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N 5327: Exploration of Science and Theories for Nursing

Grading Rubric for Description & Evaluation of Theory Paper

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Gambling disorder

BACKGROUND

Mrs. Maria Perez is a 53 year old Puerto Rican female who presents to your office today due to a rather “embarrassing problem.”

SUBJECTIVE

Mrs. Perez admits that she has had “problems” with alcohol since her father died in her late teens. She reports that she has struggled with alcohol since her 20’s and has been involved with Alcoholics Anonymous “on and off” for the past 25 years. She states that for the past two years, she has been having more and more difficulty maintaining her sobriety since they opened the new “Rising Sun” casino near her home. Mrs. Perez states that she and a friend went to visit the new casino during their grand opening at which point she was “hooked.” She states that she gets “such a high” when she is gambling. While gambling, she “enjoys a drink or two” to help calm her during high-stakes games. She states that this often gives way to more drinking and more reckless gambling. She also reports that her cigarette smoking has increased over the past two years and she is concerned about the negative effects of the cigarette smoking on her health.

She states that she attempts to abstain from drinking but that she gets such a “high” from the act of gambling that she needs a few drinks to “even out.” She also notices that when she drinks, she doesn’t smoke “as much” but enjoys smoking when she is playing at the slot machines. She also reports that she has gained weight from drinking so much- she currently weights 122 lbs., which represents a 7 lb. weight gain from her usual 115 lb. weight.

Mrs. Perez is quite concerned today because she has borrowed over $50,000 from her retirement account to pay off her gambling debts. She is very concerned because her husband does not know that she has spent this much money.

MENTAL STATUS EXAM

The client is a 53 year old Puerto Rican female who is alert, oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. Her speech is clear, coherent, and goal directed. Her eye contact is somewhat avoidant during the clinical interview. As you make eye contact with her, she looks away or looks down. She demonstrates no noteworthy mannerisms, gestures, or tics. Her self-reported mood is “sad.” Affect is appropriate to content of conversation & self-reported mood. She visual or auditory hallucinations, no delusional or paranoid thought processes are readily appreciated. Insight and judgment are grossly intact, however, impulse control is impaired. She is currently denying suicidal or homicidal ideation.

Diagnosis: Gambling disorder, alcohol use disorder

Decision Point One

 Antabuse (Disulfiram) 250 mg orally every morning ON

 Naltrexone (Vivitrol) injection, 380 mg intramuscularly in the gluteal region every 4 weeks

 Antabuse (Disulfiram) 250 mg orally daily

 Campral (Acamprosate) 666 mg orally three times/day

 E

·  Client returns to clinic in four weeks

·  Mrs. Perez states that she has noticed that she has been having suicidal ideation over the past week, and it seems to be getting worse

·  Clientis She is also reporting that she is having “out of control” anxiety.. 

Decision Point Two

Educate Mrs. Perez on the side effects of Campral and add Valium (diazepam) 5 mg orally TID to address anxiety symptoms

RESULTS OF DECISION POINT TWO Decision Point Two

Select what the PMHNP should do next:

Add on Valium (diazepam) 5 mg orally TID/PRN/anxiety

Refer to a counselor to address gambling issues

Add on Chantix (varenicline) 1 mg orally BID

• Client returns to clinic      in four weeks
• Mrs. Perez reports that      when she first received the valium, it helped her tremendously. She states      “I was like a new person- this is a miracle drug!” However, she reports      that she has trouble “waiting” between drug administration times and      sometimes takes her valium early. She is asking today for you to increase      the valium dose or frequency
• Although she reports that      her anxiety is gone, she still reports suicidal ideation, but states “with      that valium stuff, who cares?”;;;;;;;;
• Decision Point Three
•  
• Add on Wellbutrin (bupropion) XL 150 mg orally daily
• Guidance to Student
• Given her weight (less than 60      kg), Campral should have been started at 666 mg orally BID. It is possible      that the higher dose may be responsible for the severity of the symptoms      that Mrs. Perez is experiencing.
• Technically, the drug should      have been stopped (not simply decreased) once Mrs. Perez reported suicidal      ideation. Even with the decrease in dose, she is still having suicidal      ideation, which indicates the need to discontinue the drug. Although      controversy exists regarding how long to use pharmacologic approaches to      treatment of alcohol dependence, 8 weeks is probably insufficient,      therefore, the drug should not simply be discontinued without using a      different agent in its place.
• Mrs. Perez should be started on      Antabuse at 250 mg orally daily and referred to psychotherapy to address      her gambling issue.
• In all cases, the PMHNP needs      to discuss smoking cessation options with Mrs. Perez in order to address      the totality of addictions and to enhance her overall health. The decision      to begin Wellbutrin XL 150 mg orally daily may help achieve this goal, but      this choice does not address her abstinence from alcohol.
• Additionally, it should be      noted that although Mrs. Perez reports that she has been avoiding the      casino secondary to her fear that she will drink, this “fear” has not      actually treated her gambling addiction. This particular addiction has      resulted in considerable personal financial cost to Ms. Perez. Mrs. Perez      needs to be referred to a counselor who specializes in the treatment of      gambling disorder, and she should also be encouraged to establish herself      with a local chapter of Gamblers Anonymous.
• Examine Case Study: A      Puerto Rican Woman With Comorbid Addiction. You will be asked to make      three decisions concerning the medication to prescribe to this client. Be      sure to consider factors that might impact the client’s pharmacokinetic      and pharmacodynamic processes.
• At each decision point stop to      complete the following:
• Decision #1
• Which decision did you select?
• Why did you select this      decision? Support your response with evidence and references to the      Learning Resources.
• What were you hoping to achieve      by making this decision? Support your response with evidence and      references to the Learning Resources.
• Explain any difference between      what you expected to achieve with Decision #1 and the results of the      decision. Why were they different?
• Decision #2
• Why did you select this      decision? Support your response with evidence and references to the      Learning Resources.
• What were you hoping to achieve      by making this decision? Support your response with evidence and      references to the Learning Resources.
• Explain any difference between      what you expected to achieve with Decision #2 and the results of the      decision. Why were they different?
• Decision #3
• Why did you select this      decision? Support your response with evidence and references to the      Learning Resources.
• What were you hoping to achieve      by making this decision? Support your response with evidence and      references to the Learning Resources.
• Explain any difference between      what you expected to achieve with Decision #3 and the results of the      decision. Why were they different?

