Assignment: Lab Assignment: Assessing The Genitalia And Rectum

Assignment: Lab Assignment: Assessing The Genitalia And Rectum

Assignment: Lab Assignment: Assessing The Genitalia And Rectum

Assignment: Lab Assignment: Assessing The Genitalia And Rectum

For this assignment, you will analyze an Episodic note case study that describes abnormal findings in patients seen in a clinical setting. You will consider what history should be collected from the patients, as well as which physical exams and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible conditions. Please remember to pretend that this is an actual patient and gives as much detail as possible!
Week 10: Special Examinations—Breast, Genital, Prostate, and Rectal GENITALIA ASSESSMENT
Subjective: • CC: “I have bumps on my bottom that I want to have checked out.” • HPI: AB, a 21-year-old WF college student reports to your clinic with external bumps on her genital area. She states the bumps are painless and feel rough. She states she is sexually active and has had more than one partner during the past year. Her initial sexual contact occurred at age 18. She reports no abnormal vaginal discharge. She is unsure how long the bumps have been there but noticed them about a week ago. Her last Pap smear exam was 3 years ago, and no dysplasia was found; the exam results were normal. She reports one sexually transmitted infection (chlamydia) about 2 years ago. She completed the treatment for chlamydia as prescribed.
• PMH: Asthma •
Medications: Symbicort 160/4.5mcg •
Allergies: NKDA •
FH: No hx of breast or cervical cancer, Father hx HTN, Mother hx HTN, GERD •
Social: Denies tobacco use; occasional etoh, married, 3 children (1 girl, 2 boys)
Objective: • VS: Temp 98.6; BP 120/86; RR 16; P 92; HT 5’10”; WT 169lbs •
Heart: RRR, no murmurs • Lungs: CTA, chest wall symmetrical • Genital: Normal female hair pattern distribution; no masses or swelling. Urethral meatus intact without erythema or discharge. Perineum intact. Vaginal mucosa pink and moist with rugae present, pos for firm, round, small, painless ulcer noted on external labia • Abd: soft, normoactive bowel sounds, neg rebound, neg murphy’s, negMcBurney •
Diagnostics: HSV specimen obtained
Assessment: • Chancre
PLAN: This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.

• Based on the Episodic note case study:
  • Review this week’s Learning Resources, and consider the insights they provide about the case study. Refer to Chapter 3 of the Sullivan resource to guide you as you complete your Lab Assignment.
  • Search the Walden library or the Internet for evidence-based resources to support your answers to the questions provided.
  • Consider what history would be necessary to collect from the patient in the case study.
  • Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
  • Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.

The Lab Assignment

Using evidence-based resources from your search, answer the following questions and support your answers using current evidence from the literature.

• Analyze the subjective portion of the note. List additional information that should be included in the documentation.
• Analyze the objective portion of the note. List additional information that should be included in the documentation.
• Is the assessment supported by the subjective and objective information? Why or why not?
• Would diagnostics be appropriate for this case, and how would the results be used to make a diagnosis?
• Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature.

Rubric:
With regard to the SOAP note case study provided and using evidence-based resources from your search, answer the following questions and support your answers using current evidence from the literature:
·   Analyze the subjective portion of the note. List additional information that should be included in the documentation. 
Analyze the objective portion of the note. List additional information that should be included in the documentation. 
·  Is the assessment supported by the subjective and objective information? Why or why not? 
 What diagnostic tests would be appropriate for this case, and how would the results be used to make a diagnosis? 
 Would you reject or accept the current diagnosis? Why or why not?
·   Identify three possible conditions that may be considered as a differenial diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature. 
 Would you reject or accept the current diagnosis? Why or why not?
·   Identify three possible conditions that may be considered as a differenial diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature. 
Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation 
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list.

