Midterm Exam

MIDTERM 634

Is the following information subjective or objective?

Mr. M. has a respiratory rate of 32 and a pulse rate of 120.

A) Subjective

B) Objective (Answer)

Which is the proper sequence of examination for the abdomen?

A) Auscultation, inspection, palpation, percussion

B) Inspection, percussion, palpation, auscultation

C) Inspection, auscultation, percussion, palpation

D) Auscultation, percussion, inspection, palpation

Mrs. R. is a 92-year-old retired teacher who comes to your clinic accompanied by her daughter. You ask Mrs. R. why she came to your clinic today. She looks at her daughter and doesn’t say anything in response to your question. This is an example of which type of challenging patient?

A) Talkative patient

B) Angry patient

C) Silent patient

D) Hearing-impaired patient

Which of the following is a clinical identifier of metabolic syndrome?

A) Waist circumference of 38 inches for a male

B) Waist circumference of 34 inches for a female

C) BP of 134/88 for a male

D) BP of 128/84 for a female

Bill, a 55-year-old man, presents with pain in his epigastrium which lasts for 30 minutes or more at a time and has started recently. Which of the following should be considered?

A) Peptic ulcer

B) Pancreatitis

C) Myocardial ischemia

D) All of the above

A 75-year-old retired teacher presents to your clinic, complaining of severe, unrelenting anterior chest pain radiating to her back. She describes it as if someone is “ripping out her heart.” It began less than an hour ago. She states she is feeling very nauseated and may pass out. She denies any trauma or recent illnesses. She states she has never had pain like this before. Nothing seems to make the pain better or worse. Her medical history consists of difficult-to-control hypertension and coronary artery disease requiring two stents in the past. She is a widow. She denies any alcohol, tobacco, or illegal drug use. Her mother died of a stroke and her father died of a heart attack. She has one younger brother who has had bypass surgery. On examination you see an elderly female in a great deal of distress. She is lying on the table, curled up, holding her left and right arms against her chest and is restless, trying to find a comfortable position. Her blood pressure is 180/110 in the right arm and 130/60 in the left arm, and her pulse is 120. Her right carotid pulse is bounding but the left carotid pulse is weak. She is afebrile but her respirations are 24 times a minute. On auscultation her lungs are clear and her cardiac examination is unremarkable. You call EMS and have her taken to the hospital’s ER for further evaluation.

What disorder of the chest best describes her symptoms?

A) Angina pectoris

B) Pericarditis

C) Dissecting aortic aneurysm

D) Pleural pain

A patient is assigned a visual acuity of 20/100 in her left eye. Which of the following is true?

A) She obtains a 20% correct score at 100 feet.

B) She can accurately name 20% of the letters at 20 feet.

C) She can see at 20 feet what a normal person could see at 100 feet.

D) She can see at 100 feet what a normal person could see at 20 feet.

A 46-year-old former salesman presents to the ER, complaining of black stools for the past few weeks. His past medical history is significant for cirrhosis. He has gained weight recently, especially around his abdomen. He has smoked two packs of cigarettes a day for 30 years and has drunk approximately 10 alcoholic beverages a day for 25 years. He has used IV heroin and smoked crack in the past. He denies any recent use. He is currently unemployed and has never been married. On examination you find a man appearing older than his stated age. His skin has a yellowish tint and he is thin, with a prominent abdomen. You note multiple “spider angiomas” at the base of his neck. Otherwise, his heart and lung examinations are normal. On inspection he has dilated veins around his umbilicus. Increased bowel sounds are heard during auscultation. Palpation reveals diffuse tenderness that is more severe in the epigastric area. His liver is small and hard to palpation and he has a positive fluid wave. He is positive for occult blood on his rectal examination.

What cause of black stools most likely describes his symptoms and signs?

A) Infectious diarrhea

B) Mallory-Weiss tear

C) Esophageal varices

Mrs. Hill is a 28-year-old African-American with a history of SLE (systemic lupus erythematosus). She has noticed a raised, dark red rash on her legs. When you press on the rash, it doesn’t blanch. What would you tell her regarding her rash?

A) It is likely to be related to her lupus.

B) It is likely to be related to an exposure to a chemical.

C) It is likely to be related to an allergic reaction.

D) It should not cause any problems.

A 21-year-old receptionist comes to your clinic, complaining of frequent diarrhea. She states that the stools are very loose and there is some cramping beforehand. She states this has occurred on and off since she was in high school. She denies any nausea, vomiting, or blood in her stool. Occasionally she has periods of constipation, but that is rare. She thinks the diarrhea is much worse when she is nervous. Her past medical history is not significant. She is single and a junior in college majoring in accounting. She smokes when she drinks alcohol but denies using any illegal drugs. Both of her parents are healthy. Her entire physical examination is unremarkable.

What is most likely the etiology of her diarrhea?

A) Secretory infections

B) Inflammatory infections

C) Irritable bowel syndrome

D) Malabsorption syndrome

A 27-year-old policewoman comes to your clinic, complaining of severe left-sided back pain radiating down into her groin. It began in the middle of the night and woke her up suddenly. It hurts in her bladder to urinate but she has no burning on the outside. She has had no frequency or urgency with urination but she has seen blood in her urine. She has had nausea with the pain but no vomiting or fever. She denies any other recent illness or injuries. Her past medical history is unremarkable. She denies tobacco or drug use and drinks alcohol rarely. Her mother has high blood pressure and her father is healthy. On examination she looks her stated age and is in obvious pain. She is lying on her left side trying to remain very still. Her cardiac, pulmonary, and abdominal examinations are unremarkable. She has tenderness just inferior to the left costovertebral angle. Her urine pregnancy test is negative and her urine analysis shows red blood cells.