edit this or redo other assignment.

Assessing and Treating Clients with Impulsivity, Compulsivity and Addiction 

Pharmacotherapy practice to treating substance use disorders is often referred to as medication assisted treatment (MAT) (Sharp et al., 2018). In this practice, specific medications approved by Federal Drug Administration (FDA) are used in combination with counseling and behavioral therapies in treatment of a substance use disorder (Sharp et al, 2018) Medications can reduce the cravings and other symptoms associated with withdrawal from a substance by occupying receptors in the brain associated with using that drug (agonists or partial agonists), block the rewarding sensation that comes with using a substance (antagonists), or induce negative feelings when a substance is taken ( SAMHSA, 2016). MAT has been primarily used for the treatment of opioid use disorder but is also used for alcohol use disorder and the treatment of some other substance use disorders. This paper focuses on pharmacotherapy approaches to treatment of alcohol use disorder, gambling disorder and smoking addiction in a 53 year- old female of Puerto origin.

Case Scenario

Decision Number One

Naltraxone (Vivitrol) injection, 380 mg intramuscularly in gluteal region every four weeks.

Rationale: Pharmacotherapy should be used in patients with alcohol use disorder who have current, heavy use and ongoing risk for consequences from use, motivated to reduce alcohol intake and do not have medical contraindications to the individual drug choice (SAMHSA, 2016). As the 53 year-old female has acknowledged that she has a drinking problem and has tried psychosocial approach with alcoholic anonymous(AA) without success, adding medication such as naltrexone would be warranted as next step. In random clinical trials (RCTs) naltrexone medication has been shown to reduce heavy drinking and enhance the likelihood of abstinence ( Garbutt et al.,  2014)

Naltraxone is mu opioid receptor antagonist, can be in form of oral ( Revia) and injection( Vivitrol) ( Stahl, 2017). Naltraxone is FDA approved to treat alcohol dependence, blockade of effects of exogenously administered opioids (oral) and prevention of relapse to opioid dependence (Stahl, 2017).  Naltrexone reduces alcohol consumption through modulation of opioid systems, thereby reducing the reinforcing effects of alcohol and opioids (cravings, rewarding effects). Moreover, naltrexone also modifies the hypothalamic-pituitary-adrenal axis to suppress ethanol consumption.

The recommended naltrexone injectable (vivitrol) suspension is 380mg and should be administered via intramuscular (IM)injection to the gluteal area using the provided 1.5 inch 20-gauge needle(Drugs.com, 2017).  Vivitrol is extensively metabolized in humans, and elimination half-life of naltrexone via injection is 5–10 days (Drugs. com, 2017) Common side effects of naltrexone are nausea, headache, and dizziness, joint or muscle pain which subside with continued use. Special considerations include that vivitrol should not be given to patients taking opioids, and if opioids are required to treat pain, naltrexone should be discontinued. Naltrexone is contraindicated in acute hepatitis or liver failure.

The advantage usage is that naltrexone can be initiated while the individual is still drinking (Canidate et al., 2017) This allows treatment for alcohol use disorder to be provided in community-based practice at the point of maximum crisis without the need for enforced abstinence or detoxification, thus beneficial for the client. Additionally, depot preparations of naltrexone may improve adherence by reducing the frequency of medication administration from daily to monthly and by achieving a steady therapeutic level of medication, thus avoiding peak effects that can exacerbate adverse events.

The reason I did not select disulfiram (Antabuse) which by intent leads to adverse effects ( nausea, vomiting, metallic taste, tachycardia) when combined with alcohol intake, was that it  should only be used by abstinent patients in the context of treatment intended to maintain abstinence. In regards of Acamprosate, I did not select the medication because research indicates that Acamprosate should be used once abstinence is achieved (Yahn, Witterson, & Olive, 2013).

The main goal of prescribing medication for treatment for alcohol use disorder is abstinence, which remains a primary treatment focus. However, decrease of heavy drinking can be accepted as an alternative treatment goal, especially if unwanted risks (health, social and financial) are reduced.

The client returns four weeks after the injections, she has been sober since receiving injection, she denies any side effects from medications. The main chief complaint is gambling, but client is also concerned about her smoking and anxiety.

Decision Two

Refer to a Counselor for Gambling Issues 

Rationale:  Several different types of therapy are used to treat gambling disorder, including cognitive behavior therapy, psychodynamic therapy, group therapy and family therapy (American Psychiatric Association, 2016) As recent, there is no FDA approved pharmacotherapy for gambling disorder. But, pharmacotherapy approaches for problem gambling can be effective when directed toward the patient’s comorbid psychiatric condition such as bipolar disorder, obsessive compulsive disorder(OCD), and substance abuse.

