnitus, itchiness, or hearing loss. Nose: no congestion, running nose, sinus problems, or nose bleeding. Throat & Mouth: No sore throat, coughing, swallowing difficulties, or dental problems. Neck: No tenderness, signs of injury, enlarged tonsils, or a history of disc disease or compression.
Respiratory: No wheezing, coughing, shortness of breath, or breathing difficulties.
CV: Denies chest pain, edema, PND, orthopnea, syncope, or palpitations. Dyspnea on exertion
GI: No abdominal tenderness, constipation, diarrhea, distention, changes in bowel movement, or jaundice.
GU: Denies incontinence, urinary frequency, hematuria, dysuria, or burning sensation when urinating.
MS: Reports lower back pain which sometimes radiates to the left leg. He rates the pain at 7/10 on a pain scale. The severity of the pain however worsens when walking or turning when sleeping. The patient confirms that the pain has lasted for about a month, making it harder to exhibit a full range of movement on the left leg. No numbness, swelling, or redness was reported.
Psych: Denies paranoia, hallucinations, delirium, suicidal ideation, mental disturbance, memory loss, anxiety or depression, or a history of psychosis.
Neuro: Reports back pain that radiates to the left leg. Denies vertigo, tremors, syncope, seizures, paresthesia, or transient paralysis.
Integument/Heme/Lymph: No bruising, ecchymosed, ulcers, lesions, or rashes. No signs of enlarged lymph nodes.
Endocrine: Denies heat intolerance, cold intolerance, polyuria, polyphagia, or polydipsia.
Allergic/Immunologic: Denies hay fever, urticaria, persistent infections, or HIV exposure.
OBJECTIVE DATA
Physical Exam:
Vital signs: B/P 140/96, left arm, sitting, regular cuff; P 88 and regular; T 98.9 Orally; RR 18; non-labored; Wt: 215 lbs; Ht: 5’8; BMI 32.69
General: The patient appears healthy, and well oriented in person, place, and time. Seems to be uncomfortable and in moderate pain.
HEENT: External ears normal, with no deformities or lesions. External nose normal with no deformities or lesions. Bilaterally clear canals. Intact tympanic membrane with good movement and no fluid. Grossly intact bilateral hearing. Normal nasal mucosa, septum and turbinates. Complete and good hygienic dentation.
Neck: Supple with no masses. Trachea midline, No thyroid nodules, tenderness, or masses.
Chest/Lungs: Bilaterally clear to auscultation. Tactile fremitus normal. No signs of egophony. Normal respiratory effort displayed with no use of accessory muscles.
Heart/Peripheral Vascular: S1, and S2, note. Normal cardiac rhythm with no murmur, gallop, or rubs.
ABD: Suprapubic surgical scar, obese, non-tender, soft, and non-distended abdomen with no masses.
Genital/Rectal: The patient did not consent to this examination.
Musculoskeletal: Low back pain noted, radiating to the left lower leg. No evidence of trauma affecting the area was noted. Tenderness increases with extension, flexion, and twisting. Limited ROM in the left leg.
Neuro: Cranial nerves: II – XII grossly intact; 2+, symmetric, reflexes.
Diagnostics/Lab Tests and Results:
CBC – To evaluate for spinal infections
CSF analysis- For suspected spinal infection or inflammatory etiologies
X-ray of the spine- for flexion-extension views to identify spondylolisthesis and spinal instability.
MRI of the spine- to assess for suspected myelopathy or radiculopathy.
Electromyography (EMG)- to confirm compressions caused by spinal stenosis or herniated disks (Urits et al., 2019).
Assessment:
Differential Diagnosis (DDx):
Sciatica: This condition is characterized by pain that normally radiates along the sciatic nerve path, which branches from the patient’s lower back through to the buttocks and hip, and down to each leg (Kim et al., 2018). However, sciatica normally affects one side of the body. The patient in the provided case study presents with lower back pain that radiates to the left leg, which is a great indication of sciatica as the primary diagnosis.
Lumbar disc herniation: LDH is characterized by lower back pain and is common among adults between the age of 35 and 50 years. It normally results from changes in the structure of the lower lumbar spinal disk between the 4th and 5th vertebrae and between the 5th lumbar vertebra and the 1st sacral vertebra (Benzakour et al, 2019). Most patients normally present with symptoms such as lower back pain, radicular pain, limited trunk flexion, and weakness at the lumbosacral nerve roots distribution. The patient in the provided case study displayed lower back pain, however, an MRI of the spinal column is needed to confirm this diagnosis.