What type of urinary tract pain is she most likely to have?

A) Kidney pain (from pyelonephritis)

B) Ureteral pain (from a kidney stone) (Answer)

C) Musculoskeletal pain

D) Ischemic bowel pain

Chris is a 20-year-old college student who has had abdominal pain for 3 days. It started at his umbilicus and was associated with nausea and vomiting. He was unable to find a comfortable position. Yesterday, the pain became more severe and constant. Now, he hesitates to walk, because any motion makes the pain much worse. It is localized just medial and inferior to his iliac crest on the right. Which of the following is most likely?

A) Peptic ulcer

B) Cholecystitis

C) Pancreatitis

D) Appendicitis

A 68-year-old retired farmer comes to your office for evaluation of a skin lesion. On the right temporal area of the forehead, you see a flattened papule the same color as his skin, covered by a dry scale that is round and feels hard. He has several more of these scattered on the forehead, arms, and legs. Based on this description, what is your most likely diagnosis?

A) Actinic keratosis

B) Seborrheic keratosis

C) Basal cell carcinoma

D) Squamous cell carcinoma

Jim is a 60-year-old man who presents with vomiting. He denies seeing any blood with emesis, which has been occurring for 2 days. He does note a dark, granular substance resembling the coffee left in the filter after brewing. What do you suspect?

A) Bleeding from a diverticulum

B) Bleeding from a peptic ulcer

C) Bleeding from a colon cancer

D) Bleeding from cholecystitis

A 76-year-old retired farmer comes to your office complaining of abdominal pain, constipation, and a low-grade fever for about 3 days. He denies any nausea, vomiting, or diarrhea. The only unusual thing he remembers eating is two bags of popcorn at the movies with his grandson, 3 days before his symptoms began. He denies any other recent illnesses. His past medical history is significant for coronary artery disease and high blood pressure. He has been married for over 50 years. He denies any tobacco, alcohol, or drug use. His mother died of colon cancer and his father had a stroke. On examination he appears his stated age and is in no acute distress. His temperature is 100.9 degrees and his other vital signs are unremarkable. His head, cardiac, and pulmonary examinations are normal. He has normal bowel sounds and is tender over the left lower quadrant. He has no rebound or guarding. His rectal examination is unremarkable and his fecal occult blood test is negative. His prostate is slightly enlarged but his testicular, penile, and inguinal examinations are all normal. Blood work is pending.

What diagnosis for abdominal pain best describes his symptoms and signs?

A) Acute diverticulitis (Answer)

B) Acute cholecystitis

C) Acute appendicitis

D) Mesenteric ischemia

You are obtaining an arterial blood gas in the radial artery on a retired cab driver who has been hospitalized in the intensive care unit for a stroke. You are concerned about the possibility of arterial insufficiency. You perform the Allen test. This means that you:

A) Checked for patency of the radial artery

B) Checked for patency of the brachial artery

C) Checked for patency of the ulnar artery

D) Checked for patency of the femoral artery

You are a student in the vascular surgery clinic. You are asked to perform a physical examination on a patient with known peripheral vascular disease in the legs. Which of the following aspects is important to note when you perform your examination?

A) Size, symmetry, and skin color

B) Muscle bulk and tone

C) Nodules in joints

D) Lower extremity strength

A 37-year-old nurse comes for evaluation of colicky right upper quadrant abdominal pain. The pain is associated with nausea and vomiting and occurs 1 to 2 hours after eating greasy foods. Which one of the following physical examination descriptions would be most consistent with the diagnosis of cholecystitis?

A) Abdomen is soft, nontender, and nondistended, without hepatosplenomegaly or masses.

B) Abdomen is soft and tender to palpation in the right lower quadrant, without rebound or guarding.

C) Abdomen is soft and tender to palpation in the right upper quadrant with inspiration, to the point of stopping inspiration, and there is no rebound or guarding.

D) Abdomen is soft and tender to palpation in the mid-epigastric area, without rebound or guarding.

A 28-year-old patient comes to the office for evaluation of a rash. At first there was only one large patch, but then more lesions erupted suddenly on the back and torso; the lesions itch. On physical examination, you note that the pattern of eruption is like a Christmas tree and that there are a variety of erythematous papules and macules on the cleavage lines of the back. Based on this description, what is the most likely diagnosis?

A) Pityriasis rosea

B) Tinea versicolor

C) Psoriasis

D) Atopic eczema

A 58-year-old gardener comes to your office for evaluation of a new lesion on her upper chest. The lesion appears to be “stuck on” and is oval, brown, and slightly elevated with a flat surface. It has a rough, wartlike texture on palpation. Based on this description, what is your most likely diagnosis?

A) Actinic keratosis

B) Seborrheic keratosis

C) Basal cell carcinoma

D) Squamous cell carcinoma

A middle-aged man comes in because he has noticed multiple small, blood-red, raised lesions over his anterior chest and abdomen for the past several months. They are not painful and he has not noted any bleeding or bruising. He is concerned this may be consistent with a dangerous condition. What should you do?