The client was concerned about her smoking and appeared to be motivated to stop smoking, hence adding medication to assist her to quit would have been a reasonable approach to avoid health complications (e.g cardiovascular, pulmonary) associated with smoking. However, I did not select the answer as the starting dosage (Varenicline 1mg PO BID) was slightly higher than recommended starting dose. Initial 0.5 mg/day; after 3 days increase to 1 mg/day in two divided doses; after 4 days can increase to 2 mg/day in two divided dose(Stahl, 2017) . Starting at a higher would have increased the possibilities of adverse effects such nausea, vomiting and even agitation.

Adding Diazepam (Valium) would not be a good option, as Valium is an addictive benzodiazepine with longer-lasting effects than other drugs in its class. In the light of the client’s history substance use disorder and addiction, adding another addictive substance such as valium would cause more harm.

The client returns in four weeks, reports that anxiety has gone. Client reports not liking the therapist, but she has joined gambling anonymous group.

Decision Number Three

Explore the issue that Mrs Lopez is having with her counselor, and encourage her to continue attending Gamblers Anonymous meetings

Rationale: Despite that Mrs. Lopez did not have a good relationship with the counselor, but she remained committed to fighting her addiction by joining Gamblers Anonymous group. Still, counseling remains the main approach in gambling addiction treatment, hence exploring the issues that Mrs. Lopez had with counselor would help to guide the next step in treatment. Also, smoking cessation needs to be explored at this time. Assessing the client’s willingness to quit is the first step as smokers differ in their readiness to change their tobacco use (Niaura, 2017). Understanding the smokers’ perspectives is essential to providing useful assistance.

Ethical and Legal Implications in Prescribing Medications to Treat Substance Use Disorders.

In order to optimize care of clients with substance use disorder, health professionals are encouraged to learn  and appropriately use routine screening techniques, clinical laboratory tests, brief interventions, and treatment referrals ( Garbutt, 2014). Using screening tools such as CAGE Questionnaire for alcohol use dependence, would be ideal in guiding treatment approach. Additionally, client’s autonomy and confidentiality must be maintained before prescribing medications to treat an addiction. When a legal or medical obligation exists for  a health professional to test clients for substance use disorder, there is an ethical responsibility to notify clients of this testing and make a reasonable effort to obtain informed consent ( Garbutt, 2014)

References

American Psychiatric Association. (2016). What Is Gambling Disorder? Retrieved from /orders/www.psychiatry.org/patients-families/gambling-disorder/what-is-gambling-disorder

Canidate, S. S., Carnaby, G. D., Cook, C. L., & Cook, R. L. (2017). A Systematic Review of Naltrexone for Attenuating Alcohol Consumption in Women with Alcohol Use Disorders. Alcoholism: Clinical and Experimental Research, 41(3), 466-472. Retrieved from /orders/web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/pdfviewer/pdfviewer?vid=14&sid=183cffb8-9da8-48b2-a1b7-66c14f735856%40sessionmgr101

Drugs.com. (2017). Vivitrol Dosage Guide – Drugs.com. Retrieved from /orders/www.drugs.com/dosage/vivitrol.html

Garbutt, J. C., Greenblatt, A. M., West, S. L., Morgan, L. C., Kampov-Polevoy, A., Jordan, H. S., & Bobashev, G. V. (2014). Clinical and biological moderators of response to naltrexone in alcohol dependence: a systematic review of the evidence. Addiction, 109(8), 1274-1284. Retrieved from /orders/web-a-ebscohost-com.ezp.waldenulibrary.org/ehost/pdfviewer/pdfviewer?vid=8&sid=41ca863e-175d-45ae-ba36-43317c3c58e5%40sessionmgr4008

Niaura, R. (2017). Learning From Our Failures in Smoking Cessation Research | Nicotine & Tobacco Research | Oxford Academic. Retrieved from /orders/academic.oup.com/ntr/article/19/8/889/3888613

SAMHSA. (2016). Treatments for Substance Use Disorders | SAMHSA – Substance Abuse and Mental Health Services Administration. Retrieved from /orders/www.samhsa.gov/treatment/substance-use-disorders

Sharp, A., Jones, A., Sherwood, J., Kutsa, O., Honermann, B., & Millett, G. (2018). Impact of Medicaid Expansion on Access to Opioid Analgesic Medications and Medication-Assisted Treatment. American Journal of Public Health, 108(5), 642-648. Retrieved from /orders/web-a-ebscohost-com.ezp.waldenulibrary.org/ehost/pdfviewer/pdfviewer?vid=5&sid=21e9426c-0afa-475e-9a9a-e1872d98830d%40sess

Stahl, S. M. (2017). Essential psychopharmacology: The prescriber’s guide : antipsychotics and mood stabilizers. Cambridge: Cambridge University Press.

Yahn, S. L., Watterson, L. R., & Olive, M. F. (2013). Safety and Efficacy of Acamprosate for the Treatment of Alcohol Dependence. Substance Abuse: Research and Treatment, 7. Retrieved from /orders/www.ncbi.nlm.nih.gov/pmc/articles/PMC3565569/

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PICOT STATEMENT

The first step of the EBP process is to develop a question from the nursing practice problem of interest.

Select a practice problem of interest to use as the focus of your research.

Start with the patient and identify the clinical problems or issues that arise from clinical care.