Lumbar spinal stenosis: LSS is associated with narrowing of the spinal canal located in the lower back resulting in pain. Stenosis causes pressure on the patient’s spinal cord or nerves connecting the spinal column and the muscles (Deer et al., 2019). As such patients will present with lower back pain just like the one in the provided case study. However physical examination is required to assess for the presence of loss of sensation, abnormal reflexes, and weakness to confirm this diagnosis.
Lumbar muscle strain: LMS is described as an injury to the lower back characterized by mild to moderate lower back pain. The injury can lead to damage to the muscle or tendons causing spasms and soreness (Urits et al., 2019). An x-ray is however needed to confirm the impact of the injury on the tendon or muscle to confirm the diagnosis
Ankylosing spondylitis: This is an inflammatory disorder, that can lead to some of the spinal bones fusing over time. It is characterized by pain in the joints and the back (Ogdie et al., 2019). Symptoms normally appear early in life, including reduced flexion of the spine. The patient only presented with back pain which radiates to the left leg with no joint pain or reduced flexion of the spine.
Primary Diagnoses:
1.) Sciatica
PLAN: [This section is not required for the assignments in this course, but will be required for future courses.]
References
Benzakour, T., Igoumenou, V., Mavrogenis, A. F., & Benzakour, A. (2019). Current concepts for lumbar disc herniation. International orthopedics, 43(4), 841-851. https://doi.org/10.1007/s00264-018-4247-6
Deer, T. R., Grider, J. S., Pope, J. E., Falowski, S., Lamer, T. J., Calodney, A., … & Mekhail, N. (2019). The MIST guidelines: the Lumbar Spinal Stenosis Consensus Group guidelines for minimally invasive spine treatment. Pain Practice, 19(3), 250-274. https://doi.org/10.1111/papr.12744
Kim, J. H., van Rijn, R. M., van Tulder, M. W., Koes, B. W., de Boer, M. R., Ginai, A. Z., … & Verhagen, A. P. (2018). Diagnostic accuracy of diagnostic imaging for lumbar disc herniation in adults with low back pain or sciatica is unknown; a systematic review. Chiropractic & manual therapies, 26(1), 1-14. https://doi.org/10.1186/s12998-018-0207-x
Ogdie, A., Benjamin Nowell, W., Reynolds, R., Gavigan, K., Venkatachalam, S., de la Cruz, M., … & Park, Y. (2019). Real-world patient experience on the path to diagnosis of ankylosing spondylitis. Rheumatology and Therapy, 6(2), 255-267. https://doi.org/10.1007/s40744-019-0153-7
Urits, I., Burshtein, A., Sharma, M., Testa, L., Gold, P. A., Orhurhu, V., … & Kaye, A. D. (2019). Low back pain, a comprehensive review: pathophysiology, diagnosis, and treatment. Current pain and headache reports, 23(3), 1-10. https://doi.org/10.1007/s11916-019-0757-1

Literature review: the use of clinical systems to improve outcomes and efficiencies
Assignment: Literature Review: The Use of Clinical Systems to Improve Outcomes and Efficiencies
New technology—and the application of existing technology—only appears in healthcare settings after careful and significant research. The stakes are high, and new clinical systems need to offer evidence of positive impact on outcomes or efficiencies.
Nurse informaticists and healthcare leaders formulate clinical system strategies. As these strategies are often based on technology trends, informaticists and others have then benefited from consulting existing research to inform their thinking.
In this Assignment, you will review existing research focused on the application of clinical systems. After reviewing, you will summarize your findings.
To Prepare:
Review the Resources and reflect on the impact of clinical systems on outcomes and efficiencies within the context of nursing practice and healthcare delivery.
Conduct a search for recent (within the last 5 years) research focused on the application of clinical systems. The research should provide evidence to support the use of one type of clinical system to improve outcomes and/or efficiencies, such as “the use of personal health records or portals to support patients newly diagnosed with diabetes.”
Identify and select 4 peer-reviewed research articles from your research.
For information about annotated bibliographies, visit https://academicguides.waldenu.edu/writingcenter/assignments/annotatedbibliographies
The Assignment: (4-5 pages not including the title and reference page)
In a 4- to 5-page paper, synthesize the peer-reviewed research you reviewed. Format your Assignment as an Annotated Bibliography. Be sure to address the following:
Identify the 4 peer-reviewed research articles you reviewed, citing each in APA format.
Include an introduction explaining the purpose of the paper.
Summarize each study, explaining the improvement to outcomes, efficiencies, and lessons learned from the application of the clinical system each peer-reviewed article described. Be specific and provide examples.
In your conclusion, synthesize the findings from the 4 peer-reviewed research articles.
Use APA format and include a title page.
Use the Safe Assign Drafts to check your match percentage before submitting your work.