NURS 6050: Policy and Advocacy for Improving Population Health

NURS 6050: Policy and Advocacy for Improving Population Health

NURS 6050: Policy and Advocacy for Improving Population Health

NURS 6050: Policy and Advocacy for Improving Population Health

NURS 6050: Policy and Advocacy for Improving Population Health

NURS 6050: Policy and Advocacy for Improving Population Health

Week3 Discuss 6050

Melissa Hinkhouse
Week 3-Original Post
Walden University
In 2010 The Affordable Care Act (ACA) was enacted; the hope was to expand access to medical care, make coverage more affordable, and decrease the number of people without medical insurance. The Affordable Care Act (ACA) expanded and improved health insurance coverage in two primary ways. First, the number of individuals receiving insurance coverage grown by increasing access to coverage through Medicaid expansion and providing subsidies to purchase private insurance on the health care exchanges. Second, the ACA upgraded the quality and scope of coverage by improving benefit design, including implementing the essential health benefits (Willison & Singer, 2017). People who did not have coverage through their employer or Medicaid were required to purchase insurance through the Marketplace. The Marketplace was created as a one-stop-shop for people to view multiple plans and purchase insurance. Just because you have access to health care insurance does not mean you are going to receive quality health care (Teitelbaum, 2018).
Both parties have asked that the ACA be repealed or replaced for multiple reasons. Every Republican presidential candidate for 2016 has called for the repeal of the ACA. Some, but not all, Republican candidates have proposed health policies that they would like to put in place after repeal, but there is no broad agreement on a replacement for the ACA (Buettgens & Blumberg, 2016). The federal government would spend $90.9 billion less on health care for the nonelderly in 2021 if the ACA were repealed (Buettgens & Blumberg, 2016). State governments as a whole would spend $5.2 billion more on health care for the nonelderly in 2021 if the ACA were repealed (Buettgens & Blumberg, 2016). Healthcare is a priority to many Americans for obvious reasons; it was more costly for those with preexisting conditions before the ACA to obtain Medical Insurance. With the ACA the income guidelines for Medicaid where changed so additional people qualified that didn’t prior. As a Behavioral Health Nurse, I am a fan of anyone and everyone having access to Healthcare Services. I have seen to many times my patient not have the money for their medications because insurance was canceled so they go off their medications, they become unstable and ended up in the Emergency Department and admitted Inpatient, costing more money, hurting themselves and their loved ones.
Politicians are aware that election time is the best time to play the tug of war game with the heavy ticket items to capture someone votes. Republicans ran hard on promises to get rid of the law in every election since it passed in 2010. But when the GOP finally got control of the House, the Senate and the White House in 2017, Republicans found they could not reach agreement on how to “repeal and replace” the law (Kaiser Health News, 2018). And political strategists say that, when the dust clears after voting, the numbers in the Senate may not be much different, so change could be hard there too. Republicans, even with a small majority last year, could not pass a repeal bill there (Kaiser Health News, 2018). When it comes to voting, it is hard for some to know the different facts from fiction, political talk, and actual context that can be followed through. It can be frustrating but needed to research why a candidate is saying something and if he has the means to make a change. It can be time consuming to research through the political propaganda, but worth it for the issues at hand.
References
Buettgens, M., Blumberg, L. J., Holahan, J., & Ndwandwe, S. (2016, June). The Cost of
ACA Repeal. Urban Institute | Social and Economic Policy Research. /orders/www.urban.org/sites/default/files/publication/81296/2000806-The-Cost-of-the-ACA-Repeal.pdf
Kaiser Health News. (2018, November 2). The election’s impact on health care: Some bellwether
races to watch. Health Leaders. /orders/www.healthleadersmedia.com/elections-impact-health-care-some-bellwether-races-watch
Laureate Education (Producer). (2018). Introduction to Health Policy and Law with Joel
 Teitelbaum [Video file]. Baltimore, MD: Author.
Willison, C. E., & Singer, P. M. (2017, August). Repealing the Affordable Care Act essential
health benefits: Threats and obstacles. PubMed Central (PMC). /orders/www.ncbi.nlm.nih.gov/pmc/articles/PMC5508159/
Lilia Roy
Discussion Week 3 
Repeal or Replace the Affordable Care Act
Affordable care has been a topic that has a long history of wishing that we can all have medical insurance and be able to have great doctors and excellent services for very little money.  The cost of Medicaid in the United States continues to rise every day.  Many people cannot afford not to have medical insurance, but many cannot afford medical insurance.  The fact that there are so many people that live in poverty lines and must accommodate the use of medical insurance is either by state services such as Medicaid, which has been a good thing since 1960 (Milstead & Short, 2019).  The Obama Administration has tried to implement a reform of insurance for the past eight years of his presidency. Still, many think it was just an expansion to Medicaid services, which many people did not like the idea that they lost their doctors that they wanted.  He promised that people would keep the same plan and doctor, which he did not factor in that many doctors were not going to accept the proposal he offered.  Many doctors left their private sectors due because of this.  They were going to have to see more patients for less money. Another thing it put pressure on small businesses that they had to aid their employees to have medical insurance, which many can pick packages that were not good if they wanted the cost to below so they could stay in business.  Providing this insurance for employees created an extra expense for small companies, and many had to reduce their personal.  What studies saw it was that even people with insurance did not seek medical care which was not what they wanted to see
Politics plays a huge role in selling a need and targets the idea for elections and for them to win. The Obama administration sold the plan of care for all with no evidence data, which millions of Americans enrolled for insurance for the first time in history.  Obama stated that the republicans have not idea how to repeal the ACA with no plan to replace the health care issue (Obama, 2017).  The Trump administration has good intentions, but no plan on how to implement the ideas due to the people that will benefit is business and the wealthy that will not have a problem with the yearly cost of health care.  Trump wants to be able for people to choose their coverage, and some of the same things, such as preexisting medical care, will not be punished or pay more.  His goal is to create a patient health care system that promotes choice and quality (Glied & Jackson, 2017).   They also will keep kids covered until the age of 26, which they complete school.  Most of the repeal is going to cost billions of dollars to replace.  It is going to leave millions of people without insurance and health care.  It’s going to increase the national debt, and we all still have no clue how to fix it.  The idea of creating a socialist system of health care might work, but people that would lose their choice of care providers, doctors, hospitals, and patient care.  We are going to see the care that will diminish due to no incentive if a doctor sees three patients or ten per day he or she will be earning the same amount of money.  I see this in the Tricare system many providers do not perform the same volume of surgeries due to he is going to get the same amount of money he is not paid per case he is paid per salary.  I have both care systems I have Tricare, and I purchase my health care. I have both many people tell me why, but I have to.  My daughter has many needs that sometimes Tricare will not cover or will not have my choice of a doctor, so I prefer to have options for her due to she requires nothing but the best care for her Autism.  I do not want her just to see someone once a month. She needs individual attention to weekly providers such as speech pathology and occupational therapy.  I do not see anything resolved is such a huge debate of who is right and what is fair.
References
Glied, S., & Jackson, A. (2017). The future of the affordable care act and insurance coverage. American Journal of Public Health, 107(4), 538–540. Retrieved June 15, 2020, from /orders/doi.org/10.2105/ajph.2017.303665
Milstead, J. A., & Short, N. M. (2019). Health Policy and Politics (6th ed.). Jones and Barlett Learning books.
Obama, B. H. (2017). Repealing the ACA without a replacement—the risks to American health care. Obstetrical & Gynecological Survey, 72(5), 263–264. Retrieved June 15, 2020, from /orders/doi.org/10.1097/ogx.0000000000000447