A) Reassure him that there is nothing to worry about.

B) Do laboratory work to check for platelet problems.

C) Obtain an extensive history regarding blood problems and bleeding disorders.

D) Do a skin biopsy in the office.

You are assessing a patient for peripheral vascular disease in the arms, secondary to a complaint of increased weakness and a history of coronary artery disease and diabetes. You assess the brachial and radial pulses and note that they are bounding. What does that translate to on a scale of 0 to 3?

A) 0

B) 3+

C) 2+

D) 1+

You are speaking to an 8th grade class about health prevention and are preparing to discuss the ABCDEs of melanoma. Which of the following descriptions correctly defines the ABCDEs?

A) A = actinic; B = basal cell; C = color changes, especially blue; D = diameter >6 mm; E = evolution

B) A = asymmetry; B = irregular borders; C = color changes, especially blue; D = diameter >6 mm; E = evolution

C) A = actinic; B = irregular borders; C = keratoses; D = dystrophic nails; E = evolution

D) A = asymmetry; B = regular borders; C = color changes, especially orange; D = diameter >6 mm; E = evolution

Which of the following changes are expected in vision as part of the normal aging process?

A) Cataracts

B) Glaucoma

C) Macular degeneration

D) Blurring of near vision

A light is pointed at a patient’s pupil, which contracts. It is also noted that the other pupil contracts as well, though it is not exposed to bright light. Which of the following terms describes this latter phenomenon?

A) Direct reaction

B) Consensual reaction

C) Near reaction

D) Accommodation

A patient complains of knee pain on your arrival in the room. What should your first sentence be after greeting the patient?

A) How much pain are you having?

B) Have you injured this knee in the past?

C) When did this first occur?

D) Could you please describe what happened?

A 55–year-old smoker complains of chest pain and gestures with a closed fist over her sternum to describe it. Which of the following diagnoses should you consider because of her gesture?

A) Bronchitis

B) Costochondritis

C) Pericarditis

D) Angina pectoris (Answer)

A 77-year-old retired bus driver comes to your clinic for a physical examination at his wife’s request. He has recently been losing weight and has felt very fatigued. He has had no chest pain, shortness of breath, nausea, vomiting, or fever. His past medical history includes colon cancer, for which he had surgery, and arthritis. He has been married for over 40 years. He denies any tobacco or drug use and has not drunk alcohol in over 40 years. His parents both died of cancer in their 60s. On examination his vital signs are normal. His head, cardiac, and pulmonary examinations are unremarkable. On abdominal examination you hear normal bowel sounds, but when you palpate his liver it is abnormal. His rectal examination is positive for occult blood.

What further abnormality of the liver was likely found on examination?

A) Smooth, large, nontender liver

B) Irregular, large liver

C) Smooth, large, tender liver

An elderly woman with a history of coronary bypass comes in with severe, diffuse, abdominal pain. Strangely, during your examination, the pain is not made worse by pressing on the abdomen. What do you suspect?

A) Malingering

B) Neuropathy

C) Ischemia

D) Physical abuse

A 58-year-old teacher presents to your clinic with a complaint of breathlessness with activity. The patient has no chronic conditions and does not take any medications, herbs, or supplements. Which of the following symptoms is appropriate to ask about in the cardiovascular review of systems?

A) Abdominal pain

B) Orthopnea

C) Hematochezia

D) Tenesmus

You are screening people at the mall as part of a health fair. The first person who comes for screening has a blood pressure of 132/85. How would you categorize this?

A) Normal

B) Prehypertension

C) Stage 1 hypertension

D) Stage 2 hypertension

Jacob, a 33-year-old construction worker, complains of a “lump on his back” over his scapula. It has been there for about a year and is getting larger. He says his wife has been able to squeeze out a cheesy-textured substance on occasion. He worries this may be cancer. When gently pinched from the side, a prominent dimple forms in the middle of the mass. What is most likely?

A) An enlarged lymph node

B) A sebaceous cyst

C) An actinic keratosis

D) A malignant lesion

A 72-year-old teacher comes to a skilled nursing facility for rehabilitation after being in the hospital for 6 weeks. She was treated for sepsis and respiratory failure and had to be on the ventilator for 3 weeks. You are completing your initial assessment and are evaluating her skin condition. On her sacrum there is full-thickness skin loss that is 5 cm in diameter, with damage to the subcutaneous tissue. The underlying muscle is not affected. You diagnose this as a pressure ulcer. What is the stage of this ulcer?

A) Stage 1

B) Stage 2

C) Stage 3

D) Stage 4

Mr. Maxwell has noticed that he is gaining weight and has increasing girth. Which of the following would argue for the presence of ascites?

A) Bilateral flank tympany

B) Dullness which remains despite change in position

C) Dullness centrally when the patient is supine

D) Tympany which changes location with patient position

Ms. Whiting is a 68 year old who comes in for her usual follow-up visit. You notice a few flat red and purple lesions, about 6 centimeters in diameter, on the ulnar aspect of her forearms but nowhere else. She doesn’t mention them. They are tender when you examine them. What should you do?

A) Conclude that these are lessons she has had for a long time.

B) Wait for her to mention them before asking further questions.

C) Ask how she acquired them.

D) Conduct the visit as usual for the patient.