Excellent
In a 4- to 5-page paper, synthesize the peer-reviewed research you reviewed. Format your Assignment as an Annotated Bibliography. Be sure to address the following:
· Properly identify 4 peer-reviewed research articles you reviewed.
· Summarize each study, explaining the improvement to outcomes, efficiencies, and lessons learned from the application of the clinical system each peer-reviewed article described. Be specific and provide examples.
In your conclusion, synthesize the findings from the 4 peer-reviewed research articles.
77 (77%) – 85 (85%)
The responses accurately and clearly identify 4 peer-reviewed research articles for the Assignment.
The responses accurately and thoroughly summarize in detail each study reviewed, explaining in detail the improvement to outcomes, efficiencies, and lessons learned from the application of the clinical system each peer-reviewed article described.
Specific, accurate, and detailed examples are provided which fully support the responses.
Written Expression and Formatting – Paragraph Development and Organization:
Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance.
5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity.
Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation
5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors.
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list. 5 (5%) – 5 (5%)
Uses correct APA format with no errors.
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Solution
The Use of Clinical Systems to Improve Outcomes and Efficiencies: An Annotated Bibliography of Current Peer-Reviewed Articles
Clinically relevant innovative technological systems are currently the hallmark of healthcare quality and patient safety. Nurse informaticists are a relatively new expertise in nursing and the healthcare industry in general. It is a role that was necessitated by the health sector’s implementation of technology, when it became clear that the other fields were taking a lead in terms of technological adaptability.
Many more clinical systems have been developed since the acceptance and usage of electronic health record (EHR) systems in healthcare institutions (McGonigle & Mastrian, 2017). These have been shown to improve the effectiveness of healthcare delivery in total; and nursing interventions in specific. As a result, the value of these cutting-edge digital clinical systems in enhancing clinical outcomes and improving healthcare service delivery efficiency has been demonstrated (Wang et al., 2018; McGonigle & Mastrian, 2017).
On this topic, there is a plethora of evidence from peer-reviewed research, and this study focuses on the evidence on clinical systems applicability as shown by the literature in four peer-reviewed articles. This paper is therefore an annotated bibliography of four studies on clinical systems.
Annotated Bibliography
Alotaibi, Y., & Federico, F. (2017). The impact of health information technology on patient safety. Saudi Medical Journal, 38(12), 1173–1180. https://doi.org/10.15537/smj.2017.12.20631
The goal of Alotaibi and Federico (2017)’s research was to find proof that technology-based clinical systems are important in improving results and facilitating effectiveness. They discovered compelling evidence backing about fourteen clinical systems that are often utilized by various providers to enhance performance and quality of healthcare they offer to patients.
Their strong counsel, on the other hand, is that the practitioner must carefully consider which clinical system to employ and from which supplier to obtain it. This is because their research demonstrated that not every vendor’s ostensibly new and innovative clinical solutions are fool-proof. Computerized provider order entry (CPOE) systems, electronic medical record (EMR), bar code medication administration (BCMA), and clinical decision support (CDS) are some of the clinical systems for which they found evidence of a role in improving outcomes and increasing efficacy (Alotaibi & Federico, 2017).
This investigation showed that good patient data management and effective medicine prescribing and drug administration improved results and profitability. The far more essential lesson learned is that, when properly handled, technology can be a huge help in providing high-quality care delivery.
Fedele, D.A., Cushing, C.C., Fritz, A., Amaro, C.M., & Ortega, A. (2017). Mobile health interventions for improving health outcomes in youth. JAMA Pediatrics, 171(5), 461. https://doi.org/10.1001/jamapediatrics.2017.0042
The goal of Fedele et al. (2017)’s research was to determine the efficacy of clinical systems based on mobile phone telephony for delivering treatments such as education programs on preventative measures. The study was a well done meta-analysis that found that cell phone-based clinical systems have a vital role in improving results and enhancing service delivery performance (Fedele et al., 2017).
The noticeable changes in the behaviors of the young subjects as a result of the mobile phone interventions used stood for an improvement in results and effectiveness. The most essential takeaway is that, as smartphones become virtually an unavoidable requirement in today’s environment, their reach may be used to help clinical systems become safer, more effective, patient-centered, efficient, equitable, and timely (AHRQ, 2018).
Islam, M.M., Poly, T.N., & Li, Y.-C. (2018). Recent advancement of clinical information systems: Opportunities and challenges. Yearbook of Medical Informatics, 27(01), 083–090. https://doi.org/10.1055/s-0038-1667075
The goal of Islam et al. (2017) was to determine the importance of clinical information systems in promoting optimal clinical outcomes and healthcare workforce productivity. The outcomes were unmistakable. Clinical information systems have been demonstrated to be effective in decreasing clinical and pharmaceutical mistakes that would otherwise be made by healthcare personnel such as doctors and nurses (Islam et al., 2017).
