Nursing

Topic 5 DQ 1
Assessment Description Stakeholder support is necessary for a successful project implementation. Consider your internal stakeholders, such as the facility, unit, or health care setting where the change proposal is being considered, and your external stakeholders, like an individual or group outside the health care setting. Why is their support necessary to the success of your change proposal, and how you will go about securing that support?

NRNP 6635 PRAC Comprehensive Psychiatric Evaluation Template
Week 3: Tips for CPE (Comprehensive Psychiatric Evaluation)
Posted on: Monday, June 13, 2022 1:16:23 PM EDT
Hello All,
Please review the below tips.
I suggest that you all spend time reviewing Chapter 5 of Kaplan and Saddock. If you have not watched the video, I posted reviewing the course exemplar please do so.
The CC is a direct quote from the patient or caregiver if a caregiver includes that information.
The HPI is a key component that takes practice. It should be clear and concise providing information that is pertinent to the signs and symptoms being presented without excessive information. The HPI should paint a picture of the client and is the foundation for the diagnosis.
See the examples below:
Mrs. TP voluntarily presents today with a severely depressed mood x 2 months that began after the death of her dog. She feels depressed more days than not and has crying spells 6 out of 7 days. They no longer find pleasure in gardening and have been written up at work due to missing work. She denies SI/HI. Reports feeling anxious daily with difficulty falling and staying asleep.
Mrs. TP reports feeling tired daily and fatigued, with psychomotor retardation of just laying in bed. She has had an increase in appetite and gained 15 lbs in the last 2 months. When she is having a depressing day she attempts to think about her grandchildren but this has not helped, she has avoided the dog park because it makes her depression worse. She denies previous episodes of depression.
What are the s/s present, what is the trigger/precipitating event, how often and how severe, what makes s/s better what makes it worse? I realize in the case study you may not be given the how often. That is when you insert below the HPI the following information was missing… This demonstrates that you understand the key components of an HPI.
The psychosocial history is not just what is in the background document there is more information in that background document than what belongs in the psychosocial assessment you will need to be able to pick out from that background document what belongs in the psychosocial what belongs in the medical history, history, etc.
You cannot say the Physical exam is Not applicable. An exam of some sort is always applicable. What are the client’s v/s, ht/wt, and BMI? Every case study had a set of vital signs in the background information. What can you see during the interview? Is the client’s skin pale? Was a tremor present? Any acute distress?? Keep in mind when you are practicing many insurance companies require at least 3 points of vital signs for payment of services. It is best to get in the habit of documenting this now.
Diagnostic results: If you are given none in the case study tell me what you would order, why, and what evidence supports it. It may be blood work or CT of the head etc. Additionally, what assessment/screening tool would you use for this patient? Do not give every possible one but what you would order why, and, what evidence supports it. For example, if the patient expresses SI a suicide scale/assessment would be desirable.
MSE: you must give the MSE in paragraph form. The exemplar in your course is helpful but page 213 of Kaplan & Saddock gives more detail and helpful information.
Differential Diagnosis: I want to see that you can connect the presenting s/s to the diagnostic criteria. You can give background information about the diagnosis, but you must demonstrate that you can justify the diagnosis with the presentation and criteria. example” Mr.A.W. meets criteria A of depression as evidenced by ……..
Reflections: Be sure that you are addressing each of the topics in the Assignment directions.
Citations. You must have at least 3 peer review scholarly journals and evidence-based guidelines published within the last 5 years. Websites directed to patients are not scholarly and should not be used. To review correct APA citations, see the Writing Center Citations: Overview.
Be sure you start your assignment with a Title page and an introduction. The introduction should be a brief paragraph that gives some background information about the diagnosis. Then end with a purpose statement.
Writing concise sentences
Use the fewest and most efficient words possible to create information-packed sentences. Imagine that each word costs $20, and you have to budget carefully.
To clean up a wordy sentence:
Keep your adjectives in front of your nouns:
Change a person who is lively to a lively person
Change a business that is known to be trustworthy to a trustworthy business
Avoid beginning thoughts with it is or there are:
There are some people living in London who enjoy wearing hats that could be changed to the following:
Some people in London enjoy wearing hats
Avoid redundancy:
I will study the theories, ideas, and models of three theorists could be I will study the ideas of three theorists
I do realize this is a lot of information, but I feel it will help you do your best on the 1st CPE submission.
Dr. Perrigo
Announcements
Top of Form
CPE Video Review
Posted on: Monday, June 13, 2022, 2:36:51 PM EDT
Hello Everyone,
Please watch the video below. In this video, I go over the assignment and the templates provided in the course. Additionally, I point out areas where students often struggle so It will help you to watch this video. If you have questions, please let me know.
Dr. Perrigo
CPE Video Review
Posted by: Tabitha Perrigo DNP PMHNP
Posted to: NRNP-6635-3/NRNP-6635C-3-Psychopathology Diag Reasoning-2022-Summer-QTR-Term-wks-1-thru-11-(05/30/2022-08/14/2022)-PT27
CPE clarification
Posted on: Tuesday, June 14, 2022, 8:00:00 AM EDT
Hello Everyone,
You choose which case study to present listed in each week.
You will need the 7th edition APA Title page and introduction that ends with a purpose statement at the beginning of your CPE. Then begin with the template provided in your resources. You will include a conclusion as well.
If you have not already, please watch the video that was posted in the course announcements. It will help you better understand what is expected of this assignment.
When watching the case study video, you can view the transcripts and have the option of translating the transcript into other languages. You need to enter a word in the search bar then hit enter. See images below:

NRNP 6531 WK 9 HUMAN
WK 9 Assignment: i-Human Case Study: Evaluating and Managing Musculoskeletal Conditions Patients frequently present with complaints of pain, such as chronic back pain. They often seek medical care with the intent of receiving drugs to manage the pain.
Typically, for this type of pain, narcotic drugs are often prescribed. This can pose challenges for you as the advanced practice nurse prescribing the drugs.
While there is a process for evaluating back pain, it can be difficult to assess the intensity of a patient’s pain since pain is a subjective experience.
Only the person experiencing the pain truly knows whether there is a need for drug treatments. For this Case Study Assignment, you will analyze an i-Human simulation case study about an adult patient with a musculoskeletal condition.
Based on the patient’s information, you will formulate a differential diagnosis, evaluate treatment options, and create an appropriate treatment plan for the patient.
Photo Credit: SCIEPRO / Science Photo Library / Getty Images
To prepare:
Review this week’s Learning Resources. Consider how to assess, diagnose, and treat patients with musculoskeletal conditions.
Access i-Human from this week’s Learning Resources and review this week’s i-Human case study. Based on the provided patient information, think about the health history you would need to collect from the patient.
Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. Reflect on how the results would be used to make a diagnosis.
Identify three to five possible conditions that may be considered in a differential diagnosis for the patient.
Consider the patient’s diagnosis. Think about clinical guidelines that might support this diagnosis.
Develop a treatment plan for the patient that includes health promotion and patient education strategies for patients with musculoskeletal conditions.
Assignment As you interact with this week’s i-Human patient, complete the assigned case study. For guidance on using i-Human, refer to the i-Human Graduate Programs Help link within the i-Human platform.
By Day 7 Complete your Assignment in i-Human.
Submission and Grading Information To submit your completed Assignment for review and grading, do the following:
Please save your Assignment using the naming convention “WK9Assgn+last name+first initial.(extension)” as the name.
Click the Week 9 Assignment Rubric to review the Grading Criteria for the Assignment
Click the Week 9 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK9Assgn+last name+first initial.(extension)” and click Open.
If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
Click on the Submit button to complete your submission. Grading Criteria
WK 9 i-Human Notes: Gloria Jenkins
Page 1 of 10
WK 9 i-Human Notes: Gloria Jenkins
– With the i-Human, in the HPI, you must add the risk factors.