A 55-year-old secretary with a recent history of breast cancer, for which she underwent surgery and radiation therapy, and a history of hypertension comes to your office for a routine checkup. Which of the following aspects of the physical are important to note when assessing the patient for peripheral vascular disease in the arms?

A) Femoral pulse, popliteal pulse

B) Dorsalis pedis pulse, posterior tibial pulse

C) Carotid pulse

D) Radial pulse, brachial pulse

A 62-year-old woman has been followed by you for 3 years and has had recent onset of hypertension. She is still not at goal despite three antihypertensive medicines, and you strongly doubt nonadherence. Her father died of a heart attack at age 58. Today her pressure is 168/94 and pressure on the other arm is similar. What would you do next?

A) Add a fourth medicine

B) Refer to nephrology

C) Get a CT scan

D) Listen closely to her abdomen

Which of the following is consistent with obturator sign?

A) Pain distant from the site used to check rebound tenderness

B) Right hypogastric pain with the right hip and knee flexed and the hip internally rotated

C) Pain with extension of the right thigh while the patient is on her left side or while pressing her knee against your hand with thigh flexion

D) Pain that stops inhalation in the right upper quadrant

A 17-year-old high school senior presents to your clinic in acute respiratory distress. Between shallow breaths he states he was at home finishing his homework when he suddenly began having right-sided chest pain and severe shortness of breath. He denies any recent traumas or illnesses. His past medical history is unremarkable. He doesn’t smoke but drinks several beers on the weekend. He has tried marijuana several times but denies any other illegal drugs. He is an honors student and is on the basketball team. His parents are both in good health. He denies any recent weight gain, weight loss, fever, or night sweats. On examination, you see a tall, thin young man in obvious distress. He is diaphoretic and is breathing at a rate of 35 breaths per minute. On auscultation you hear no breath sounds on the right side of his superior chest wall. On percussion he is hyperresonant over the right upper lobe. With palpation he has absent fremitus over the right upper lobe.

What disorder of the thorax or lung best describes his symptoms?

A) Spontaneous pneumothorax

B) Chronic obstructive pulmonary disease (COPD)

C) Asthma

D) Pneumonia

Monique is a 33-year-old administrative assistant who has had intermittent lower abdominal pain approximately one week a month for the past year. It is not related to her menses. She notes relief with defecation, and a change in form and frequency of her bowel movements with these episodes. Which of the following is most likely?

A) Colon cancer

B) Cholecystitis

C) Inflammatory bowel disease

D) Irritable bowel syndrome

Mrs. LaFarge is a 60-year-old who presents with urinary incontinence. She is unable to get to the bathroom quickly enough when she senses the need to urinate. She has normal mobility. Which of the following is most likely?

A) Stress incontinence

B) Urge incontinence

C) Overflow incontinence

D) Functional incontinence

Which of the following percussion notes would you obtain over the gastric bubble?

A) Resonance

B) Tympany

C) Hyperresonance

D) Flatness

A 17-year-old high school senior presents to your clinic in acute respiratory distress. Between shallow breaths he states he was at home finishing his homework when he suddenly began having right-sided chest pain and severe shortness of breath. He denies any recent traumas or illnesses. His past medical history is unremarkable. He doesn’t smoke but drinks several beers on the weekend. He has tried marijuana several times but denies any other illegal drugs. He is an honors student and is on the basketball team. His parents are both in good health. He denies any recent weight gain, weight loss, fever, or night sweats. On examination you see a tall, thin young man in obvious distress. He is diaphoretic and is breathing at a rate of 35 breaths per minute. On auscultation you hear no breath sounds on the right side of his superior chest wall. On percussion he is hyperresonant over the right upper lobe. With palpation he has absent fremitus over the right upper lobe.

What disorder of the thorax or lung best describes his symptoms?

A) Spontaneous pneumothorax (Answer)

B) Chronic obstructive pulmonary disease (COPD)

C) Asthma

D) Pneumonia

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Assessing A Healthcare Program/Policy Evaluation

To Prepare:

· Review the Healthcare Program/Policy Evaluation Analysis Template provided in the Resources.

· Select an existing healthcare program or policy evaluation or choose one of interest to you.

· Review community, state, or federal policy evaluation and reflect on the criteria used to measure the effectiveness of the program or policy described.

The Assignment: (2–3 pages)

Based on the program or policy evaluation you selected, complete the Healthcare Program/Policy Evaluation Analysis Template. Be sure to address the following:

· Describe the healthcare program or policy outcomes.

· How was the success of the program or policy measured?

· How many people were reached by the program or policy selected?

· How much of an impact was realized with the program or policy selected?

· At what point in program implementation was the program or policy evaluation conducted?

· What data was used to conduct the program or policy evaluation?

· What specific information on unintended consequences was identified?

· What stakeholders were identified in the evaluation of the program or policy? Who would benefit most from the results and reporting of the program or policy evaluation? Be specific and provide examples.

· Did the program or policy meet the original intent and objectives? Why or why not?

· Would you recommend implementing this program or policy in your place of work? Why or why not?

· Identify at least two ways that you, as a nurse advocate, could become involved in evaluating a program or policy after 1 year of implementation.