Following the PICOT format, write a PICOT statement in your selected practice problem area of interest, which is applicable to your proposed capstone project.

The PICOT statement will provide a framework for your capstone project (the project students must complete during their final course in the RN-BSN program of study).

Conduct a literature search to locate research articles focused on your selected practice problem of interest. This literature search should include both quantitative and qualitative peer-reviewed research articles to support your practice problem.

Select six peer-reviewed research articles which will be utilized through the next 5 weeks as reference sources. Be sure that some of the articles use qualitative research and that some use quantitative research. Create a reference list in which the six articles are listed. Beneath each reference include the article’s abstract. The completed assignment should have a title page and a reference list with abstracts.

Suggestions for locating qualitative and quantitative research articles from credible sources:

1. Use a library database such as CINAHL Complete for your search.
2. Using the advanced search page check the box beside “Research Article” in the “Limit Your Results” section.
3. When setting up the search you can type your topic in the top box, then add quantitative or qualitative as a search term in one of the lower boxes. Research articles often are described as qualitative or quantitative.

To narrow/broaden your search, remove the words qualitative and quantitative and include words that narrow or broaden your main topic. For example: Diabetes and pediatric and dialysis. To determine what research design was used, review the abstract and the methods section of the article. The author will provide a description of data collection using qualitative or quantitative methods.

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.

Healthcare Information Technology Trends

Healthcare Information Technology Trends

Make sure it is in APA 7 format and at least 3-4 paragraphs and references.

Throughout history, technological advancements have appeared for one purpose before finding applications elsewhere that lead to spikes in its usage and development. The internet, for example, was originally developed to share research before becoming a staple of work and entertainment. But technology—new and repurposed—will undoubtedly continue to be a driver of healthcare information. Informaticists often stay tuned to trends to monitor what the next new technology will be or how the next new idea for applying existing technology can benefit outcomes.

In this Discussion, you will reflect on your healthcare organization’s use of technology and offer a technology trend you observe in your environment.

To Prepare:

• Reflect on the Resources related to digital information tools and technologies.
• Consider your healthcare organization’s use of healthcare technologies to manage and distribute information.
• Reflect on current and potential future trends, such as use of social media and mobile applications/telehealth, Internet of Things (IoT)-enabled asset tracking, or expert systems/artificial intelligence, and how they may impact nursing practice and healthcare delivery.

By Day 3 of Week 6

Post a brief description of general healthcare technology trends, particularly related to data/information you have observed in use in your healthcare organization or nursing practice. Describe any potential challenges or risks that may be inherent in the technologies associated with these trends you described. Then, describe at least one potential benefit and one potential risk associated with data safety, legislation, and patient care for the technologies you described. Next, explain which healthcare technology trends you believe are most promising for impacting healthcare technology in nursing practice and explain why. Describe whether this promise will contribute to improvements in patient care outcomes, efficiencies, or data management. Be specific and provide examples.

By Day 6 of Week 6

Respond to at least two of your colleagues* on two different days, offering additional/alternative ideas regarding opportunities and risks related to the observations shared.

Click on the Reply button below to reveal the textbox for entering your message. Then click on the Submit button to post your message.

*Note: Throughout this program, your fellow students are referred to as colleagues.

Throughout history, technological advancements have appeared for one purpose before finding applications elsewhere that lead to spikes in its usage and development. The internet, for example, was originally developed to share research before becoming a staple of work and entertainment. But technology—new and repurposed—will undoubtedly continue to be a driver of healthcare information. Informaticists often stay tuned to trends to monitor what the next new technology will be or how the next new idea for applying existing technology can benefit outcomes.

In this Discussion, you will reflect on your healthcare organization’s use of technology and offer a technology trend you observe in your environment.

To Prepare:

• Reflect on the Resources related to digital information tools and technologies.
• Consider your healthcare organization’s use of healthcare technologies to manage and distribute information.
• Reflect on current and potential future trends, such as use of social media and mobile applications/telehealth, Internet of Things (IoT)-enabled asset tracking, or expert systems/artificial intelligence, and how they may impact nursing practice and healthcare delivery.

By Day 3 of Week 6

Post a brief description of general healthcare technology trends, particularly related to data/information you have observed in use in your healthcare organization or nursing practice. Describe any potential challenges or risks that may be inherent in the technologies associated with these trends you described. Then, describe at least one potential benefit and one potential risk associated with data safety, legislation, and patient care for the technologies you described. Next, explain which healthcare technology trends you believe are most promising for impacting healthcare technology in nursing practice and explain why. Describe whether this promise will contribute to improvements in patient care outcomes, efficiencies, or data management. Be specific and provide examples.

By Day 6 of Week 6

Respond to at least two of your colleagues* on two different days, offering additional/alternative ideas regarding opportunities and risks related to the observations shared.

Click on the Reply button below to reveal the textbox for entering your message. Then click on the Submit button to post your message.

*Note: Throughout this program, your fellow students are referred to as colleagues.

I will be adding two discussions that will need replies. At least 2-3 references each and 2 paragraphs also for each.