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

W10 Assign 2: Assignment 2: National Organization of Nurse Practitioner Faculties (NONPF) Competencies

The Rubric is below. Add 3 in-text citations and references:- Assignment 2: National Organization of Nurse Practitioner Faculties (NONPF) Competencies
Nine broad areas of core competence that apply to all nurse practitioners, regardless of specialty or patient population focus. NONPF created the first set of Nurse Practitioner Competencies in 1990; the most recent updates were incorporated in 2017. This course was designed to prepare you to synthesize knowledge gained throughout the program and to apply each of the nine core competencies within your selected areas of practice and your representative communities.
The nine areas of competency are:
· Scientific Foundations
· Leadership
· Quality
· Practice Inquiry
· Technology and Information Literacy
· Policy
· Health Delivery System
· Ethics
· Independent Practice
To Prepare
· Review this week’s Learning Resources, focusing on the NONPF Core Competencies Content.
 
The Assignment
For each of the nine NONPF competencies,
· write one paragraph explaining how the program has prepared you to meet the competency (for a total of at least nine paragraphs).
· Then, propose how you plan to engage in social change in your community as a nurse practitioner.
· Finally, describe 1–2 legislative and/or advocacy activities in which your state nurse practitioner organization(s) are involved.
· Be specific and provide examples.
 

RUBRIC

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Learning Resources
 
Required Readings (click to expand/reduce)
American Nurses Credentialing Center. (n.d.). Psychiatric-mental health nurse practitioner (across the lifespan) certification (PMHNP-BC).
/orders/www.nursingworld.org/our-certifications/psychiatric-mental-health-nurse-practitioner/
· Scroll to ANCC Study Aids – Free for sample test questions and study guides to help you prepare for your certification exam.
 