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The Impact Of Nursing Informatics On Patient Outcomes And Patient Care Efficiencies

The Impact Of Nursing Informatics On Patient Outcomes And Patient Care Efficiencies

The Impact Of Nursing Informatics On Patient Outcomes And Patient Care Efficiencies

The Impact Of Nursing Informatics On Patient Outcomes And Patient Care Efficiencies

APA format 7th edition. Peer reviewed article

Assignment: The Impact of Nursing Informatics on Patient Outcomes and Patient Care Efficiencies

In the Discussion for this module, you considered the interaction of nurse informaticists with other specialists to ensure successful care. How is that success determined?

Patient outcomes and the fulfillment of care goals is one of the major ways that healthcare success is measured. Measuring patient outcomes results in the generation of data that can be used to improve results. Nursing informatics can have a significant part in this process and can help to improve outcomes by improving processes, identifying at-risk patients, and enhancing efficiency.

To Prepare:

· Review the concepts of technology application as presented in the Resources.

· Reflect on how emerging technologies such as artificial intelligence may help fortify nursing informatics as a specialty by leading to increased impact on patient outcomes or patient care efficiencies.

The Assignment: (4-5 pages)

In a 4- to 5-page project proposal written to the leadership of your healthcare organization, propose a nursing informatics project for your organization that you advocate to improve patient outcomes or patient-care efficiency. Your project proposal should include the following:

· Describe the project you propose.

· Identify the stakeholders impacted by this project.

· Explain the patient outcome(s) or patient-care efficiencies this project is aimed at improving and explain how this improvement would occur. Be specific and provide examples.

· Identify the technologies required to implement this project and explain why.

· Identify the project team (by roles) and explain how you would incorporate the nurse informaticist in the project team.

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.

• Chapter 25, “The Art of      Caring in Technology-Laden Environments” (pp. 525–535)
• Chapter 26, “Nursing Informatics and the      Foundation of Knowledge” (pp. 537–551)

American Nurses Association. (2018). Inclusion of recognized terminologies supporting nursing practice within electronic health records and other health information technology solutions. Retrieved from /orders/www.nursingworld.org/practice-policy/nursing-excellence/official-position-statements/id/Inclusion-of-Recognized-Terminologies-Supporting-Nursing-Practice-within-Electronic-Health-Records/

Glassman, K. S. (2017). Using data in nursing practice. American Nurse Today, 12(11), 45–47. Retrieved from /orders/www.americannursetoday.com/wp-content/uploads/2017/11/ant11-Data-1030.pdf 

Macieria, T. G. R., Smith, M. B., Davis, N., Yao, Y., Wilkie, D. J., Lopez, K. D., & Keenan, G. (2017). Evidence of progress in making nursing practice visible using standardized nursing data: A systematic review. AMIA Annual Symposium Proceedings, 2017, 1205–1214. Retrieved from /orders/www.ncbi.nlm.nih.gov/pmc/articles/PMC5977718/

Office of the National Coordinator for Health Information Technology. (2017). Standard nursing terminologies: A landscape analysis. Retrieved from /orders/www.healthit.gov/sites/default/files/snt_final_05302017.pdf 

Rutherford, M. A. (2008). Standardized nursing language: What does it mean for nursing practice? Online Journal of Issues in Nursing, 13(1), 1–12. doi:10.3912/OJIN.Vol13No01PPT05.

Note: You will access this article from the Walden Library databases.

Thew, J. (2016, April 19). Big data means big potential, challenges for nurse execs. Retrieved from /orders/www.healthleadersmedia.com/nursing/big-data-means-big-potential-challenges-nurse-execs

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. doi:10.1016/j.techfore.2015.12.019.

Note: You will access this article from the Walden Library databases.

Required Media

Laureate Education (Executive Producer). (2012). Data, information, knowledge and wisdom continuum [Multimedia file]. Baltimore, MD: Author. Retrieved from http://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6051/03/mm/continuum/index.html

Public Health Informatics Institute. (2017). Public Health Informatics: “shipping” information for better health [Video file]. Retrieved from /orders/www.youtube.com/watch?v=q1gNQ9dm0zg.

Public Health Informatics Institute. (2017). Public Health Informatics: knowledge “architecture” [Video file]. Retrieved from /orders/www.youtube.com/watch?v=sofmUeQkMLU.

Cancer And Approach To Care

The nursing process is a tool that puts knowledge into practice. By utilizing this systematic problem-solving method, nurses can determine the health care needs of an individual and provide personalized care.

Write a paper (1,750-2,000 words) on cancer and approach to care based on the utilization of the nursing process. Include the following in your paper:

1. Describe the diagnosis and staging of cancer.

2. Describe at least three complications of cancer, the side effects of treatment, and methods to lessen physical and psychological effects.

3. Discuss what factors contribute to the yearly incidence and mortality rates of various cancers in Americans.

4. Explain how the American Cancer Society (ACS) might provide education and support. What ACS services would you recommend and why?

5. Explain how the nursing process is utilized to provide safe and effective care for cancer patients across the life span. Your explanation should include each of the five phases and demonstrate the delivery of holistic and patient-focused care.

6. Discuss how undergraduate education in liberal arts and science studies contributes to the foundation of nursing knowledge and prepares nurses to work with patients utilizing the nursing process. Consider mathematics, social and physical sciences, and science studies as an interdisciplinary research area.

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

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

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

This benchmark assignment assesses the following programmatic competencies:

RN-BSN

2.1: Incorporate liberal arts and science studies into nursing knowledge.