Mike’s  discussion

With the advent of high speed data and network interface with surging speeds, the introduction of the electronic health record system to the hospital network and the adoption of informatics into the health care sector, some of the noticeable technological trends fostered by the aforementioned developments includes but is not limited to the use of zoom calls for conferences and meetings, the use of information technology to offer opportunities in telephone or video medicine. “An electronic health record (EHR) is a digital version of a patient’s paper chart. EHRs are real-time, patient-centered records that make information available instantly and securely to authorized users. While an EHR does contain the medical and treatment histories of patients, an EHR system is built to go beyond standard clinical data collected in a provider’s office and can be inclusive of a broader view of a patient’s care.” (HealthIT.gov., 2018c)

Given the ease at which the health care sector thrives in the wake of technological and data advancement due to innovation and research, the infrastructures surrounding the smooth running of these innovative ideas are sometimes faced with challenges associated with their use. Some of the potential challenges associated with the use of these ground breaking innovations include but is not limited to adequate man power and staffing to man the system, monitor it and also do necessary repairs when the need arise, the problem of lack of an emergency back up should the primary system experience a problem requiring extensive repairs and or replacement, the need for data collection, inspection, interpretation and utilization presents with an issue if no qualified personnel is available to undertake the duties described above.

Given the premise of the ease of use and the need to pursue enhancement in technology and innovation with regards to the health care sector and patient care safety, one potential benefit associated with data safety, legislation and patient care is the ease at which a patient can get attended to by a physician or a mid level provider at the comfort of their home using either a tele conference approach or a video platform like zoom. The down side or potential risk concomitant with this mode of patient care is associated to cases that require the physical presence of a provider or a physician in cases of emergency where the situation requires a one on one attention as in the case of doing invasive procedures or extensive surgeries. “Telehealth is still a new and evolving technology; while the offsite interventions or contacts often lead to less time being wasted on non – care oriented task because of the efficiencies offered by the technology applications, its use must never be associated with less care.” (McGonigle, 2017, p361)

Following from the disruption in the normal work flow of the health care sector due to the COVID 19 pandemic, some of the health care technology trends I believe are most promising for inputting health care technology in nursing practice include the use of advancements in tele medicine which presents with advantages in no over head or staff to maintain, no rent or space to pay in the case of stand alone private clinics whose owners pay a premium to utilize an assigned space for their respective practices. Given our present global circumstance of COVID 19 pandemic, I will say for the time being, the use of zoom calls and advancements in tele medicine is the best alternative to a face to face contact with a patient, since quite a lot can be accomplished using a phone line and or a video call with the exception of limitations to cases that require invasive approach or emergency intervention like the need to intubate a patient. “In a connected care environment, more citizens are engaging in their health care through mobile apps and social media tools. Given this growing health care engagement, it is important for health care professionals to have the knowledge and skills to evaluate and recommend appropriate digital tools.” (Skiba, 2017)

References

HealthIT.gov. (2018c). What is an electronic health record (EHR)? Retrieved from 

            /orders/www.healthit.gov/faq/what-electronic-health-record-ehr

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

Skiba, D. (2017). Evaluation tools to appraise social media and mobile applications. Informatics, 4(3), 32–40. 

Dea’s Discussion

Main Post

Some of the healthcare technology trends that I have observed in my nursing practice are telehealth and electronic MAR. This electronic technology was created for providers to get information in real-time and it is only accessible to qualified staff. (HealthIT.gov, 2018c). We still paper chart at our detox, mental health hospital so these two technologies are used at work. We have only had electronic MARs for a few years but it does collect data that we use for clinical decisions. One of the challenges of the e-MAR is the lack of knowledge on how to use the system. This is more of a physician problem than a nursing problem although new nurses or PRN nurses who have never used the system or have not been trained enough on the system can find it challenging. When physicians do not know how to use the system correctly they typically put in orders wrong, especially when a patient is on a detox medication taper. This is dangerous because if you have a new nurse or a PRN nurse and a physician who does not know how to use the system, then medication errors can and do happen.

One benefit to the e-MAR is data safety. With the e-MAR, we can scan their armband or look a patient up by their name and date of birth. Once this information is entered by a nurse, the patient’s e-MAR profile comes up and this is where you can go over medications, allergies, or any other important information that needs to be verified. There are also risks when it comes to e-MARs. For example, data safety can be a concern. Even though technology has their patient’s data information as a priority, there are security and privacy issues. For example, how consent is obtained and patient trust plays a part in the safety of data. If trust is not kept, then patients may not be willing to give important information when seeking care (McGonigle & Mastrian, 2017 pp. 284-285).

Another benefit to e-MARs is due to legislation. There is legislation in place to protect patient information. The government uses the American Recovery and Reinvestment Act as legislation. It protects patients by addressing development, adoption, and implementation (McGonigle & Mastrian, 2017 p.149). A risk for data safety for the e-MAR is if a nurse leaves the computer up and on a patient’s profile. Another patient can easily see what is on the screen. This does not provide privacy for the patient. When you are done with the computer, you are supposed to log out of the patient’s file. This is one-way data is not safe.

Lastly, the benefit of having an e-MAR is patient care. The e-MAR allows staff to stay on task with medication distribution. The e-MAR lets the nurses know what medication is due and what the dose is. The e-MAR also provides safety to the patient. If the wrong medication is scanned the system does not allow the nurse to go any further. This allows the nurse to verify what she is scanning is correct. This provides safety in patient care. On the other hand, a risk to patient care is if the system does not have the right allergies put into the system and the wrong medication is given. Many of the patients that come into the hospital are not in the right mind at the time of admission. As a hospital, we rely on the data collected and entered into the system before they receive medications. Collecting data can be a risk to the patient which would lead to poor patient care.