– 80 percent of the class don’t write the risk factors down. So there goes two points or three points right there, which you can have. So, make sure you write the HPI in the right place.
– You have to go to EMR button, click on there and posted in there, and then add your risk factors to your usual onset location and information and guaranteed, that you won’t lose points there.
– As far as testing, you have to research it. There’s just no two ways about it. If your expectation is that you can sit down and just work through the eye human, whether knowledge as a nurse, you are mistaken and because you, you need additional information.
– Make sure that you look at the link that she posted and then will discuss briefly what tests to order. Make sure you look at the link that the instructor posted, and she discusses briefly talking about what tests to order. Now, if you and you don’t get graded down for ordering too many tests. However, if you order X-ray, an MRI and CT scan, for sure, you are going to get graded down because you can’t order all three. Insurance doesn’t allow it. Prior authorization doesn’t allow it.
– However, if you order X-ray, an MRI and CT scan, for sure, you are going to get graded down because you can’t order all three. Insurance doesn’t allow it. Prior authorization doesn’t allow it. So, all you are doing is delaying patient care because you have to do authorization. They call you from x-ray, they call you from CT. They say, well, what do you want? So do familiarize yourself with what you are looking for and which test. It shows that the based as far as the BMP and a CMP, remember what’s on it and then ask yourself, how does knowledge about a BMP relate to back pain?
– So do familiarize yourself with what you are looking for and which taste. It shows that the based as far as the the BMP and a CMP, remember what’s on it and then ask yourself, how does knowledge about a BMP relate to back pain?….There really isn’t!
– So the same with a CBC. What are the two main factors for you to order a CBC? Look at a white blood cell to see if there is an infection there. Or look at the hemoglobin and hematocrit to see if there is anemia. Does anemia relate to back pain? And then of course platelets because low platelets may be an indication of bleeding or
WK 9 i-Human Notes: Gloria Jenkins
Page 2 of 10
something else going on in the bone, which will be important. So think about it when you order tests, approach it in that manner.
– For instance, with this week well as Sed Rate or is RB valuable? I think so because it’s an indication for acute inflammation.
– It is very true to a real life. So, make sure you ask the appropriate questions or order the appropriate tests. Because it, again, you don’t get graded down, but you will get graded down if you order a CT or MRI or an MRI and back x-ray because it just doesn’t work that way!
So that’s about our testing. Then as far as your differential diagnosis, she still believes that the best way to come up with your differential diagnosis is to look at your symptoms, organize your symptoms in acute and chronic. So, if a patient arrives with, for instance, let’s lady with back pain and she tells you she’s had back pain for seven years. You really must decide. Does she have chronic back pain or is this an acute event? And for that reason, you then look at what is going on and we’ll walk through it here in a minute specifically.
As far as the Plan, you do not need to write a SOAP NOTE! You write a soap note. I’m not even going to look at it. The score is 0. It is not a soap note. You must follow the outline that is listed below these instructions. You write orders. You don’t have to write in rationale for me, I want to see what your order is.
– Now, some of you still get tripped up with if this is that or if this doesn’t work in that it doesn’t work that way because you write orders for right now patient in front of you. And this is a Case Study not about what needs to be done. It’s orders for RIGHT NOW. You need not list your differential diagnosis or a rationale for your differential diagnosis.
– And then finally, you must have references. And that is you list the references at the bottom. You need three references. But again, no rationale is needed. All right. So, let’s look at back pain, to successfully treat back pain, you have to know that back pain is one of the TOP 5 complaints that patients will present to you in the clinic with it affects more men than women.
– An onset is as early as 40 years of age start coming in with back pain. Now that doesn’t mean that at 21 years of age people are coming in with back pain or an 80 year old can present. This is just the most time they present. Finally, the most common diagnosis itself is herniated discs.
WK 9 i-Human Notes: Gloria Jenkins
Page 3 of 10
– You should focus your interview on ruling out a herniated disc in my right because that is historically and research shows is the most common complain.
– Knowing that you also need to look at your “Onset”.
– We are going back to physiology. I jumped that. So, let’s look at the spine, the spinal discs that are stacked on top of each other. And in-between is this glutinous gel that kind of space it out as well as the muscles on the side that keeps your spinal cord. The kind of stacked up.
– So when you have pain in your back, you have to consider disc problems as well as muscle because those are the two primary things that can cause back pain. So, muscle strain can cause back pain, but it’s got nothing to do with the disk. Whereas a herniated disc or discitis is trauma to a fracture. Fracture to the back can be excruciating painful, but I have nothing to do with the with the muscle itself.
– Don’t get tripped up by that. Because osteoarthritis is degeneration of the disc that glutinous it’s area. It’s sort of this integrates. Now that disc is closer on each other. They wrap around each other. They get displaced. They cause inflammation.
– People start having leaning over this way or they walk that way. Now that I have muscle pain from that too because they are compensating for what’s going on in there in the back. So let me just make sure I have everything. So then if it is a herniation or the location is very important because herniation can be both in the cervical spine, the thoracic spine, or the lumbar spine. So, it’s very important to differentiate if it’s lumbar or thoracic when you call it a herniation.
– Most common differentials then for visiting back pain in the office is going to be osteoarthritis. This irradiation, trauma, blunt force because of a motor vehicle accident, this narrowing and spinal stenosis. But remember you can’t diagnose spice spinal stenosis or a herniation or anything for that matter until you have an X-ray.
– So would I make that? I would put it on my list my list of things going on. But I can’t make the diagnosis. It’s back pain until I can figure out what kind of back pain it or lumbar pain or lumbar lumbar curve is another word that we use. . So, you have to look. You’re going to be guided with acute onset or chronic. So, it’s easy to rule out the chronic. First, you watch your patient walking into the room.
– In fact, in my office, I asked my nurse not to put anybody on the exam and table. Doesn’t matter for what your complaint is. They sit in the chair, get their blood pressure in the
WK 9 i-Human Notes: Gloria Jenkins
Page 4 of 10
chair. And then I ask them to get on there because that is a great way to examine how mobile they are, how uncomfortable they are. So that way you look at them. If they can’t get on the table, you will simply say, “Can you tie a shoe?” Osteoarthritis or the back limits range of motion. So those people can’t bend down to tie their shoe. They can’t move from side to side, reach to the left because they stiff.
– You can quickly figure out if this is an acute problem or a chronic problem. So then we get to the that the list of things that are also back pain. But it’s kind of like the things you want to put in the back of your mind. And I’m going to look at my lips list here. Always. First on my list is history of cancer. If you have been a woman and it can be a 40-year-old that has a history of breast cancer, or it can be a 80 year old that has a history of colon cancer inherit, resected and now they fight.
– Or a history or undiagnosed cancer. Compression fraction is the first thing that comes into my mind. I always put that there. Then medications. So, people use steroids. A young guy that comes in with terrible back pain, and he has point tenderness of the spine.
he’s either using steroids, anabolic steroids, do puffed himself up and don’t forget the 60-year-old man that’s getting into it and getting it on. He looks like he’s 70 up here, but his body looks like is a 40-year-old that guides using steroids. Steroids causes bone problems.
So you want to put that in the back of your mind. Then piriformis syndrome is another one of my favorites. People forget about.
Piriformis syndrome is the nerve that runs through the kind of from the spine through this little hole pair from hole that sits where the gluteus maximus overlaps the gluteus minimus and the leg muscle comes in little hole that goes through.
– – So if you have any inflammation of your muscle, you’re going to have piriformis syndrome and it is not backed by it. It feels like back pain, and it feels like sciatica, but it’s not. Then the other thing you must consider sciatica. Sciatica is deferred pain.