3.1 Utilize the nursing process to provide safe and effective care for patients across the life span.

RUBRIC: A detailed description of the diagnosis and staging of cancer presented. The description is informative and well-developed. Three or more complications of cancer are detailed. The side effects of treatment and methods to lessen the physical and psychological effects are thoroughly described. The discussion is accurate, detailed, and presents all significant factors contributing to the yearly incidence. A detailed explanation for how the ACS might provide education and support is presented. The role and function of the ACS are clear and informative. ACS services to be recommended are discussed and rationale is provided for the recommendation and mortality rates of various cancers in Americans. Strong rationale and evidence support the discussion. A well-developed explanation of how the nursing process is utilized to provide safe and effective care for cancer patients across the life span is presented. The explanation clearly describes how the process provides safe and effective care for patients across the life span. Strong rationale or evidence is provided for support. Insight into the nursing process and its utilization to provide safe and effective care for patients across the life span is demonstrated. A thorough discussion on how undergraduate education in the liberal arts and science studies contributes to the foundation of nursing knowledge and prepares nurses to work with patients utilizing the nursing process is presented. A strong correlation for how undergraduate education contributed to nursing knowledge and prepares nurses to work with patients utilizing the nursing process is clearly established. Insight into the contribution of liberal arts and science studies to nursing practice is demonstrated. Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear. Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative. Writer is clearly in command of standard, written, academic English. All format elements are correct. Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.

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Health Assessment Check-Off Project

Complete the “Health Assessment Check-Off Project” template using a patient that you have previously worked with. Ensure that you have adequately completed the assessment steps and given a proper recommendation.

APA style is not required, but 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 not required to submit this assignment to LopesWrite.

Health Assessment Check-Off Project 

Physical Exam Documentation

Chief Complaint:

History of Present Illness:

Past Medical History (Hx):

Past Surgical Hx:

Family Hx:

Social Hx:

Allergies:

Medications:

Review of symptoms by system:

Physical Exam:

Assessment:

Treatment Plan:

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CALLING ALL NURSES

 Master of Science

Master of Science, Nursing Core

Clinical Practice Experience (CPE) Record

Student Name: __________________________________________ Date: _________________________ (By submitting this CPE Record to Evaluation, you attest that you completed each required activity.)

Course Instructor Name: _________________________________________________________________

Course: Essentials of Advanced Nursing Roles and Interprofessional Practice

Welcome to the Clinical Practice Experience (CPE) for this course. The CPE for the Master of Science in Nursing program core courses consists of a variety of semi-structured activities. CPE provides the opportunity to integrate new knowledge into practice and to attain the identified professional competencies (AACN, 2016). By completing all the activities and evidence listed within this document, and earning a grade of “Competent,” you will earn 25 indirect CPE hours for this course.*

CPE Objective:

In this CPE, you will take on the role of an advanced professional nurse responsible for molding policy issues facing the nursing profession and healthcare. You will build on the knowledge gained thus far in your MSN core course work and learn more about how to lead and educate interprofessional teams to build and advance policy advocacy by developing an advocacy plan for a social determinant of your choosing.

In this CPE, you will experience the role of an advanced professional nurse in two phases:

· Phase 1: You will research and plan for advocacy.

· Phase 2: You will develop the structure for your advocacy team.

Student Instructions:

· Complete and date the required activities

· Type in your name and date the top of this form

· Type in the name of your faculty of record for this course (your assigned Course Instructor)

· Submit the completed CPE Record for evaluation

PHASE 1: ADVOCACY ACTION PLAN

CPE

Date Activity Completed

☐

Review all of the activity and evidence requirements for this CPE, including Phase 1 and Phase 2. Break down each activity from each phase into strategic tasks and specific due dates in order to meet the activity deadlines. Create a CPE schedule table in your e-portfolio that lists your tasks, due dates, and estimated time needed to complete each activity.

☐

Review health data sites such as /orders/www.countyhealthrankings.org/explore-health-rankings and /orders/www.usnews.com/news/healthiest-communities. Enter

your zip code to investigate some health issues in your county and state.

Using data and resources from the two websites above and other sources you can find in a Google search or the WGU library, identify: a health issue in your community, a specific portion of the population in your community most effected by the health issue, the social factor or condition (social determinant of health (SDOH)) that leads to, worsens, or complicates the health issue for this specific population, and your recommended policy change to address the SDOH.

Complete the table below and email just the table to your assigned course instructor for feedback. Revise table based on CI feedback and complete below prior to submitting CPE Record:

Health Issue in My Community

Data Source

Target Population Affected (3 characteristics)

SDOH

(identify just 1 social factor/condition that predisposes target population to health issue)

Recommended Policy Change

Date table was emailed to Course Instructor for feedback.

Review the Guide to Identifying a Social Determinant of Health (SDOH) and Preparing to Write a Policy Brief located in Course Tips. Part of building a successful policy brief involves generating interest in the issue by creating an advocacy action plan.

Review the “ Answering the Call ” series presented by the Sigma Theta Tau International Honor Society of Nursing organization. Watch the recorded video title “Creating an Advocacy Action Plan” found in Course Tips. Based on what you have learned, create a brief summary (less than 100 words) of the process you will use to create your advocacy action plan.