As a result, the increase in results and efficacy was proved by a decrease in medical errors, which was the focus of the Institute of Medicine or IOM report To Err Is Human in 1999 (Palatnik, 2016). The takeaway is that innovation, in the form of novel healthcare systems, can help to reduce avoidable fatalities.
Rao-Gupta, S., Kruger, D., Leak, L.D., Tieman, L.A., & Manworren, R.C.B. (2018). Leveraging interactive patient care technology to improve pain management engagement. Pain Management Nursing, 19(3), 212–221. https://doi.org/10.1016/j.pmn.2017.11.002
Interactive patient care clinical systems, according to Rao-Gupta et al. (2018), are effective in improving treatment outcomes. They were able to show that this approach may significantly improve the work of administering medication orders.
As a result of the automation and integration of the drug systems, better outcomes and efficiency were demonstrated (Rao-Gupta et al., 2018). The lesson learned was that well-designed clinical systems improve health satisfaction and clinician efficacy, just as they had in the other research studies summarized above.
Conclusion
Clinical information systems are becoming increasingly important in the delivery of treatment. This is owing to their growing importance in promoting efficiencies and providing high-quality care. As a result, healthcare advanced technologies are and will remain to be a significant part of healthcare delivery methods. Peer-reviewed research evidence has proven that well-designed clinical systems are helpful in enhancing patient outcomes and practitioner performance.
References
Agency for Healthcare Research and Quality [AHRQ] (2018). Six domains of health care quality. https://www.ahrq.gov/talkingquality/measures/six-domains.html
Alotaibi, Y., & Federico, F. (2017). The impact of health information technology on patient safety. Saudi Medical Journal, 38(12), 1173–1180. https://doi.org/10.15537/smj.2017.12.20631
Fedele, D.A., Cushing, C.C., Fritz, A., Amaro, C.M., & Ortega, A. (2017). Mobile health interventions for improving health outcomes in youth. JAMA Pediatrics, 171(5), 461. https://doi.org/10.1001/jamapediatrics.2017.0042
Islam, M.M., Poly, T.N., & Li, Y.-C. (2018). Recent advancement of clinical information systems: Opportunities and challenges. Yearbook of Medical Informatics, 27(01), 083–090. https://doi.org/10.1055/s-0038-1667075
McGonigle, D., & Mastrian, K.G. (2017). Nursing informatics and the foundation of knowledge, 4th ed. Jones & Bartlett Learning.
Palatnik, A. (2016). To err is human. Nursing Critical Care, 11(5), 4. https://doi.org/10.1097/01.CCN.0000490961.44977.8d
Rao-Gupta, S., Kruger, D., Leak, L.D., Tieman, L.A., & Manworren, R.C.B. (2018). Leveraging interactive patient care technology to improve pain management engagement. Pain Management Nursing, 19(3), 212–221. https://doi.org/10.1016/j.pmn.2017.11.002
Wang, Y., Kung, L., & Byrd, T.A. (2018). Big data analytics: Understanding its capabilities and potential benefits for healthcare organizations. Technological Forecasting and Social Change, 126(1), 3–13. https://doi.org/10.1016/j.techfore.2015.12.019

Big data risks and rewards
Discussion: Big Data Risks and Rewards
When you wake in the morning, you may reach for your cell phone to reply to a few text or email messages that you missed overnight. On your drive to work, you may stop to refuel your car. Upon your arrival, you might swipe a key card at the door to gain entrance to the facility. And before finally reaching your workstation, you may stop by the cafeteria to purchase a coffee.
From the moment you wake, you are in fact a data-generation machine. Each use of your phone, every transaction you make using a debit or credit card, even your entrance to your place of work, creates data. It begs the question: How much data do you generate each day? Many studies have been conducted on this, and the numbers are staggering: Estimates suggest that nearly 1 million bytes of data are generated every second for every person on earth.
As the volume of data increases, information professionals have looked for ways to use big data—large, complex sets of data that require specialized approaches to use effectively. Big data has the potential for significant rewards—and significant risks—to healthcare. In this Discussion, you will consider these risks and rewards.
To Prepare:
Review the Resources and reflect on the web article Big Data Means Big Potential, Challenges for Nurse Execs.
Reflect on your own experience with complex health information access and management and consider potential challenges and risks you may have experienced or observed.