That means it is nerve pain that is radiating down the leg. You must have a back problem for you to have sciatica because it’s I had it somewhere that you have a pinched nerve that’s causing radiation TO leg, that is a problem for you. So bear that in mind.
– Other things is a UTI, make sure that they don’t have any symptoms of a UTI. And remember though, if they are not symptomatic in you do find a UA and you will not treat because the only thing it’s back pain. So, make sure it’s kind of hard to say well, I order a U/A.
The lady that comes in now because she has very specific symptoms that tells you exactly what the problem is, and I already gave you most of the diagnosis so you should know where to start. Then. Don’t forget about kidney stones can cause back pain, pyelonephritis can aortic dissection, peripheral vascular disease can
WK 9 i-Human Notes: Gloria Jenkins
Page 5 of 10
claudication. Backload that is imputed to legs can cause it. Already talked about cancers and steroids. Osteoporosis is another one.
– – There is 2 that you definitely cannot miss. Herpes Zoster (shingles), So you have to lift your patient’s gown. Not just feel for it because I’ve done that. I’ve missed disaster ones because I didn’t actually look at it back. And it was clearly this string of vesicles. Make sure you look, you actually visualize it.
– And then lastly, there are people that are malingering. So, if you are seeing somebody that comes in repeatedly for back pain and you’ve ruled everything out.
Both inflammatory disorders, which is your lupus or poly myalgia, rheumatic, as well as your your acute in osteoarthritis and your herniated disc or trauma,
– So if you are seeing somebody that comes in repeatedly for back pain and you’ve ruled everything out. Both inflammatory disorders, which is your lupus or poly myalgia, rheumatic, as well as your acute in osteoarthritis and your herniated disc or trauma, you have to at some stage consider malingering and diplomatically address that.
– So what are the symptoms? So we’re going to just quickly look at symptoms. Usually, it’s pain. It can be chronic or acute onset pain. And again, it can be point tenderness of the spine.
If you have point tenderness at the spine, they have a herniated disc, but you cannot miss infectious discitis of the left. But you can only have discitis is if you have somebody that has a fever or chills. So CR my ruling this out. But herniated disc can be trauma, it can be a exercise.
It can be somebody that’s moving, and I keep picked up boxes. All of those things can cause it. So pain, make sure that you rule out according to the symptoms associated with it. It can be numbness and tingling.
If you have numbness and tingling, report it is in the upper, then you look at a cervical fold, your CT of the cervical spine. If it is lower extremity, then you have to look at your MRI
. – It’s important to know is your do they have sensation? Do they have numbness or tingling? And do they have problems with with stool or urination? So those are the those are the criteria for ordering an MRI. Okay. Now, the other one is muscle weakness.
When you order, when you consider much muscle weakness, something else you have to put in there is deconditioning. So are they do they look like they have sarcopenia, which is muscle wasting. Do they have Is it potentially a stroke?
WK 9 i-Human Notes: Gloria Jenkins
Page 6 of 10
– Now remember, if you have a stroke, your upper and lower is affected. So you have to decide yourself, what am I going to scan the brain? But you must have the symptoms to prove that you’re going to scan the brain. And then you have paralysis. If you have paralysis, you have a problem.
So P and P paralysis is a problem. You need to do an MRI and you need to scan the brain too, because sudden onset paralysis is a problem. If they had a motor vehicle accident. Very possible that they May be acquired. But you will not be seeing that patient in the office.
And if a patient comes to your office with back pain after they’ve been in a motor vehicle accident, you immediately going to defer them to the emergency room because first of all, there’s usually going to be litigation.
So, unless you want to be caught up in that litigation and be accused of missing something or in appropriately managing the patient needs to be seen in the emergency room and a proper scan of the of the spine or whatever the problem will be needs to be done.
– With symptoms if they look at and fevers, chills. If they have fever or chills show your primary diagnosis is going to be either they have discitis or have a urinary tract infection and its deferred pain.
– Do you see any edema that is there an open wound, sacred wound? These old people don’t wipe themselves very well. They’re not very well hygiene they sit on there but the whole day then I know that they have sacred author, but there it is. Now it’s causing pain for them.
Then numbness and tingling. You always ask about it but there’s no way to examine them if they have numbness and tingling, be aware of that.
– But you can do a filament test way you evaluate this sensation because they may have diabetic neuropathy or just the neuropathy from some other problem.
So, you have to document sensation. Then. We already talked about the muscle. Look at is it muscle is the muscle weakness? Is there is the muscle a good tone? Or is it totally muscle wasted? And then if you are concerned about a neurological problem, there’s two ways to do it.
You’re going to check reflexes in any case to see if the reflex is intact. But you can also do the anal wink.
– when you examine this patient, you ask them to take take your pants off and you just take your finger and tap it right on the the anus.
If there is a contraction there, you will. You have normal reflexes or normal neural nearby neurological nerve innervation to the lower body because it’s right there.
Now. It doesn’t mean that now you’re done. You can leave your neurological exam. That’s a whole different ballgame. If you have a neurological problem or suspected, you have to do a neuro exam which is different from a simple back exam.
– Document gait.
WK 9 i-Human Notes: Gloria Jenkins
Page 7 of 10
– We kind of talked about BMP and CMP, CBC. If you’re going to do that. Inflammatory markers, you don’t need SED Rate and lactic acid and a CPA CRP. One is, is usually enough.
I find a sed rate most effective because all it tells you is this inflammation. You can have elevated sed rate with osteoarthritis. But it’s mostly effective for me with the malingering patient that you’ve done all the scans, nothing shows.
You do a Sed Rate if that Sed Rate is elevated, they have something going on there. They have inflammation. So, you do have something to treat.
– Standard is the X-ray, spinal X-ray or a hip x-ray or a x-ray of the upper extremity, the femur. So most insurance companies, mostly Medicare and Medicaid, because we have these back problems mostly when they get older, will not jump to an a CT scan or MRI unless an X-ray has been done because the first thing you have to rule out is a fracture, be that a compression fracture or blunt fracture innovation by avulsion fracture, you have to do that if they have deferred pain.
So you palpate the spine, you’re going to do an X-ray if they have a lumbar pain but it’s not on the spine but it’s actually on the sides.
–
– Don’t forget your frog leg, hip. They especially if they fell because they can have a site grow for the fracture. They can have a hip fracture, or they can have and I’m just thinking that it’s blowing out. I just had somebody with it in yeah. The piriformis syndrome.
So you’re going to do your X-ray. The X-ray will not show you or it will just rule out anything in your back. So it’s a diagnosis of exclusion, a piriformis syndrome point tenderness right on the middle of the butt. Then your next one will be your CT scan.
If you have an X-ray that shows a herniated disc with cause that’s what you’ll see on an X-ray, herniated disc for foramina, stenosis for Amnon, a narrowing. Those are the things you’ll see on you on your X-ray or fractures. If you see an X-ray that shows that you have inflammatory changes because you can see it because they will be shadowing around it, then your next step will be a CT scan.
So, when you want to rule out this guide us. When you have somebody with blunt force trauma that has numbness and tingling, anybody that has signs and symptoms of sciatica, you’re going to start with an x-ray and then you proceed to a CT scan.
Or if you have both, you can order both, but you probably going to have to do a prior authorization and they’ll do the X-ray first before they will do the CT scan. Simply, good money management for that. And then finally your MRI. The MRI is your soft tissue.
– When you write pain medication, you always have to remember that you’re actually increase this person’s chances of getting worse. First of all, they’re going to sit around because they sedated and they think they don’t have it. You need them to move.