☐

Search the internet and WGU Library for information on building policy advocacy in nursing. Learn more about nursing’s role in policy by visiting the National League for Nursing (NLN), Advocacy & Public Policy site and the American Association of Colleges of Nursing (AACN), Policy & Advocacy site. Note the toolkits and resources available. Using what you have learned from your research, create a SMART goal for moving your policy brief forward.

☐

Before a policy can be formulated, it must first command attention or it will not be included on the policymakers agenda. After you have identified an issue and created a policy brief, you will need to draw attention to your policy brief so it can be included as an agenda item. This is the first stage in the public policy cycle, which is called agenda-setting . To start the agenda-setting phase, create a list with contact information of your local, state, and federal policymakers (e.g. Legislator, County Commissioner, School Board President, Mayor, Director of Public Health, etc.). For Federal legislators, start with /orders/www.congress.gov to find your state’s representatives.

☐

Using the contact information you assembled, contact one of the policymakers from your contact list to inquire about the process for agenda-setting. If the policymaker does not respond to your request for information in a timely fashion, search the internet to learn about the process for agenda-setting. (Note: You are not sharing your policy change recommendation. You are simply inquiring about the process for agenda setting.)

☐

Based on the agenda setting process you identified, create an action plan that includes five strategies you will use to begin the process of informing the media and stakeholders of the importance of your identified policy issue.

☐

Create a 3–5 minute GoReact video reflection discussing your Phase 1 CPE. If you have trouble with the GoReact link, you can copy and paste the URL directly into your browser: /orders/lrps.wgu.edu/provision/173986697 What insights did you gain from the experience of researching and planning for policy advocacy? Are there things you would do differently next time you are involved in policy advocacy? Provide encouraging and constructive comments to the video reflections of two peers in GoReact.

Phase 1 Evidence (Upload the following to your e-portfolio:)

1. CPE schedule table of the tasks and timelines that you developed for this CPE

2. Advocacy action plan summary (100 words or less) of the process you will use to create your advocacy plan

3. SMART goal for moving your policy brief forward

4. List of local, state, or federal policymakers’ contact information

5. Screenshot or copy of the inquiry email or letter you sent to learn more about the process you must follow for agenda setting

6. Action plan for informing media and stakeholders that includes five strategies for informing the media and stakeholders of the importance of your identified policy issue

7. Three screenshots to document your GoReact video reflection that includes an image of your reflection video and an image for each of your peer responses

8. A brief, written reflection summary of your video reflection below your screenshot

PHASE 2: STRUCTURING THE ADVOCACY TEAM

CPE

Date Activity Completed

☐

Review the CPE Schedule table created in Phase 1 to ensure you are still making progress towards meeting your timelines. Adjust the schedule table if necessary.

☐

Nursing policy advocacy is more effective when there is support from members of an interprofessional healthcare team. To learn more about forming interprofessional teams, review this American Nurses Association article and develop the skills to be an effective communicator across care teams by completing some of the modules in Team STEPPS from the Agency for Healthcare Research and Quality (AHRQ). List seven or more techniques you learned about team-building that will be useful when forming and leading your interprofessional policy advocacy team, and explain why the seven techniques are important for forming and leading interprofessional policy advocacy teams.

☐

Identify key interprofessional stakeholders, by role or title, that will form your interprofessional policy advocacy team. Create a list of five interprofessional stakeholders, and describe how these individuals will contribute to meeting the SMART goal you established.

☐

As an advanced professional nurse, you are responsible for educating the advocates on the policy issue and the process for agenda-setting. Create an agenda for your first team meeting that includes a list of items you will discuss. This agenda should inform and educate the team regarding the policy brief you created and the process that should be used for agenda-setting. Once you have created your agenda, share this with policy advocates to get their feedback and suggestions. Include their feedback in your GoReact video reflection.

☐

Create a 3–5 minute GoReact video reflection of your experiences describing what you learned during the process of building a structure for your policy advocacy team and creating an educational agenda to build advocacy for your policy issue. If you have trouble with the GoReact link, you can copy and paste the URL directly into your browser: /orders/lrps.wgu.edu/provision/173986697

Include your perceptions regarding the feedback you received from the policy advocate’s review of your agenda. Provide positive comments on two peers’ videos.

Phase 2 Evidence (Upload the following to your e-portfolio:)

1. List of seven interprofessional team-building techniques you learned about interprofessional team-building with a description of why each of these will be important when forming and leading your interprofessional policy advocacy team

2. List of five interprofessional stakeholders and a description of how each stakeholder will contribute to meeting your SMART goal

3. Team meeting agenda for your first team meeting that includes a list of items you will discuss

4. Three screenshots to document your GoReact video reflection, that includes an image of your reflection video and an image for each of your peer responses

5. A brief, written reflection summary of your video reflection below your screenshot

*American Association of Colleges of Nursing. (2016). Clinical practice experiences FAQs. Retrieved from /orders/www.aacnnursing.org/CCNE-Accreditation/Resources/FAQs/Clinical-Practice.

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Practicum Experience Plan

For this Assignment, you will consider the areas you aim to focus on to gain practical experience as an advanced practice nurse. Then, you will develop a Practicum Experience Plan (PEP) containing the objectives you will fulfill in order to achieve your aims. In this practicum experience, when developing your goals and objectives, be sure to keep psychiatric assessment and diagnostic reasoning in mind.