By Day 3 of Week 5
Post a description of at least one potential benefit of using big data as part of a clinical system and explain why. Then, describe at least one potential challenge or risk of using big data as part of a clinical system and explain why. Propose at least one strategy you have experienced, observed, or researched that may effectively mitigate the challenges or risks of using big data you described. Be specific and provide examples.
Excellent
Main Posting 45 (45%) – 50 (50%)
Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.
Supported by at least three current, credible sources.
Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.
Main Post: Timeliness 10 (10%) – 10 (10%)
Posts main post by day 3.
First Response 17 (17%) – 18 (18%)
Response exhibits synthesis, critical thinking, and application to practice settings.
Responds fully to questions posed by faculty.
Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.
Demonstrates synthesis and understanding of learning objectives.
Communication is professional and respectful to colleagues.
Responses to faculty questions are fully answered, if posed.
Response is effectively written in standard, edited English.
Second Response 16 (16%) – 17 (17%)
Response exhibits synthesis, critical thinking, and application to practice settings.
Responds fully to questions posed by faculty.
Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.
Demonstrates synthesis and understanding of learning objectives.
Communication is professional and respectful to colleagues.
Responses to faculty questions are fully answered, if posed.
Response is effectively written in standard, edited English.
Participation 5 (5%) – 5 (5%)
Meets requirements for participation by posting on three different days.
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Solution
Big Data Risks and Rewards
Big data is the organization of large complex data set that acts as the central processing zone when more detailed information is needed, providing an opportunity for reliability and credibility for the information when making important decisions. As such, big data analytics is one of the most popular undertakings that has taken over the healthcare industry.
Considering the huge amount of data that the healthcare facilities handle, its complexity can only be resolved with the big data analytics to manage the data and get important information that can inform various organizational decisions (Glassman, 2017).
With the demand for specialized treatments, disease control, cost benefit analysis, visibility into performance and an increasing demand for healthcare professional management, the healthcare institutions have adopted the big data analytics in order to effectively manage all these elements.
Nevertheless, the big data has arrived with a mix of benefits and a fair share of challenges. Its application within the healthcare industry has not been easy, with the professionals and the institutions being required to undergo an extra mile to ensure that the data integration within the clinical systems yields the best results in terms of reliable information that informs decisions.
To begin with, one major potential benefit of using big data as part of a clinical system has been reduction of the medical errors. With various data required to perform diagnostic analysis, right from the personal details to medical history, as well as various examination results, the patient data is huge and complex (Wang et al., 2018).
Big data has however brought in a connection of all these data, where important diagnostic decisions can be made in record time after retrieving the important clinical data from the facility system which has enabled accuracy in diagnostic and medical procedures, thus minimizing the medical error cases that can be witnessed with a non-integrated data.
However, one notable challenge for using big data as part of a clinical system is the assurance for data safety and security. Patient and other stakeholders’ data is sensitive and keeping it safe when consolidated together online requires employment of high technical measures and data protocols for its protection (Abouelmehdi et al., 2018).
Cases of data loss and data theft can be catastrophic and therefore, data safety is a serious challenge to the clinical systems when it comes to the management and use of big data. In my observation, many healthcare institutions have however made a big milestone in mitigating the data risks through hiring of nursing informatics and other information experts that will ensure the establishment of data protocols for data capture, storage, sharing and retrieval.
This ensures that only the authorized personnel may access the stored data. On the other hand, these experts also ensure that the data is protected through strong firewalls which prevents illegal online access for the clinical systems.
References
Abouelmehdi, K., Beni-Hessane, A., & Khaloufi, H. (2018). Big healthcare data: Preserving
security and privacy. Journal of Big Data, 5(1), 1-18. doi:http://dx.doi.org/10.1186/s40537-017-0110-7
Glassman, S. K. (2017). Using Data in Nursing Practice. Practice Matters. America Nurse
Today.
Wang, Y.; Kung, L.; Byrd, T.A. (2018). Big data analytics: Understanding its capabilities and
potential benefits for healthcare organizations. Technol. Forecast. Soc. Chang. 126, 3-13.

Literature Evaluation table
PLEASE WRITE ON THE LITERATURE EVALUATION TABLE PROVIDED.
Assessment Description In nursing practice, accurate identification and application of research is essential to achieving successful outcomes. The ability to articulate research data and summarize relevant content supports the student’s ability to further develop and synthesize the assignments that constitute the components of the capstone project.
The assignment will be used to develop a written implementation plan. For this assignment, provide a synopsis of the review of the research literature. Using the ;Literature Evaluation Table; determine the level and strength of the evidence for each of the eight research articles you have selected.
The articles should be current (within the last 5 years) and closely relate to the PICOT question developed earlier in this course. The articles may include quantitative research, descriptive analyses, longitudinal studies, or meta-analysis articles. A systematic review may be used to provide background information for the purpose or problem identified in the proposed capstone project.