In today’s world, many people in the community are taking responsibility for their healthcare and that is being done by using mobile apps and social media (Skiba, 2017). These technology trends are most promising for impacting nursing practice and impacting patient outcomes. Mobile apps and social media impact nursing practice because they provide a tool to help in educating patients. For example, as you educate your patients, you can guide them to the Center for Disease Control and Prevention (CDC) for further information. Many times, patients do not have questions until a later time and this will allow them to take initiative in their care. These trending technologies are a great tool for nurses to utilize in their practice and will continue to impact their nursing practice. Technology is not going anywhere soon so as nurses, we need to embrace these tools and use them to our advantage. When nurses provide reliable resources, the patients will be less like to surf the web for the answers to their health questions. There are a lot of mobile apps and social media outlets that can lead patients down the wrong path. As nurses, it is our job to know what apps and social media outlets will lead to improving patient outcomes. That being said, it seems that technology trends, the impact of nursing practice, and improving patient outcomes are intertwined.

References

HealthIT.gov. (2018c). What is an electronic health record (EHR)? Retrieved from /orders/www.healthit.gov/faq/what-electronic-health-record-ehr

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

Skiba, D. (2017). Evaluation tools to appraise social media and mobile applications. Informatics, 4(3), 32-40.

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Nursing Assessment

Assessment

Assessment

Week 2/Discussion 2/ my post

 While interviewing and examining a 17-year-old male, you discover a white patch on his buccal mucosa and slanting palpebral fissures in his eyes. He also states during the interview that he plays baseball and is hoping to earn an athletic scholarship to college.

When the 17-year-old boy says he plays baseball and would like to get an athletic scholarship for college, we can suspect that he spends a lot of time in the field, exposed his self to sun and has been exposed to smokeless tobacco which is prevalent in the baseball sport. An increased use of smokeless tobacco use in sports, mainly in baseball is been reported  in 2016 (Jarvis, 2016). ), “Leukoplakia is chalky white, thick raised patch with well-defined borders.”  This is attached firmly to the buccal mucosa, even if you scraping hard it will not come off. You can also see it in individual who are heavily tobacco user as well as alcohol (Jarvis, 2016). White patches in the mouth also called excessive Candida you may see it in patient with weak immune system, steroid inhaler user, and HIV infection, use of broad-spectrum antibiotics, leukemia, and malnutrition.Slight upward or downward slanting of palpebral fissures normally occurs on a familial basis or in groups such as people of Asian descent. So in this case the slating palpable fissures in his eyes found during the assessment can be suspect that this patient is Asian or is an Asian descent. In non-Asians, the palpebral fissures are horizontal (Jarvis, 2008). Usually when narrowed, upward slanted palpebral fissures are present it could be indication of Down syndrome. In this case this 17-year-old boy should have been ruled out earlier than the age of 17. I would conduct a cranial nerve examination using Snellen chart test for visual acuity to see if there are any deficits in the optic nerve. Patients near vision could also be assessing (Jarvis, 2016).  An ophthalmoscope consult should be place to “examine the ocular fundus to determine the color, size, and shape of the optic disc” (Jarvis, 2016, p. 644). I will also get order for a CT scan to rule out ICP  if during retina exam  patient’s margins of the optic disc become blurred and indistinct. I would first want to initially suspect that the patient has papilledema, also known as a choked disc which is an increase in cranial pressure (ICP) (Jarvis, 2016).

As a Health care professionals we are educated and trained on strategies to teach patients and family members about this condition. First and foremost, would be for the patient to have genetic testing done to confirm a Down syndrome diagnosed. If the test results are positive, then the health care professional can provide the family and patient with the appropriate resources and specialty professionals to aid them in coping with their new diagnosis. The one most important thing that a health care professional can do is to empower the patient and family. This can be accomplished by carrying out interventions in a manner in which family members acquire a sense of control over their own efforts to meet their needs. Health care professionals can also enable families by creating opportunities for family members to become more competent and self-sustaining with respect to their abilities to mobilize their social networks to get their needs met and attain desired goals (Cohen, 2013). It is important to also let the patient know that his career of playing baseball may be limited in college may grossing diminish if other manifestations of condition sets in later in life.

Some special considerations that can help to educate the patient and family on health promotion and disease intervention would include continuous monitoring measures, including yearly audiologic assessment and yearly ophthalmologic assessment, ongoing management of manifestation of the disorder and related conditions, as well as discussion of issues identified with the move into adulthood. If it were discovered that the patient has developed the habit of using smokeless tobacco, I would educate him on the harmful effects of smokeless tobacco such as the increase risk for cancer, and encourage him to seek out measures to quit.  I would also remind him that at the age of 17 it is illegal to obtain to tobacco products and that he could jeopardize his chances of playing baseball on the collegiate level via an athletic scholarship if caught breaking the law. Furthermore, I would encourage this patient to seek alternative measure to quit smoking, and pick up healthier habits like chewing sugar free gum in place of using smokeless tobacco.

References

Cohen, W. I. (2003). Health Care Guidelines for Individuals with Down Syndrome-1999 Revision. Down Syndrome, 237-245. doi:10.1002/0471227579.ch17

Jarvis, C. (2016). Physical examination & health assessment. (7th ed.). St. Louis: Elsevier.

Jarvis, C. (2008). Pocket companion for physical examination and health assessment. (5thed.).  St. Louis:  Elsevier.

PROFESSOR QUESTION/NEEDS TO ANSWER TO PROFESSOR BASE ON MY POST.