So what are you going to do to get them moving? If they are narcotics, they don’t want to
WK 9 i-Human Notes: Gloria Jenkins
Page 8 of 10
move. They just sit around and do nothing. If you prescribe non-steroidal. You have to know who is a high-risk candidate for still non-steroidal and who is not a high-risk? Is this person appropriate? So for instance, my 80 year old that comes in with back pain, they don’t get any narcotics, aren’t even look at narcotics.
Non-steroidal. Last ditch Either like it because it causes GI bleeding and by the time the 80, what is the risk factor GI bleed? So, groom your critical thinking to always say what is in the patient’s best interests.
– Because part of your treatment plan should be grooming your passion of what they pay in expectation is, if you have a disc herniation and you’re not a candidate for any intervention other than medication and physical therapy, European expectation will never be 0.
And you just must be honest with your patient. And that’s we respect comes in if you tell them, hey, our goal is going to be keep your pain in the 45 range. They will appreciate you for that. They will. So, make sure you’re paying expectation is your treatment plan is safe, it’s appropriate medications for the age and that you it doesn’t nobody can walk away with no pain.
Then you don’t have to write the dive diagnosis. Right. Orders. I don’t want to see this. If the Tylenol doesn’t help, we will send him to the orthopedist. What is that? That’s not an order. You are managing this, so you must give it a good shot.
And just as an FYI, when you refer somebody to a gastroenterologist or a hematologist, they expect a good baseline workup has been completed. So, the first time somebody presents with back pain, you must at least make a good effort of diagnosing it in treating it before you refer them to a surgeon.
Unless of course, it is something that is that you must have back surgery for. But because your X-ray or CT scan shows that, but you must at least have a good workout before you can send them off to refer
. Alrighty. Good luck with it. Make sure you do all effort to attain that tutorial on the 25th. It will be recorded, so it will be available for you to watch.
i-Human outline and EXAMPL for the plan
Posted by Hermien Creger at Monday, November 22, 2021 8:32:21 PM Last Edited:Friday, December 3, 2021 12:28:28 PM You MUST follow this outline.
If you write an essay or a book, or a story you will receive ZERO. Therapeutic & non-therapeutic modalities (should be written as orders or rx.
Not an essay) 5 pts (note there may be 8/9 orders or as little as 3/4, but there will be very specific key things that you cannot miss) Additional labs or diagnostic tests 5 pts (note, there may be 3/4 or nothing) Health Promotion 5 pts Patient Education 5 pts
WK 9 i-Human Notes: Gloria Jenkins
Page 9 of 10
Consults 5 pts Disposition w/ rational 5 pts EXAMPLE PLAN (30 points) : YOU MUST WRITE ORDERS. NO ESSAYS!
Therapeutic and non-therapeutic modalities: (5 points)
1.Meloxicam 5mg Po Daily
2.Vitamin D 1000units Po weekly
3.Tylenol 1000mg Po TID
4.Alternate Ice and heat
5. Knee brace on during the day, off at night Additional labs or diagnostic test
1. Rheumatoid factor and Uric Acid Health Promotion: (5 points) -Schedule osteoporosis screening -Goal weight loss is 5% -Update your flu vaccine and take your COVID booster -AHA rec exercise most days of the week: consider water aerobics – Stop smoking Education: (5 points)
1. You have OA in your knee that is causing pain. First line tx is tylenol. NSAIDs and PT. Avoid Narcotics for risk of fall
2. Meloxicam can cause BLE edema/CHF and kidney injury. Take only once a day and complete after 7 days. If you notice blood in your stool or swelling in your legs call the office
2. Avoid repetitive movements like running /walking long distances
3. You are at risk for fall . Make sure you work on balance and may use a walker
4.Notify your job that you should limit weight bearing to 10lbs Consult w/ brief rational (5 points)
1.Orthopedic surgeon: evaluate steroid knee injection
2.Physical Therapy: strength training F/U and rational (5 points) 1 month to evaluate effectiveness of brace and progress with strength Screen for SE of Nsaid use and effectiveness of plan
WK 9 i-Human Notes: Gloria Jenkins
Page 10 of 10

NURS 6630 WK6 Assignment Generalized Anxiety Disorder
NURS 6630 WK 6 Assignment: Assessing and Treating Patients with Anxiety Disorders
Common symptoms of anxiety disorders include chest pains, shortness of breath, and other physical symptoms that may be mistaken for a heart attack or other physical ailment. These manifestations often prompt patients to seek care from their primary care providers or emergency departments. Once it is determined that there is no organic basis for these symptoms, patients are typically referred to a psychiatric mental health practitioner for anxiolytic therapy.
For this Assignment, as you examine the patient case study in this week’s Learning Resources, consider how you might assess and treat patients presenting with anxiety disorders.
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 requiring anxiolytic therapy.
The Assignment: 5 pages
Examine Case Study: A Middle-Aged Caucasian Man with Anxiety.
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. 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.
Page 2 of 3
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.
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.
Week 6: Therapy for Patients With Anxiety Disorders and PTSD Treatment
I’m no longer at the mercy of my PTSD, and I would not be here today had I not had the proper diagnosis and treatment. It’s never too late to seek help.
P.K. Philips, PTSD patient For individuals presenting with posttraumatic stress disorder (PTSD) and other anxiety disorders, everyday life can be a constant challenge.
Clients requiring anxiolytic therapy may present with anxiousness, depression, substance abuse issues, and even physical symptoms related to cardiovascular, respiratory, and gastrointestinal ailments.
As a psychiatric nurse practitioner, you must be prepared to address the many needs of individuals seeking treatment for PTSD and other anxiety disorders.
This week, as you study anxiolytic therapies and PTSD treatments, you examine the assessment and treatment of patients with PTSD and other anxiety disorders.
You also explore ethical and legal implications of these therapies.
Reference: Philips, P. K. (n.d.). My story of survival: Battling PTSD. Anxiety and Depression Association of America. https://adaa.org/living-with-anxiety/personal-stories/my-story-survival-battling-ptsd
Learning Objectives
Students will:
Assess patient factors and history to develop personalized plans of anxiolytic therapy for patients
Analyze factors that influence pharmacokinetic and pharmacodynamic processes in patients requiring anxiolytic therapy
Synthesize knowledge of providing care to patients presenting with anxiolytic therapy
Analyze ethical and legal implications related to prescribing anxiolytic therapy to patients across the lifespan
Assess psychopharmacologic approaches to treatment for patients across the lifespan

5052 Assignment: Evidence Based Project Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews
Assignment: Evidence-Based Project, Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews
Your quest to purchase a new car begins with an identification of the factors important to you. As you conduct a search of cars that rate high on those factors, you collect evidence and try to understand the extent of that evidence. A report that suggests a certain make and model of automobile has high mileage is encouraging. But who produced that report? How valid is it? How was the data collected, and what was the sample size?
In this Assignment, you will delve deeper into clinical inquiry by closely examining your PICO(T) question. You also begin to analyze the evidence you have collected.
To Prepare:
Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry.
Develop a PICO(T) question to address the clinical issue of interest you identified in Module 2 for the Assignment. This PICOT question will remain the same for the entire course.
Use the key words from the PICO(T) question you developed and search at least four different databases in the Walden Library. Identify at least four relevant systematic reviews or other filtered high-level evidence, which includes meta-analyses, critically-appraised topics (evidence syntheses), critically-appraised individual articles (article synopses). The evidence will not necessarily address all the elements of your PICO(T) question, so select the most important concepts to search and find the best evidence available.
Reflect on the process of creating a PICO(T) question and searching for peer-reviewed research.
My PICO (T) question is Does nursing burnout have an impact on patient safety and satisfaction?
The Assignment (Evidence-Based Project)
Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews
Create a 6- to 7-slide PowerPoint presentation in which you do the following:
Identify and briefly describe your chosen clinical issue of interest.