While APA style is not required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center. This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

NURS 6051: Transforming Nursing and Healthcare Through Technology
When you wake in the morning, you may reach for your cell phone to reply to a few text or email messages that you missed overnight. On your drive to work, you may stop to refuel your car. Upon your arrival, you might swipe a key card at the door to gain entrance to the facility. And before finally reaching your workstation, you may stop by the cafeteria to purchase a coffee.
NURS 6051: Transforming Nursing and Healthcare Through TechnologyNURS 6051: Transforming Nursing and Healthcare Through Technology
From the moment you wake, you are in fact a data-generation machine. Each use of your phone, every transaction you make using a debit or credit card, even your entrance to your place of work, creates data. It begs the question: How much data do you generate each day? Many studies have been conducted on this, and the numbers are staggering: Estimates suggest that nearly 1 million bytes of data are generated every second for every person on earth.
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As the volume of data increases, information professionals have looked for ways to use big data—large, complex sets of data that require specialized approaches to use effectively. Big data has the potential for significant rewards—and significant risks—to healthcare.
In this Discussion, you will consider these risks and rewards.
To Prepare:
Review the Resources and reflect on the web article Big Data Means Big Potential, Challenges for Nurse Execs.
Reflect on your own experience with complex health information access and management and consider potential challenges and risks you may have experienced or observed.
By Day 3 of Week 5
Post a description of at least one potential benefit of using big data as part of a clinical system and explain why. Then, describe at least
one potential challenge or risk of using big data as part of a clinical system and explain why. Propose at least one strategy you have
experienced, observed, or researched that may effectively mitigate the challenges or risks of using big data you described. Be specific
and provide examples.
By Day 6 of Week 5
Respond to at least two of your colleagues* on two different days, by offering one or more additional mitigation strategies or further
insight into your colleagues’ assessment of big data opportunities and risks

NURS 6630 WK 8 Assignment 2
Page 1 of 3
Assignment 2: Assessing and Treating Patients with Sleep/Wake Disorders
Sleep disorders are conditions that result in changes in an individual’s pattern of sleep (Mayo Clinic, 2020).
Not surprisingly, a sleep disorder can affect an individual’s overall health, safety, and quality of life. Psychiatric nurse practitioners can treat sleep disorders with psychopharmacologic treatments, however, many of these drugs can have negative effects on other aspects of a patient’s health and well-being.
Additionally, while psychopharmacologic treatments may be able to address issues with sleep, they can also exert potential challenges with waking patterns. Thus, it is important for the psychiatric nurse practitioner to carefully evaluate the best psychopharmacologic treatments for patients that present with sleep/wake disorders.
Reference: Mayo Clinic. (2020). Sleep disorders. https://www.mayoclinic.org/diseases-conditions/sleep-disorders/symptoms-causes/syc-20354018
To prepare for this Assignment:
Review this week’s Learning Resources, including the Medication Resources indicated for this week.
Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients with sleep/wake disorders.
The Assignment: 5 pages
Examine Case Study: Pharmacologic Approaches to the Treatment of Insomnia in a Younger Adult.
You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.
At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.
Page 2 of 3
Introduction to the case (1 page)
Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.
Decision #1 (1 page)
Which decision did you select?
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #2 (1 page)
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #3 (1 page)
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Page 3 of 3
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Conclusion (1 page)
Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.
Note: Support your rationale with a minimum of five academic resources.
While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.
Reminder : The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references.
The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting.

Discussion: Pharmacokinetics and Pharmacodynamics
This first week we have a Discussion and an Assignment. For the Discussion you will think of a situation you have experienced. Please see the instructions for details.
You may have looked at the rubric regarding grading for both the Discussion posts as well as the Assignments that will be done during this course. I do follow both of these grading schematics. What I am looking for in both is as follows:
Content is very important to me, so I want you to make sure that your posts and writings for assignments are substantial and are from credible sources (i.e., textbook, publications, etc.). Sources such as drugs.com, Medscape.com, etc., can be used, but they CANNOT be the only sources you have. The latter are set up as information sites only and will not always be accurate.
2. In your discussions, as well as assignments, you should be focusing on the medication parts of the assignment. This is a pharmacology class, so I want you to be researching how the disease is treated, why those treatments the best for the specific disease state, what complications come from treatment, how to avert possible problems with treatment, how to deal with comorbidities during treatments, etc. This is not all inclusive, but some of the things I want you to be thinking about. This will help ensure that you will get the most out of this class and sharpen your reasoning skills as to why certain treatments are used once you are in practice.