Buppert, C. (2021). Nurse practitioner’s business practice and legal guide (7th ed.). Jones & Bartlett Learning.
· Chapter 12, “Lawmaking and Health Policy”
· Chapter 14, “Standards of Care for Nurse Practitioner Practice”
· Chapter 15, “Measuring Nurse Practitioner Performance”
 
The National Organization of Nurse Practitioner Faculties. (2017). Nurse practitioner core competencies. /orders/cdn.ymaws.com/www.nonpf.org/resource/resmgr/competencies/20170516_NPCoreCompsContentF.pdf
 
The National Organization of Nurse Practitioner Faculties. (n.d.). National organization of nurse practitioner faculties. /orders/www.nonpf.org/
 
Stewart, J. G., & DeNisco, S. M. (2019). Role development for the nurse practitioner (2nd ed.). Jones & Bartlett Learning.
· Chapter 11, “Concepts of the Professional”
· Chapter 12, “Health Policy and the Nurse Practitioner”
· Chapter 14, “Mentoring”
Zakhari, R. (2021). The psychiatric-mental health nurse practitioner certification review manual. Springer Publishing Company.
· Chapter 1, “Preparing to Pass the Psychiatric-Mental Health Nurse Practitioner Certification Exam” (for review as needed)
· Chapter 16, “Practice Test”
 
Exit

ESSENTIALS OF EVIDENCE-BASED

Course Project: Part 1—Identifying a Researchable Problem
One of the most challenging aspects of EBP is to actually identify the answerable question.
 
—Karen Sue Davies
 
Formulating a question that targets the goal of your research is a challenging but essential task. The question plays a crucial role in all other aspects of the research, including the determination of the research design and theoretical perspective to be applied, which data will be collected, and which tools will be used for analysis. It is therefore essential to take the time to ensure that the research question addresses what you actually want to study. Doing so will increase your likelihood of obtaining meaningful results.
In this first component of the Course Project, you formulate questions to address a particular nursing issue or problem. You use the PICOT model—patient/population, intervention/issue, comparison, and outcome—outlined in the Learning Resources to design your questions.
 
To prepare:
 
Review the article, “Formulating the Evidence Based Practice Question: A Review of the Frameworks,” found in the Learning Resources for this week. Focus on the PICOT model for guiding the development of research questions.
 
Review the section beginning on page 71 of the course text, titled, “Developing and Refining Research Problems” in the course text, which focuses on analyzing the feasibility of a research problem.
Reflect on an issue or problem that you have noticed in your nursing practice. Consider the significance of this issue or problem.
 
Generate at least five questions that relate to the issue which you have identified. Use the criteria in your course text to select one question that would be most appropriate in terms of significance, feasibility, and interest. Be prepared to explain your rationale.
 
Formulate a preliminary PICO question—one that is answerable—based on your analysis. What are the PICO variables (patient/population, intervention/issue, comparison, and outcome) for this question?
Note: Not all of these variables may be appropriate to every question. Be sure to analyze which are and are not relevant to your specific question.
Using the PICOT variables that you determined for your question, develop a list of at least 10 keywords that could be used when conducting a literature search to investigate current research pertaining to the question.
 
To complete:
 
Write a 3- to 4-page paper that includes the following:
A summary of your area of interest, an identification of the problem that you have selected, and an explanation of the significance of this problem for nursing practice
The 5 questions you have generated and a description of how you analyzed them for feasibility
Your preliminary PICOT question and a description of each PICOT variable relevant to your question
At least 10 possible keywords that could be used when conducting a literature search for your PICOT question and a rationale for your selections
 
Reference:
 
 
Davies, K. S. (2011). Formulating the evidence based practice question: A review of the frameworks. Evidence Based Library and Information Practice, 6(2), 75–80. Retrieved from /orders/ejournals.library.ualberta.ca/index.php/EBLIP/article/viewFile/9741/8144
 
Required Readings
 
Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer.
Chapter 2, “Evidence-Based Nursing: Translating Research Evidence into Practice” (Review pages 14–31)
Chapter 5, “Literature Reviews: Finding and Critiquing Evidence”
In this chapter, you focus on conducting a literature review. Topics include how to identify the relevant literature on a given topic and then how to critique the strengths and weaknesses of the literature that you have found. Finally, the chapter examines how to synthesize the research findings into a written literature review.
Houde, S. C. (2009). The systematic review of literature: A tool for evidence-based policy. Journal of Gerontological Nursing, 35(9), 9–12.
Retrieved from the Walden Library databases.
 