Describe how you developed a PICO(T) question focused on your chosen clinical issue of interest.
Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected.
Provide APA citations of the four relevant peer-reviewed articles at the systematic-reviews level related to your research question. If there are no systematic review level articles or meta-analysis on your topic, then use the highest level of evidence peer reviewed article.
Describe the levels of evidence in each of the four peer-reviewed articles you selected, including an explanation of the strengths of using systematic reviews for clinical research. Be specific and provide examples.
Discussion: Searching Databases
Create a 6- to 7-slide PowerPoint presentation in which you do the following:
Identify and briefly describe your chosen clinical issue of interest. (Nursing shortage)
Describe how you developed a PICO(T) question focused on your chosen clinical issue of interest.
Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected.
Provide APA citations of the four relevant peer-reviewed articles at the systematic-reviews level related to your research question. If there are no systematic review level articles or meta-analyses on your topic, then use the highest level of evidence peer-reviewed article.
Describe the levels of evidence in each of the four peer-reviewed articles you selected, including an explanation of the strengths of using systematic reviews for clinical research. Be specific and provide examples.

NRNP 6635 Week 1: History and Theories of Psychopathology
The history of the diagnosis of mental disorders is fraught with examples of how cultural norms and prejudices interfere with and warp a diagnosis. The result is that normal behavior and orientations have been pathologized as an illness or disease.
An example of this would be the story of Alan Turing, the famous British computer scientist of the 20th century, who was instrumental in inventing modern computers and deciphering German code in World War II. He was convicted in 1952 in England of gross indecency for being gay.
Turing was forced by the courts to undergo 12 months of hormone therapy and could no longer work for the British government. At the time, homosexuality was pathologized as a mental disorder in the Diagnostic and Statistical Manual of Mental Disorders and was criminalized in most Western countries.
It was not until 1973 that the American Psychiatric Association (APA) finally removed homosexuality from the DSM. Historically, the process of rendering a diagnosis has been used to pathologize those who fell outside what was considered the cultural norm of human behavior.
This process often marginalized diagnosed populations and prevented individuals from receiving appropriate care. It is of utmost importance to consider cultural issues that influence how you as a clinician interpret a client’s behavior and how cultural issues influence how a client may express behavior.
This week, you explore the history of psychopathology and the evolution of theoretical perspectives in the field.
Learning Objective Students will:
Analyze historical and currently recognized biological, psychological, and sociocultural factors that inform the expression, course, and prevalence of psychopathology Learning Resources Required Readings (click to expand/reduce) Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.
Chapter 1, Neural SciencesChapter 2, Contributions of the Psychosocial Sciences
Chapter 3, Contributions of the Sociocultural Sciences
Chapter 4, Theories of Personality and Psychopathology
Chapter 31.17c, Child Psychiatry: Other Conditions: Identity Problem
Butcher, J. N., & Kendall, P. C. (2018).
Introduction to childhood and adolescent psychopathology. In J. N. Butcher & P. C. Kendall (Eds.), APA handbook of psychopathology: Child and adolescent psychopathology., Vol. 2. (pp. 3–14). American Psychological Association. https://go.openathens.net/redirector/waldenu.edu?url=https://doi.org/10.1037/0000065-001
Cheung, F. M., & Mak, W. W. S. (2018).
Sociocultural factors in psychopathology. In J. N. Butcher & J. M. Hooley (Eds.), APA handbook of psychopathology: Psychopathology: Understanding, assessing, and treating adult mental disorders., Vol. 1. (pp. 127–147). American Psychological Association. https://go.openathens.net/redirector/waldenu.edu?url=https://doi.org/10.1037/0000064-006
Jackson, C. E., & Milberg, W. P. (2018).
Examination of neurological and neuropsychological features in psychopathology. In J. N. Butcher & J. M. Hooley (Eds.), APA handbook of psychopathology: Psychopathology: Understanding, assessing, and treating adult mental disorders., Vol. 1. (pp. 65–90). American Psychological Association. https://go.openathens.net/redirector/waldenu.edu?url=https://doi.org/10.1037/0000064-004
Masten, A. S., & Kalstabakken, A. W. (2018).
Developmental perspectives on psychopathology in children and adolescents. In J. N. Butcher & P. C. Kendall (Eds.), APA handbook of psychopathology: Child and adolescent psychopathology., Vol. 2. (pp. 15–36). American Psychological Association. https://go.openathens.net/redirector/waldenu.edu?url=https://doi.org/10.1037/0000065-002
Discussion: Factors That Influence the Development of Psychopathology
Photo Credit: Getty Images/Blend Images
In many realms of medicine, objective diagnoses can be made: A clavicula is broken. Infection is present. TSH levels meet the diagnostic criteria for hypothyroidism. Psychiatry, on the other hand, deals with psychological phenomena and behaviors. Can these, too, be “defined objectively and by scientific criteria (Gergen, 1985), or are they social constructions?” (Sadock et al., 2015).
Thanks to myriad advances during recent decades, we know that psychopathology is caused by many interacting factors. Theoretical and clinical contributions to the field have come from the neural sciences, genetics, psychology, and social-cultural sciences.
How do these factors impact the expression, classification, diagnosis, and prevalence of psychopathology, and why might it be important for a nurse practitioner to take a multidimensional, integrative approach?
To Prepare:
Review this week’s Learning Resources, considering the many interacting factors that contribute to the development of psychopathology.
Consider how theoretical perspective on psychopathology impacts the work of the PMHNP.
By Day 3 of Week 1
Explain the biological (genetic and neuroscientific); psychological (behavioral and cognitive processes, emotional, developmental); and social, cultural, and interpersonal factors that influence the development of psychopathology.
Read a selection of your colleagues’ responses By Day 6 of Week 1 Respond to at least two of your colleagues on 2 different days by explaining the implications of why, as an advanced practice nurse, it is important to adopt a multidimensional, integrative model of psychopathology.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post.
Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
Hello All,
Welcome to NRNP 6635.
I look forward to getting to know each of you during this term. To get started I strongly encourage you all to review the syllabus and resources found on the left hand navigation panel Under the “Getting Started” heading.
Tips you may find helpful as you complete your course assignments.
Please be sure to read the directions carefully. Furthermore, understand that the rubric attached to each assignment will be used to determine your grade. Therefore, if the rubric assigns a percentage of points for references then you need to be sure you provide references.
I advise you all to complete the assignment early, wait 24 hours and go back review your assignment with the rubric as a guide to ensure you are covering all the requirements. Using bold level 1 headings that draw attention to each required prompt from your assignment directions will help you to ensure you are addressing each prompt.
Walden requires that papers have a title page, introduction and conclusion.
To review:
Please be sure you read the directions and rubric for each assignment carefully.
Include a title page, introduction that ends with a purpose statement, and conclusion for all submissions.
Assignment require the use of APA; you must support your work with current (published in last 5 years) evidence.
Avoid using consumer driven website, you should focus on scholarly peer reviewed journals.
I suggest you complete your assignments early so that you will be able to submit a draft to safeAssign prior to submitting your assignment.
Review the safe assign report prior to submitting understand that if you match to another source you risk a referral to the academic integrity committee.
You may want to consider using a plagiarism service such as Grammarly.com to help you avoid plagiarism (This is NOT required just a suggestion).
Read your work aloud prior to submitting it will help you find errors.
Use level 1 headings for each of the assignment prompts. (See page 48-49 of APA manual 7th ed)
Review the APA Style Overview https://academicguides.waldenu.edu/writingcenter/apa o Review the SON Writing Template found at this link: SON_Writing_Template_with_Instructions _3_ _3_.doc
Check your Walden email 3-4 times weekly at a minimum
When emailing an instructor please include the course and section number this one is NRNP 6635C-3
Check Blackboard for announcements at least every 48 hours. There may not be an announcement every 48 hours, but important information will be posted there.