Discussion: Pharmacokinetics and Pharmacodynamics
As an advanced practice nurse assisting physicians in the diagnosis and treatment of disorders, it is important to not only understand the impact of disorders on the body, but also the impact of drug treatments on the body. The relationships between drugs and the body can be described by pharmacokinetics and pharmacodynamics.
Pharmacokinetics describes what the body does to the drug through absorption, distribution, metabolism, and excretion, whereas pharmacodynamics describes what the drug does to the body.
When selecting drugs and determining dosages for patients, it is essential to consider individual patient factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes. These patient factors include genetics, gender, ethnicity, age, behavior (i.e., diet, nutrition, smoking, alcohol, illicit drug abuse), and/or pathophysiological changes due to disease.
For this Discussion, you reflect on a case from your past clinical experiences and consider how a patient’s pharmacokinetic and pharmacodynamic processes may alter his or her response to a drug.
To Prepare
Review the Resources for this module and consider the principles of pharmacokinetics and pharmacodynamics.
Reflect on your experiences, observations, and/or clinical practices from the last 5 years and think about how pharmacokinetic and pharmacodynamic factors altered his or her anticipated response to a drug.
Consider factors that might have influenced the patient’s pharmacokinetic and pharmacodynamic processes, such as genetics (including pharmacogenetics), gender, ethnicity, age, behavior, and/or possible pathophysiological changes due to disease.
Think about a personalized plan of care based on these influencing factors and patient history in your case study.
By Day 3 of Week 1
Post a description of the patient case from your experiences, observations, and/or clinical practice from the last 5 years. Then, describe factors that might have influenced pharmacokinetic and pharmacodynamic processes of the patient you identified. Finally, explain details of the personalized plan of care that you would develop based on influencing factors and patient history in your case. Be specific and provide examples.
By Day 6 of Week 1
Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days by suggesting additional patient factors that might have interfered with the pharmacokinetic and pharmacodynamic processes of the patients they described. In addition, suggest how the personalized plan of care might change if the age of the patient were different and/or if the patient had a comorbid condition, such as renal failure, heart failure, or liver failure.
Main post-45 (45%) – 50 (50%)
Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.
Supported by at least three current, credible sources.
Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.
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Solution
Pharmacokinetics and Pharmacodynamics
Pharmacodynamics and pharmacokinetics of different medications are very important to understand before making prescriptions for patients. Rosenthal &Burchum (2018) describe pharmacokinetics as the study of drug movement within the body and pharmacodynamics as the study of drug effects produced in the body, both biochemical and physiological, after consumption.
Pharmacokinetics studies processes of absorption, distribution, metabolism, and excretion of drugs after intake (Rosenthal & Burchum, 2018). A good understanding of drug reactions and processes in the body is important in making proper prescriptions and avoiding medication errors that can impair the health of the patients. This paper will discuss a case study with factors that influence pharmacodynamics and pharmacokinetics and establish a personalized plan of care for the patient.
Anne a 70-year old female comes to the clinic because she has been feeling unwell for two days and describes to the physician that ‘she has not been feeling like herself. The patient is hypertensive and experiencing tachycardia. There are no complaints of pain from the patient but she has a health history of anxiety, depression, COPD, hypertension, and chronic kidney disease. Anne is admitted for the hypertensive condition for further check-up and follow-up. The patient manages her depression with a serotonin reuptake inhibitor and an ace inhibitor for hypertension.
In treating this patient, chronic kidney disease is a key factor to consider. Uncontrolled hypertension could have been caused by chronic kidney malfunctioning. Another factor to consider is the compliance of the patient to medications while at home. Environmental exposure could be another factor to consider in this case. A renal function examination would be important to determine if Anne is having acute renal failure.
If Anne suffers from acute renal impairment, long-term medications which are excreted via the kidney would be avoided. Alternations of drugs, in this case, will be based on pharmacokinetics due to kidney dysfunction (Keller & Hann, 2018). In renal compromised patients, the excretion factor of each drug plays a major role. Environmental exposure will be important to consider since according to Banerjee (2020), pollutants such as pesticides alter the drug-metabolizing enzymes and interfere with the whole process of drug pharmacokinetics. Any exposure to pesticides either at the workplace or residence would interfere with the effectiveness of the given medication.
In conclusion, proper history taking and understanding of each patient is important in determining the treatment plan of patients. In this case, Anne would be stabilized from the hypertensive condition then continue with home dose with keen monitoring. The increased medication would be necessary in case of recurrent hypertension.