For our 1st pt-

The diagnosis of whiplash is a key differential diagnosis for our first patient. When we consider the patients complaints; HA, decreased ROM in the neck, vertigo, loss of hearing to one ear, sweating and uncontrollable eye movements, along with the recent possible mechanism of injury; the MVA whiplash does fit a possible diagnosis for this patient. When we think of the causes of whiplash, we think of a force strong enough to whip the patients neck backward and forward, placing a great deal of stress on the neck muscles and ligaments. What additional differential diagnosis is appropriate for our first patient, based on the S/S?

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Medic Case Study

I need this in next 12 hours.

Case Study ► Peter Smith is a 73-year-old male with mild Type 2 diabetes. He states that he has needed to urinate more frequently during the last 2 weeks, and he feels a burning sensation when he urinates. He has also been very tired lately. Based on the vital signs you measured and Peter’s current complaints, the physician ordered a fasting blood glucose and a urinalysis.

What is the likely diagnosis for Mr. Smith?
Why did the physician order both a urinalysis and a blood glucose test?
Why might Mr. Smith’s vital signs show that his temperature is slightly elevated?
Based on the laboratory test results, the physician prescribed an antibiotic for Mr. Smith. What can you advise Mr. Smith to do in addition to taking the antibiotic as prescribed?

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Technology Proposal Project

Module 4: Technology Project Proposal

Submit the completed assignment by 11:59 PM, Sunday of Module 4.

Overview

A fundamental aspect of nursing informatics is project implementations based on technology for patient care problems. The American Nurses Association (ANA) Scope and Standards of Nursing Informatics Practice requires the Nurse Informaticist to propose, implement, and evaluate technological advances for quality patient care. The Quality and Safety Education for Nursing’s (QSEN) pre-licensure Informatics competencies relate to how informatics supports safe, quality patient care through the following:

· Value nurses’ involvement in design, selection, implementation, and evaluation of information technologies to support patient care

· Describe examples of how technology and information management are related to the quality and safety of patient care

· Apply technology and information management tools to support safe processes of care

For this assignment, you will develop a proposal for a new technology that is currently not being used in your area of nursing practice. Keep in mind that technology has some form of electronic component to it for this paper.

Starting with the need, identify why the need exists for the new technology. What data is collected that tells you a problem exists? How will this technology answer the problem? Provide an analysis of the current situation and potential opportunity for improving patient care. With any new technology project, there must be stakeholder identification, an identification of quality indicators, projected benefits, consideration for training, and evaluation of outcomes.

Write a 6-10 page formal APA paper that describes the new technology following the directions below. This does not include title page and references. The 6-10 range allows you to expand or contract your paper and gives you some leeway on the total number of pages.

The purpose of this assignment is to encourage a depth and breadth of understanding about new technology and the impact on patient care. This assignment allows insight into the many facets of bringing about change from inception to evaluation.

This assignment is 20 points, or 20% of your final grade.

Directions

1. The Technology Proposal Project is a formal paper so plan accordingly. Use section headers (Background of Problem, Technology, Quality, Stakeholders, Evaluation and Conclusion). Please keep in mind that the following is to be used as a guide. You still need to demonstrate original and critical thinking on the topics.

NUR 451 Nursing Informatics

1

2. Provide a background on the new technology. This should include one to two pages that provides a general understanding of the problem, in a global sense, that the proposed technology could address. Include:

a. Context for the problem. Consider the following questions when writing this section: What is the problem for health care? How do you know it is a problem? What data is currently collected that demonstrates a problem exists? For example, you might discuss how the Centers for Medicare and Medicaid will no longer reimburse for specific processes of care or patient outcomes (falls, pressure ulcers, etc.). The data should relate back to the problem you identified with the technological solution. In a later section you will provide specific rates for your area of practice. Here, you will provide national rates or incidence, if available.

b. You should have a minimum of two peer-reviewed articles that show that the problem exists in health care.

3. Introduce the proposed technology. This should include 1-2 pages that proposes the technology using the following to guide your writing:

a. Provide a brief background on the technology to include what it is and what it does. This section should answer the question, why is this technology important to fix the identified problem?

b. Provide a context for the technology. For example, perform a literature search on error rates and glucometers or check the manufacturer’s fact sheet for research that supports the need for the new glucometer. This allows an understanding of the broader need for changes to support the new technology.

c. Include a minimum of 3 peer-reviewed references (different than the ones used for the background section) that relate to the technology or the need for the technology. For example, look for evidence that shows the technology has fixed the problem in other facilities.

4. Identify the quality impacts of the new technology. This section is the selling point for your project and should include 1-2 pages on how the technology can improve the quality and safety of patient care that is specific to your area of practice. Use the following to help guide your writing:

a. What specific process of care or quality patient care outcomes are affected by the proposed technology? For example, your technology may be a new type of compression stocking that uses biofeedback. The quality indicator would be your specific hospital’s pressure ulcer or venous thromboembolism rates.

b. How does the technology promote patient safety? Provide a clear and insightful paragraph regarding patient safety.

5. Identify the stakeholders who must be included in any decisions regarding the proposed technology. This section should be 1 page or about 2 paragraphs. Provide a critical analysis of who should be included, the role in the organization, and a rationale for their inclusion. When writing this section, consider who is affected by your project? Who needs to be involved in the buy-in, use, purchase, upkeep, management, training, and evaluation of the technology? This may include technical support, nurses from specific areas, managers,

information technology, biomed, central supply, pharmacists, physicians, nursing assistants, unit secretaries, etc. Consider the following questions while writing this section:

a. How does the stakeholder’s support influence the success of the project? Who are the primary stakeholders? Why would you include them? How could you secure their buy-in for the project? How will they be included in implementing the technology?