To Prepare

• Review your Clinical Skills Self-Assessment Form you submitted last week and think about areas for which you would like to gain application-level experience and/or continued growth as an advanced practice nurse. How can your experiences in the Practicum help you achieve these aims?
• Review the information related to developing objectives provided in this week’s Learning Resources.  Your practicum learning objectives that you want to achieve during your Practicum experience must be:
  • Specific
  • Measurable
  • Attainable
  • Results-focused
  • Time-bound
  • Reflective of the higher-order domains of Bloom’s taxonomy (i.e., application level and above)

Note: Please make sure your objectives are outlined in your Practicum Experience Plan (PEP).

• Discuss your professional aims and your proposed practicum objectives with your Preceptor to ascertain if the necessary resources are available at your practicum site.

Assignment

Record the required information in each area of the Practicum Experience Plan template, including three to four (3–4) practicum learning objectives you will use to facilitate your learning during the practicum experience.

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Functional Health Patterns Community Assessment Guide

Perform a direct assessment of a community of interest using the “Functional Health Patterns Community Assessment Guide.” -The community of interest is Scottsdale, Arizona USA. Address every bulleted statement in the 2 following sections with data or rationale for deferral. 1.) Value/Belief Pattern • Predominant ethnic and cultural groups along with beliefs related to health. • Predominant spiritual beliefs in the community that may influence health. • Availability of spiritual resources within or near the community (churches/chapels, synagogues, chaplains, Bible studies, sacraments, self-help groups, support groups, etc.). • Do the community members value health promotion measures? What is the evidence that they do or do not (e.g., involvement in education, fundraising events, etc.)? • What does the community value? How is this evident? • On what do the community members spend their money? Are funds adequate? 2.) Health Perception/Management • Predominant health problems: Compare at least one health problem to a credible statistic (CDC, county, or state). • Immunization rates (age appropriate). • Appropriate death rates and causes, if applicable. • Prevention programs (dental, fire, fitness, safety, etc.): Does the community think these are sufficient? • Available health professionals, health resources within the community, and usage. • Common referrals to outside agencies.

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Environmental Health

Environmental Health

Environmental Health

Question 1

1. Which of the following groups of chemicals was widely used as insulating fluid in electrical equipment?

[removed]		Dioxins
[removed]		Polybrominated diphenyl ethers (PBDEs)
[removed]		Polychlorinated biphenyls (PCBs)

1 points

Question 2

1. Occupational asthma is known to be caused by synthetic organic chemicals, dusts, and _______________.

[removed]		alpha radiation
[removed]		certain bacteria
[removed]		certain metals

1 points

Question 3

1. Which of the following products are made using processes that involve perfluorochemicals (PFCs)?

[removed]		Consumer electronics
[removed]		Flexible plastic containers
[removed]		Non-stick coatings

1 points

Question 4

1. The effect of _______________ in inducing _______________ appears to have no threshold.

[removed]		lead / neurotoxicity
[removed]		methylmercury / decrement in IQ
[removed]		particulates / fibrosis

1 points

Question 5

1. In the United States today, young children get most of their exposure to the lead in lead paint by __________.

[removed]		ingesting chips of paint
[removed]		ingesting dust that contains lead
[removed]		inhaling airborne lead

1 points

Question 6

1. Which of the following is the most common medium for people’s exposures to solvents?

[removed]		Dust
[removed]		Groundwater
[removed]		Meat or fish

1 points

Question 7

1. _______________ are the major cause of stratospheric ozone depletion.

[removed]		Chlorofluorocarbons (CFCs)
[removed]		Perfluorochemicals (PFCs)
[removed]		Polybrominated diphenyl ethers (PBDEs)

1 points

Question 8

1. In the human body, carbon monoxide (CO) _______________.

[removed]		binds to hemoglobin, displacing oxygen
[removed]		compromises the body’s defenses against airborne particulates
[removed]		concentrates in the thyroid, causing thyroid cancer

1 points

Question 9

1. _______________ are widely used to degrease metals—for example, in the manufacture of electronic components.

[removed]		Perfluorochemicals (PFCs)
[removed]		Phthalates
[removed]		Solvents

1 points

Question 10

1. Hearing loss is associated not only with exposure to noise, but also with exposure to _________.

[removed]		air fresheners
[removed]		household pesticides
[removed]		secondhand smoke

1 points

Question 11

1. Which of the following pollutants is a key contributor to acid deposition?

[removed]		Carbon dioxide
[removed]		Carbon monoxide
[removed]		Ozone
[removed]		Sulfur dioxide

1 points

Question 12

1. When automobiles burn gasoline, they:

[removed]		emit ozone, which reacts with volatile organic compounds (VOCs) to form photochemical smog.
[removed]		emit VOCs, which react with NOx and other chemicals to form photochemical smog.
[removed]		increase ozone at ground level, contributing to depletion of ozone in the stratosphere.

1 points

Question 13

1. Many phthalates affect the _______________.

[removed]		central nervous system
[removed]		endocrine system
[removed]		respiratory system

1 points

Question 14

1. Sick building syndrome is a set of __________.

[removed]		construction features of a building that make people feel ill
[removed]		indoor air pollutants associated with construction materials
[removed]		symptoms that people experience when they spend time in a building

1 points

Question 15

1. Some likely human health impacts of polybrominated diphenyl ethers (PBDEs) are suggested by their chemical structure, which is similar to that of _______________.

[removed]		human growth hormone
[removed]		neurotransmitters
[removed]		thyroid hormones

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