This week you will submit your 1st discussion. The learning objective is to Analyze historical and currently recognized biological, psychological, and sociocultural factors that inform the expression, course, and prevalence of psychopathology.
You will need to carefully review this weeks learning resources. Please note for future use: the study guide for your midterm is in week 1 resources. Review the directions in your assignment and given below. Be sure to pay attention to the directions for responding to your peers.
Note that you are required to do more than merely add to your peers previous discussion. Reviewing the rubric prior to submission will be vital to you getting the best grade possible. Note the requirement for current credible sources. This means peer reviewed articles (not websites) published in the last 5 years.
By Day 3 of Week 1
Explain the biological (genetic and neuroscientific); psychological (behavioral and cognitive processes, emotional, developmental); and social, cultural, and interpersonal factors that influence the development of psychopathology. Read a selection of your colleagues’ responses
This week you will submit your 1st discussion. The learning objective is to Analyze historical and currently recognized biological, psychological, and sociocultural factors that inform the expression, course, and prevalence of psychopathology. You will need to carefully review this weeks learning resources. Please note for future use: the study guide for your midterm is in week 1 resources.
Review the directions in your assignment and given below. Be sure to pay attention to the directions for responding to your peers. Note that you are required to do more than merely add to your peers previous discussion. Reviewing the rubric prior to submission will be vital to you getting the best grade possible. Note the requirement for current credible sources. This means peer reviewed articles (not websites) published in the last 5 years.
By Day 3 of Week 1
Explain the biological (genetic and neuroscientific); psychological (behavioral and cognitive processes, emotional, developmental); and social, cultural, and interpersonal factors that influence the development of psychopathology.
Read a selection of your colleagues’ responses
By Day 6 of Week 1 Respond to at least two of your colleagues on 2 different days by explaining the implications of why, as an advanced practice nurse, it is important to adopt a multidimensional, integrative model of psychopathology.
Other useful tips for Discussions: 1. 0. Have your name in the top left corner and include Main post or Peer response #1 or #2
Include a brief introduction and purpose statement.
Use level one headings for each assignment prompt . For example in this weeks assignment you would have a heading for Biological, Psychological, then Social, Cultural and Interpersonal.
End the main post with brief summary.
Support you work with peer reviewed journals published within the last 5 years. You may use your textbooks and original authors research but these do not count toward the required number of peer reviewed journal. DO NOT use websites. Websites do not represent scholarly work and many of these are consumer/patient driven.
Do not use direct quotes. Synthesis is required, when you use direct quotes you demonstrate the knowledge of the original authors not your own.
Be certain you read to the directions for how to response to your peers.

Capstone Change Project Evaluation Plan
Assessment Description The assignment will be used to develop a written implementation plan.
Review your strategic plan to implement the change proposal, the objectives, the outcomes, and listed resources.
Develop a process to evaluate the intervention if it were implemented.
Write a 150-250 word summary of the evaluation plan that will be used to evaluate your intervention.
Address the following in your summary
What data was collected?
What tool will be used to collect the data?
Who will be responsible for collecting data?
How will this data be communicated to the team?
APA style is not required, but solid academic writing is expected.

Discussion: Searching Databases
Discussion: Searching Databases
When you decide to purchase a new car, you first decide what is important to you. If mileage and dependability are the important factors, you will search for data focused more on these factors and less on color options and sound systems.
The same holds true when searching for research evidence to guide your clinical inquiry and professional decisions. Developing a formula for an answerable, researchable question that addresses your need will make the search process much more effective. One such formula is the PICO(T) format.
In this Discussion, you will transform a clinical inquiry into a searchable question in PICO(T) format, so you can search the electronic databases more effectively and efficiently. You will share this PICO(T) question and examine strategies you might use to increase the rigor and effectiveness of a database search on your PICO(T) question.
To Prepare:
Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry.
Review the materials offering guidance on using databases, performing keyword searches, and developing PICO(T) questions provided in the Resources.
Based on the clinical issue of interest and using keywords related to the clinical issue of interest, search at least two different databases in the Walden Library to identify at least four relevant peer-reviewed articles related to your clinical issue of interest. You should not be using systematic reviews for this assignment, select original research articles.
Review the Resources for guidance and develop a PICO(T) question of interest to you for further study. It is suggested that an Intervention-type PICOT question be developed as these seem to work best for this course.
By Day 3 of Week 4
Post a brief description of your clinical issue of interest. This clinical issue will remain the same for the entire course and will be the basis for the development of your PICOT question. Describe your search results in terms of the number of articles returned on original research and how this changed as you added search terms using your Boolean operators. Finally, explain strategies you might make to increase the rigor and effectiveness of a database search on your PICO(T) question. Be specific and provide examples.
RUBRIC
Excellent Good Fair Poor
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.
40 (40%) – 44 (44%)
Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module.
At least 75% of post has exceptional depth and breadth.
Supported by at least three credible sources.
Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.
35 (35%) – 39 (39%)
Responds to some of the discussion question(s).
One or two criteria are not addressed or are superficially addressed.
Is somewhat lacking reflection and critical analysis and synthesis.
Somewhat represents knowledge gained from the course readings for the module.
Post is cited with two credible sources.
Written somewhat concisely; may contain more than two spelling or grammatical errors.
Contains some APA formatting errors.
0 (0%) – 34 (34%)
Does not respond to the discussion question(s) adequately.
Lacks depth or superficially addresses criteria.
Lacks reflection and critical analysis and synthesis.
Does not represent knowledge gained from the course readings for the module.
Contains only one or no credible sources.
Not written clearly or concisely.
Contains more than two spelling or grammatical errors.
Does not adhere to current APA manual writing rules and style.
Main Post: Timeliness 10 (10%) – 10 (10%)
Posts main post by day 3.
0 (0%) – 0 (0%) 0 (0%) – 0 (0%) 0 (0%) – 0 (0%)
Does not 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.
15 (15%) – 16 (16%)
Response exhibits critical thinking and application to practice settings.
Communication is professional and respectful to colleagues.
Responses to faculty questions are answered, if posed.
Provides clear, concise opinions and ideas that are supported by two or more credible sources.
Response is effectively written in standard, edited English.
13 (13%) – 14 (14%)
Response is on topic and may have some depth.
Responses posted in the discussion may lack effective professional communication.
Responses to faculty questions are somewhat answered, if posed.
Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
0 (0%) – 12 (12%)
Response may not be on topic and lacks depth.
Responses posted in the discussion lack effective professional communication.
Responses to faculty questions are missing.
No credible sources are cited.
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.
14 (14%) – 15 (15%)
Response exhibits critical thinking and application to practice settings.
Communication is professional and respectful to colleagues.
Responses to faculty questions are answered, if posed.
Provides clear, concise opinions and ideas that are supported by two or more credible sources.
Response is effectively written in standard, edited English.
12 (12%) – 13 (13%)
Response is on topic and may have some depth.
Responses posted in the discussion may lack effective professional communication.
Responses to faculty questions are somewhat answered, if posed.
Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
0 (0%) – 11 (11%)
Response may not be on topic and lacks depth.
Responses posted in the discussion lack effective professional communication.
Responses to faculty questions are missing.
No credible sources are cited.
Participation 5 (5%) – 5 (5%)
Meets requirements for participation by posting on three different days.
0 (0%) – 0 (0%) 0 (0%) – 0 (0%) 0 (0%) – 0 (0%)
Does not meet requirements for participation by posting on 3 different days.
ORDER A PLAGIARISM-FREE PAPER HERE !!