References
Banerjee, et al. (01/17/2020). Effect of environmental exposure and pharmacogenomics of drug metabolism. https://doi.org/10.2174/1389200221666200110153304
Keller, F., & Hann, A. (2018). Principles of drug response and alterations in kidney disease. CJASN September 2018, 13 (9) 1413-1420; https://doi.org/10.2215/CJN.10960917
Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.

Professional Nursing and State-Level Regulations
Discussion: Professional Nursing and State-Level Regulations
Boards of Nursing (BONs) exist in all 50 states, the District of Columbia, American Samoa, Guam, the Northern Mariana Islands, and the Virgin Islands. Similar entities may also exist for different regions. The mission of BONs is the protection of the public through the regulation of nursing practice. BONs put into practice state/region regulations for nurses that, among other things, lay out the requirements for licensure and define the scope of nursing practice in that state/region.
It can be a valuable exercise to compare regulations among various state/regional boards of nursing. Doing so can help share insights that could be useful should there be future changes in a state/region. In addition, nurses may find the need to be licensed in multiple states or regions.
To Prepare:
Review the Resources and reflect on the mission of state/regional boards of nursing as the protection of the public through the regulation of nursing practice.
Consider how key regulations may impact nursing practice.
Review key regulations for nursing practice of your state’s/region’s board of nursing and those of at least one other state/region and select at least two APRN regulations to focus on for this Discussion..
By Day 3 of Week 5
Post a comparison of at least two APRN board of nursing regulations in your state/region with those of at least one other state/region. Describe how they may differ. Be specific and provide examples. Then, explain how the regulations you selected may apply to Advanced Practice Registered Nurses (APRNs) who have legal authority to practice within the full scope of their education and experience. Provide at least one example of how APRNs may adhere to the two regulations you selected.
My State is Pennsylvania
Excellent
Main Posting 45 (45%) – 50 (50%)
Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.
Supported by at least three current, credible sources.
Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.
Main Post: Timeliness 10 (10%) – 10 (10%)
Posts main post by day 3.
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Solution
Professional Nursing and State-Level Regulations
The nursing practice and scope are defined by the nurse practice act that is regulated by the board of nursing in all the states in the United States. Cimiotti et al., (2019) discuss that the laws and regulations are developed by the Bon to ensure that nurses in practice are qualified and have met the educational requirements as well as certification to be a nurse. This is important because it helps in preventing unqualified nurses from practicing thus avoiding malpractice and medical errors fem happening.
Additionally, this is improving patient safety (Chesney, & Duderstadt, 2017). Therefore, in the state of Pennsylvania, advanced practice registered nurses follow state law and regulation that allows them to diagnose medical conditions, implement treatment plans, order and perform diagnostic tests among other responsibilities with a written collaborative agreement with a certified and licensed physician (Pittman et al., 2020).
Another state law regulation in this state is that APRNs may prescribe drugs, devices, and schedules II-V controlled substances following the collaborative agreement signed by the APNR alongside a licensed physician.
On the other hand, the APRNs in the state of Pennsylvania with proper training and experience can receive a federal waiver to dispense products containing buprenorphine while being supervised by a licensed physician.
When compared with the state of New Jersey, APRNs require a joint protocol agreement with a licensed physician to perform their responsibilities. Additionally, APRNs in the state of New Jersey are required to have an additional six hours in pharmacological education to be allowed to prescribe medication and devices (Weaver, et al., 2021). Certification from the New Jersey state board of nursing is required for any nurse who wishes to practice as an APRN. However, they must have an advanced level of education like a master of Science in nursing.
APRNs in the state of Pennsylvania are not allowed to have full practice authority; however, they obtain their prescriptive authority by signing a collaborative agreement with a licensed physician. On the other hand, APRNs in Pennsylvania adheres to the prescriptive authority and practice authority by signing a collaborative agreement that is reviewed and updated after every two years.
References
Chesney, M. L., & Duderstadt, K. G. (2017). States’ progress toward nurse practitioner full practice authority: Contemporary challenges and strategies. Journal of Pediatric Health Care, 31(6), 724-728.
Cimiotti, J. P., Li, Y., Sloane, D. M., Barnes, H., Brom, H. M., & Aiken, L. H. (2019). Regulation of the nurse practitioner workforce: implications for care across settings. Journal of nursing regulation, 10(2), 31-37.
Pittman, P., Leach, B., Everett, C., Han, X., & McElroy, D. (2020). NP and PA privileging in acute care settings: Do scope of practice laws matter?. Medical Care Research and Review, 77(2), 112-120.
Weaver, S. H., de Cordova, P. B., Leger, A., & Cadmus, E. (2021). Licensed Practical Nurse Workforce in New Jersey as Described by LPNs and Employers. Journal of Nursing Regulation, 12(1), 60-70.