6. Describe an evaluation plan for the technology. This section should be 1-3 pages. Include a data collection plan that details who will collect data that reflects the success or failure of the technology.

a. Who should be responsible for evaluating the effectiveness of the technology? How will the data be collected? Will there be a pre- and post-survey or data collection? Would you include a pilot program or test the change first? What information would be collected? Where should the evaluation be disseminated? The plan should be something that is feasible to put into practice.

7. Conclusion that summarizes the main points of the paper

8. Submit a 6-10 page (not counting references and title page) APA paper that addresses the above areas. Provide at least 5 references no older than 6 years. Follow the rubric for details on grading.

Grading Rubric

Use this rubric to guide your work on Assignment #3:

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Benchmark – Community Teaching Plan: Community Presentation

Based on the feedback offered by the provider, identify the best approach for teaching. Prepare a presentation based on the Teaching Work Plan and present the information to your community.

Options for Delivery

Select one of the following options for delivery and prepare the applicable presentation:

1. PowerPoint presentation – no more than 30 minutes
2. Pamphlet presentation – 1 to 2 pages
3. Poster presentation

Selection of Community Setting

These are considered appropriate community settings. Choose one of the following:

1. Public health clinic
2. Community health center
3. Long-term care facility
4. Transitional care facility
5. Home health center
6. University/School health center
7. Church community
8. Adult/Child care center

Community Teaching Experience Approval Form

Before presenting information to the community, seek approval from an agency administrator or representative using the “Community Teaching Experience Approval Form.” Submit this form as directed in the Community Teaching Experience Approval assignment drop box.

General Requirements

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

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

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Critical Appraisal Of Jean Watson’s Theory Of Human Caring 2

Watson’s Theory Of Human Caring 2

Watson’s Theory Of Human Caring 2

Jean Watson’s Theory of Human Caring is a conceptual thread in the USU College of Nursing’s curriculum framework. The purpose of this assignment is to offer students the opportunity to be exposed to Human Caring Science while providing students with the skills of critical appraisal of evidence.

1. Students will select one nursing research article that focuses on a study that used Jean Watson’s Theory of Human Caring as a theoretical framework.
2. Students should use as a guide, an appropriate Rapid Critical Appraisal Checklist found in Melnyk & Fineout-Overholt (2019; pp. 708-722).
3. The critiques are to be informal, although correct grammar, spelling, etc., are expected. The critique should include a brief description of the study that was reviewed and should address elements of the study relevant to critique.
4. Students will provide a written critique on a critical appraisal of the elements relevant to the nature of the research study such as type of study, design, quality of the study; and rationale, as well as implications for practice and further research and/or evaluation.

The grade will be based on accuracy, level of content and structure of the document.

please use these Examples of research articles incorporating Jean Watson’s theory  in USU online library:

Durgun Ozan, Y., & Okumus, H. (2017). Effects of nursing care based on

Watson’s theory of human caring on anxiety, distress, and coping when

infertility treatment fails: A randomized controlled trial. Journal of Caring

Sciences, 6(2), 95-109.

Rossillao, K. (2018).  Caritas education: Theory to practice…2018

National Teaching Institute research abstracts presented at the AACN

National Teaching Institute, Boston, Massachusetts, May 21-24, 2018.

American Journal of Critical Care, 27(3), e 14 – e15.

Expectations

• Length: 4-5 pages (including title and reference pages)
• Format: Formal paper in APA 6th ed format
• Citations: If used (not required) cite references according to APA 7th ed.

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Intervention And Ethical Decision-Making

5 DQ 2

Over the ten years I have been a Registered Nurse, I have daily interactions with patients that both share and have a different worldview than I do. I find myself extremely lucky to work in a multicultural environment with co-workers, staff and patients that have many different religious cultural and overall worldviews. This environment has allowed me to understand other cultures a lot better, while being able to provide high quality care. An individual’s worldview of spirituality and faith affects, shapes impact their perspective (Grand Canyon University, 2018).

I feel that my strengths in facilitating spiritual care for patients with different worldviews than mine include being open minded, understanding and being compassionate. It is important to educate patients and families on the importance of certain medications, treatments or plans, however ultimately the patient always has the right to refuse. It is our job to provide the best education and information that we possibly can however, the patient and family has the right to choose, and it is our ultimate duty to respect their decision. My weakness in facilitating spiritual care for patients include not knowing every different spiritual view. Every day, I feel I learn something new about what others believe in or value. I find asking culturally appropriate questions are truly helpful. For the most part, people are very willing to share and open up about their beliefs and why and what they value in their lives. It is also important to assess the patient and family for spiritual needs which can include dietary or medical restrictions. At my hospital, this assessment is done upon admission and can be a very helpful tool.

For me personally, the person who would have the final say in terms of ethical decision-making and interventions in the event of a difficult situation would be my next of kin. At the moment, this role would go to my husband. I have found that regardless of cultures or religion, every family or individual is unique and has specific needs that are distinctive only to that person. It is essential that the nurse knows the needs of the individual patient in order to provide the best care possible.

When it comes to facilitating spiritual care for patients with worldviews different from your own, what are your strengths and weaknesses? If you were the patient, who would have the final say in terms of ethical decision-making and intervention in the event of a difficult situation?

Using 200-300 words APA format with at least two references. Sources must be published within the last 5 years.

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