Solution
Searching Databases in Clinical Inquiry
The clinical issue of interest for this clinical inquiry is pressure ulcers in bed-bound patients. This is a significant problem that affects those patients who have been bed-ridden for long periods of time and who lack appropriate or timely nursing care. Pressure ulcers are therefore a quality improvement (QI) concern and are an indicator that the quality of care in the setting in which the patient is admitted is wanting.
Nurses can assess the risk of developing pressure ulcers in bed-ridden patients by using the Braden Scale. The other two scales or tools that can be used are the Norton Scale and the Waterflow Scale (Gaspar et al., 2019; Kottner et al., 2019). Some of the causes of pressure ulcers include neglect, being bed-ridden or immobile, poor nutritional status, and frailty. To discover the available evidence-based interventions to prevent pressure ulcers, a search of research databases is carried out using a PICOT statement that provides key words for the search (Melnyk & Fineout-Overholt, 2019; Melnyk et al., 2009).
When carrying out the search for evidence for this topic in research databases, the original search yielded a total of 8,032 articles. On close scrutiny, it was clear that most of these were not quite specific to what the PICOT question is asking. What were therefore needed were filtering and the use of Boolean operators to narrow down the search.
When the search terms “pressure ulcers,” “prevention,” and “bed-ridden” were combined using the Boolean operator “AND”, the search now yielded more specific articles numbering 76. Out of this, the strategies that might be used to increase the rigor and effectiveness of the database search on the PICOT question include filtering using the dates of publication (for instance, within the last ten years or five years), and filtering using the type of study (e.g. randomized controlled trial or RCT, systematic review and meta-analysis, and so on).
References
Gaspar, S., Peralta, M., Marques, A., Budri, A., & Gaspar de Matos, M. (2019). Effectiveness on hospital-acquired pressure ulcers prevention: A systematic review. International Wound Journal, 16(5), 1087-1102. http://dx.doi.org/10.1111/iwj.13147
Hekmatpou, D., Mehrabi, F., Rahzani, K., & Aminiyan, A. (2018). The effect of Aloe Vera gel on prevention of pressure ulcers in patients hospitalized in the orthopedic wards: A randomized triple-blind clinical trial. BMC Complementary and Alternative Medicine, 18(1), 1-11. https://doi.org/10.1186/s12906-018-2326-2
Kottner, J., Cuddigan, J., Carville, K., Balzer, K., Berlowitz, D., Law, S., … & Sigaudo-Roussel, D. (2019). Prevention and treatment of pressure ulcers/injuries: The protocol for the second update of the international Clinical Practice Guideline 2019. Journal of Tissue Viability, 28(2), 51-58. https://doi.org/10.1016/j.jtv.2019.01.001
Melnyk, B.M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice, 4th ed. Wolters Kluwer.
Melnyk, B.M., Fineout-Overholt, E., Stillwell, S.B., & Williamson, K.M. (2009). Evidence-based practice: Step by step: Igniting a spirit of inquiry. American Journal of Nursing, 109(11), 49–52. http://dx.doi.org/10.1097/01.NAJ.0000363354.53883.58
Nixon, J., Smith, I. L., Brown, S., McGinnis, E., Vargas-Palacios, A., Nelson, E. A., … & Henderson, V. (2019). Pressure relieving support surfaces for pressure ulcer prevention (PRESSURE 2): Clinical and health economic results of a randomized controlled trial. EClinicalMedicine, 14, 42-52. http://dx.doi.org/10.1016/j.eclinm.2019.07.018

Topic 10 DQ 2
Discuss why EBP is an essential component of the practice of a BSN-prepared RN. Identify two ways in which you will continue to integrate evidence into your practice and encourage it within your work environment. What obstacles could challenge this plan, and what steps will you take to minimize their impact?

Assignment: Evidence-Based Project, Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews
Assignment: Evidence-Based Project, Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews
Your quest to purchase a new car begins with an identification of the factors important to you. As you conduct a search of cars that rate high on those factors, you collect evidence and try to understand the extent of that evidence. A report that suggests a certain make and model of automobile has high mileage is encouraging. But who produced that report? How valid is it? How was the data collected, and what was the sample size?
In this Assignment, you will delve deeper into clinical inquiry by closely examining your PICO(T) question. You also begin to analyze the evidence you have collected.
To Prepare:
Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry.
Develop a PICO(T) question to address the clinical issue of interest you identified in Module 2 for the Assignment. This PICOT question will remain the same for the entire course.
Use the key words from the PICO(T) question you developed and search at least four different databases in the Walden Library. Identify at least four relevant systematic reviews or other filtered high-level evidence, which includes meta-analyses, critically-appraised topics (evidence syntheses), critically-appraised individual articles (article synopses). The evidence will not necessarily address all the elements of your PICO(T) question, so select the most important concepts to search and find the best evidence available.
Reflect on the process of creating a PICO(T) question and searching for peer-reviewed research.
The Assignment (Evidence-Based Project)
Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews
Create a 6- to 7-slide PowerPoint presentation in which you do the following:
Identify and briefly describe your chosen clinical issue of interest.
Describe how you developed a PICO(T) question focused on your chosen clinical issue of interest.
Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected.
Provide APA citations of the four relevant peer-reviewed articles at the systematic-reviews level related to your research question. If there are no systematic review level articles or meta-analysis on your topic, then use the highest level of evidence peer reviewed article.
Describe the levels of evidence in each of the four peer-reviewed articles you selected, including an explanation of the strengths of using systematic reviews for clinical research. Be specific and provide examples.
By Day 7 of Week 5
Submit Part 2 of your Evidence-Based Project.
RUBRIC
Excellent Good Fair Poor
Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews Create a 6- to 7-slide PowerPoint presentation in which you do the following: · Identify and briefly describe your chosen clinical issue of interest. · Describe how you developed a PICO(T) question focused on your chosen clinical issue of interest. · Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected. · Provide APA citations of the four peer-reviewed articles you selected. · Describe the levels of evidence in each of the four peer-reviewed articles you selected, including an explanation of the strengths of using systematic reviews for clinical research. Be specific and provide examples. 81 (81%) – 90 (90%)
The presentation clearly and accurately identifies and describes in detail the chosen clinical issue of interest.
The presentation clearly and accurately describes in detail the developed PICO(T) question.
The presentation clearly and accurately identifies four or more research databases used to conduct a search for the peer-reviewed articles selected.
The presentation clearly and accurately provides full APA citations for at least four peer-reviewed articles selected, including a thorough and detailed explanation of the strengths of using systematic reviews for clinical research.
The presentation includes specific and relevant examples that fully support the research.
The presentation provides a complete, detailed, and accurate synthesis of two outside resources related to the peer-reviewed articles selected, and fully integrates at least two outside resources and two or three course-specific resources that fully support the presentation.
72 (72%) – 80 (80%)
The presentation accurately identifies and describes the chosen clinical issue of interest.
The presentation accurately describes the developed PICO(T) question focused on the chosen clinical issue of interest.
The presentation accurately identifies at least four research databases used to conduct a search for the peer-reviewed articles selected.
The presentation accurately provides APA citations for at least four peer-reviewed articles selected, including an adequate explanation of the strengths of using systematic reviews for clinical research.
The presentation includes relevant examples that support the research presented.
The presentation provides an accurate synthesis of at least one outside resource related to the peer-reviewed articles selected. The response integrates at least one outside resource and two or three course-specific resources that may support the presentation.
63 (63%) – 71 (71%)
The presentation inaccurately or vaguely identifies and describes the chosen clinical issue of interest.
The presentation inaccurately or vaguely describes the developed PICO(T) question focused on the chosen clinical issue of interest.
The presentation inaccurately or vaguely identifies at least four research databases used to conduct a search for the peer-reviewed articles selected.