This article emphasizes the importance of systematic reviews of literature. The authors present an overview of resources that may assist in conducting systematic reviews.
Krainovich-Miller, B., Haber, J., Yost, J., & Jacobs, S. K. (2009). Evidence-based practice challenge: Teaching critical appraisal of systematic reviews and clinical practice guidelines to graduate students. Journal of Nursing Education, 48(4), 186–195.
Retrieved from the Walden Library databases.
 
This article reviews the features of the TREAD Evidence-Based Practice Model. In particular, the authors of this article stress how the model emphasizes the use of standardized critical appraisal tools and Level I evidence.
Robeson, P., Dobbins, M., DeCorby, K., & Tirilis, D. (2010). Facilitating access to pre-processed research evidence in public health. BMC Public Health, 10, 95.
Retrieved from the Walden Library databases.
 
This article describes a hierarchy of pre-processed evidence and how it is adapted to the public health setting. The authors identify a range of resources with relevant public health content.
Walden Student Center for Success. (2012). Clinical Question Anatomy. Retrieved July 9, 2014, from http://academicguides.waldenu.edu/content.php?pid=183871&sid=2950360
Barker, J. (n.d.) Basic search tips and advanced Boolean explained. Retrieved August 3, 2012, from http://www.lib.berkeley.edu/TeachingLib/Guides/Internet/Boolean.pdf
 
This resource provides a graphical representation of different approaches to research and gives examples of each.
Davies, K. S. (2011). Formulating the evidence based practice question: A review of the frameworks. Evidence Based Library and Information Practice, 6(2), 75–80. Retrieved from /orders/ejournals.library.ualberta.ca/index.php/EBLIP/article/viewFile/9741/8144
 
This article reviews the frameworks commonly used to assist in generating answerable research questions. The author recommends considering the individual elements of the frameworks as interchangeable (depending upon the situation), rather than trying to fit a situation to a specific framework.
Walden University Library. (2012). Levels of evidence. Retrieved from http://academicguides.waldenu.edu/c.php?g=80240&p=523225
 
This guide provides a listing of evidence-based clinical resources, including systematic reviews and meta-analyses, critically appraised topics, background information and expert opinions, and unfiltered resources.
Indiana State University. (n.d.). Database search strategies. Retrieved July 6, 2012, from http://libguides.indstate.edu/content.php?pid=118904&sid=1065428
 
In this resource, the most common types of database searches are highlighted. It includes topics such as nesting searches, phrase searches, and using synonyms of key words in the search.
Library of Congress Online Catalog. (2008). Boolean searching. Retrieved from http://catalog.loc.gov/help/boolean.htm
 
This web page provides a basic overview of Boolean searches and provides simple examples of key search terms.
Walden University. (n.d.b.). Searching and retrieving materials in the research databases. Retrieved August 10, 2012, from http://academicguides.waldenu.edu/foundationscoursedocs/SearchingRetrieving
 
This resource provides tips for searching in the Walden Library. It includes a guide to keyword searches, an explanation of Boolean searches, and tips on locating specific journals or articles.
Document: Course Project Overview (Word document)
 
Note: You will use this document to complete the Project throughout this course.
Media
Laureate Education (Producer). (2012e). Finding resources for EBP. Baltimore, MD: Author.
 
Note: The approximate length of this media piece is 6 minutes.
 
In this video, Dr. Marianne Chulay identifies sources where nurses can find evidence to support their practices. She provides several examples of resources that provide specific information about best practices in health care.
 
 
Accessible player
Laureate Education (Producer). (2012f). Finding sources of evidence. Baltimore, MD: Author.
 
Note: The approximate length of this media piece is 9 minutes.
 
Dr. Kristen Mauk explains the process of performing a literature review in this video. She provides advice for nursing students in browsing databases and analyzing sources of evidence.
 
 
Accessible player
Laureate Education (Producer). (2012g). Hierarchy of evidence pyramid. Baltimore, MD: Author.
 
This multimedia piece explains the hierarchy of evidence pyramid. The piece offers definitions and key information for each level of the pyramid.
 