The presentation inaccurately or vaguely provides APA citations for at least four peer-reviewed articles selected, including an inaccurate or vague explanation of the strengths of using systematic reviews for clinical research.
The presentation includes inaccurate or vague examples to support the research presented.
The presentation provides a vague or inaccurate synthesis or outside resources related to the peer-reviewed articles selected. The response minimally integrates resources that may support the presentation.
0 (0%) – 62 (62%)
The presentation inaccurately and vaguely identifies and describes the chosen clinical issue of interest or is missing.
The presentation inaccurately and vaguely describes the developed PICO(T) question, or is missing.
The presentation inaccurately and vaguely identifies less than four research databases used to conduct a search for the peer-reviewed articles selected or is missing.
The presentation inaccurately and vaguely provides APA citations for at least four peer-reviewed articles selected, including an inaccurate and vague explanation of the strengths of using systematic reviews for clinical research, or is missing.
The presentation includes inaccurate and vague examples to support the research presented or is missing.
The presentation provides a vague and inaccurate synthesis of no outside resources related to the articles selected and fails to integrate any resources to support the presentation or is missing.
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 are provided, which delineates all required criteria.
4 (4%) – 4 (4%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.
Purpose, introduction, and conclusion of the assignment is stated yet is brief and not descriptive.
3.5 (3.5%) – 3.5 (3.5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60–79% of the time.
Purpose, introduction, and conclusion of the assignment is vague or off topic.
0 (0%) – 3 (3%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion are provided. 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. 4 (4%) – 4 (4%) Contains a few (one or two) grammar, spelling, and punctuation errors. 3.5 (3.5%) – 3.5 (3.5%) Contains several (three or four) grammar, spelling, and punctuation errors. 0 (0%) – 3 (3%) Contains many (five or more) grammar, spelling, and punctuation errors that interfere with the reader’s understanding. Total Points: 100 ORDER A PLAGIARISM-FREE PAPER HERE !! Solution EBP Part 1: Identifying Research Methodologies for Personality Disorders The philosophy of practice that is premised on the use of only interventions that have been proven by research to be efficacious is referred to as evidence-based practice or EBP. But the body of EBP knowledge is not static but dynamic as it keeps on changing day by day as new evidence of efficacy emerges. This new knowledge for EBP is generated by a process known as clinical inquiry which is undertaken by using the PICOT model. This model requires the identification of the clinical issue of interest or problem (P) requiring evidence-based interventions. Alternatively, the patient population (P) this issue affects is identified as well as the problem itself. This is followed by the intervention to be investigated (I), the comparison or current intervention (C), the expected outcome (O), and the timeframe for the application of the intervention (T) (Melnyk & Fineout-Overholt, 2019). In this EBP project, the clinical issue of interest chosen is the treatment of personality disorders. For this, the PICOT statement or question is “In adult patients diagnosed with a personality disorder (P), does the use of psychotherapy combined with pharmacotherapy (I), compared to pharmacotherapy alone (C), result in better symptom remission (O) within a span of six months (T)?” The purpose of this paper is therefore to analyze four peer-reviewed articles from research databases CINAHL, PubMed, Cochrane, and ProQuest that provide evidence for the best intervention to manage personality disorders. Full citation of selected article Article #1 Article #2 Choi-Kain, L.W., Albert, E.B., & Gunderson, J.G. (2016). Evidence-based treatments for borderline personality disorder. Harvard Review of Psychiatry, 24(5), 342–356. https://doi.org/10.1097/hrp.0000000000000113 Ellison, W.D. (2020). Psychotherapy for borderline personality disorder: Does the type of treatment make a difference? Current Treatment Options in Psychiatry, 7, 416-428. https://doi.org/10.1007/s40501-020-00224-w Why you chose this article and/or how it relates to the clinical issue of interest (include a brief explanation of the ethics of research related to your clinical issue of interest) This article was chosen as it relates to the clinical issue of interest in that it investigates evidence-based treatments for borderline personality disorder. BPD is one of the personality disorders as classified by the DSM-5 (Sadock et al., 2015). The ethics of research have been avoided in this research as it is a review of previous trials on therapies for PDs. This article was chosen because it relates to the clinical issue of interest. It is about reviewing the current evidence-based psychotherapeutic treatments that are available for BPD as one of the PDs. The issue of ethics did not arise as the research was not a primary study but a filtered one. Brief description of the aims of the research of each peer-reviewed article The aim of this review was to evaluate four major available peer-reviewed therapies for BPD. The aims were (i) to provide a summary of available evidence-based psychotherapeutic treatments for BPD, and (ii) to evaluate their effectiveness and the evidence supporting that. Brief description of the research methodology used Be sure to identify if the methodology used was qualitative, quantitative, or a mixed-methods approach. Be specific. The methodology was a systematic quantitative review of existing literature. Each of these modalities was assessed individually and their merits and demerits and compared against the others. The methodology is a qualitative systematic review of the available scholarly evidence. A brief description of the strengths of each of the research methodologies used, including reliability and validity of how the methodology was applied in each of the peer-reviewed articles you selected. The strength of this paper is in its being a review of several primary research articles on the subject. It is therefore a summary of sorts which is better than a single study focussing on one therapy. Its reliability and validity depends on the collective reliability and validity of the four articles reviewed. Being a review, its validity and reliability are sound. The major strength of this methodology is that filtered research provides the best and highest evidence in the pyramid of evidence at level 1. As a sum of the primary studies reviewed, the validity and reliability or generalizability of this study is beyond reproach (good). General Notes/Comments The findings of this study are instrumental in generating new knowledge for enriching EB clinical practice. This study adds to the body of knowledge available for EBP. Conclusion This identification of research methodologies has been conducted systematically according to the tenets of clinical inquiry. A clear issue of clinical interest has been identified and a PICOT statement generated with it to facilitate the search for evidence from published peer-reviewed literature. Reputable research databases have been used to search for evidence and finally four of the several articles retrieved have been reviewed in the matrix above. They show clearly that psychotherapy is the best intervention for personality disorders, but that prudent clinical practice requires that a combination of psychotherapy and pharmacotherapy be used for the best patient outcomes. References Choi-Kain, L.W., Albert, E.B., & Gunderson, J.G. (2016). Evidence-based treatments for borderline personality disorder. Harvard Review of Psychiatry, 24(5), 342–356. https://doi.org/10.1097/hrp.0000000000000113 Ellison, W.D. (2020). Psychotherapy for borderline personality disorder: Does the type of treatment make a difference? Current Treatment Options in Psychiatry, 7, 416-428. https://doi.org/10.1007/s40501-020-00224-w Haswell, N. (2019). The four ethical principles and their application in aesthetic practice. Journal of Aesthetic Nursing, 8(4), 177-179. https://doi.org/10.12968/joan.2019.8.4.177 Melnyk, B.M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice, 4th ed. Wolters Kluwer. Pearce, S., Scott, L., Attwood, G., Saunders, K., Dean, M., De Ridder, R., Galea, D., Konstantinidou, H., & Crawford, M. (2018). Democratic therapeutic community treatment for personality disorder: Randomised controlled trial. The British Journal of Psychiatry, 210(2), 149-156. https:/doi.org/10.1192/bjp.bp.116.184366 Sadock, B.J., Sadock, V.A., & Ruiz, P. (2015). Synopsis of psychiatry: Behavioral sciences clinical psychiatry, 11th ed. Wolters Kluwer. Timäus, C., Meiser, M., Bandelow, B., Engel, K.R., Paschke, A.M., Wiltfang, J., & Wedekind, D. (2019). Pharmacotherapy of borderline personality disorder: What has changed over two decades? A retrospective evaluation of clinical practice. BMC Psychiatry, 19(393), 1-11. https://doi.org/10.1186/s12888-019-2377-z