 
DO 4 Pages Please. Complete.
NURS 5052/NURS 6052: Essentials of Evidence-Based Practice
Course Project Overview
Evidence-based practice involves a great deal more than simply reading nursing periodicals on a regular basis. Nurses can take a more proactive approach to evidence-based practice by identifying authentic problems and concerns, and then using that to guide their inquiries into current research. In this way, nurses can connect the results of relevant research studies to their nursing practice.
For the Course Project, you identify and apply relevant research to a specific nursing topic or problem. You begin by formulating an answerable question that is relevant to nursing and evidence-based practice. In later weeks of this course, you continue the course project by conducting a literature review and then determining how the evidence from the literature can be applied to nursing practice.
Before you begin, review this document, which contains information about all three parts of the Course Project.
Note: This Course Project will serve as the Portfolio Assignment for the course. In addition to submitting portions of this Project in Weeks 2 and 5, you will turn in all three deliverables in Week 10.
Course Project: Part 1–Identifying a Researchable Problem
One of the most challenging aspects of EBP is to actually identify the answerable question. —Karen Sue Davies
Formulating a question that targets the goal of your research is a challenging but essential task. The question plays a crucial role in all other aspects of the research, including the determination of the research design and theoretical perspective to be applied, which data will be collected, and which tools will be used for analysis. It is therefore essential to take the time to ensure that the research question addresses what you actually want to study. Doing so will increase the likelihood of obtaining meaningful results.
In this first component of the course project, you formulate questions to address a particular nursing issue or problem. You use the PICOT model—patient/population, intervention/issue, comparison, and outcome—outlined in the weekly Learning Resources to design your questions.
To prepare:
· Review the article, “Formulating the Evidence Based Practice Question: A Review of the Frameworks,” found in the Learning Resources for Week 2. Focus on the PICOT model for guiding the development of research questions.
· Review the section beginning on page of the course text, 75 titled, “Developing and Refining Research Problems” in the course text, which focuses on analyzing the feasibility of a research problem.
· Reflect on an issue or problem that you have noticed in your nursing practice. Consider the significance of this issue or problem.
· Generate at least 5 questions that relate to the issue that you have identified. Use the criteria in your course text to select one question that would be most appropriate in terms of significance, feasibility, and interest. Be prepared to explain your rationale.
· Formulate a preliminary PICOT question—one that is answerable—based on your analysis. What are the PICOT variables (patient/population, intervention/issue, comparison, and outcome) for this question? Note: Not all of these variables may be appropriate to every question. Be sure to analyze which are and are not relevant to your specific question.
· Using the PICOT variables that you determined for your question, develop a list of at least 10 keywords that could be used when conducting a literature search to investigate current research pertaining to the question.
To complete:
Write a 3- to 4-page paper that includes the following:
· A summary of your area of interest, an identification of the problem that you have selected, and an explanation of the significance of this problem for nursing practice
· The 5 questions that you have generated, and a description of how you analyzed them for feasibility
· Your preliminary PICOT question and a description of each PICOT variable relevant to your question
· At least 10 possible keywords that could be used when conducting a literature search for your PICOT question and a rationale for your selections
Part 1 of the Course Project is due by Day 7 of Week 2. It will also be a component of your Portfolio Assignment for this course, which is due by Day 7 of Week 10.
Reference: Davies, K. S. (2011). Formulating the evidence based practice question: A review of the frameworks. Evidence Based Library and Information Practice, 6(2), 75–80. Retrieved from /orders/ejournals.library.ualberta.ca/index.php/EBLIP/article/viewFile/9741/8144
Course Project: Part 2—Literature Review
The literature review is a critical piece in the research process because it helps a researcher determine what is currently known about a topic and identify gaps or further questions. Conducting a thorough literature review can be a time-consuming process, but the effort helps establish the foundation for everything that will follow. For this part of your Course Project, you will conduct a brief literature review to find information on the question that you developed in Week 2. This will provide you with experience in searching databases and identifying applicable resources.
To prepare:
· Review the information in Chapter 5 of the course text, focusing on the steps for conducting a literature review and for compiling your findings.
· Using the question that you selected in your Week 2 Project (Part 1 of the Course Project), locate 5 or more full-text research articles that are relevant to your PICOT question. Include at least 1 systematic review and 1 integrative review if possible. Use the search tools and techniques mentioned in your readings this week to enhance the comprehensiveness and objectivity of your review. You may gather these articles from any appropriate source, but make sure at least 3 of these articles are available as full-text versions through Walden Library’s databases.
· Read through the articles carefully. Eliminate studies that are not appropriate and add others to your list as needed. Although you may include more, you are expected to include a minimum of five articles. Complete a literature review summary table using the Literature Review Summary Table Template located in this week’s Learning Resources.
· Prepare to summarize and synthesize the literature using the information on writing a literature review found in Chapter 5 of the course text.
To complete:
Develop a 2- to 3-page literature review that includes the following:
· A synthesis of what the studies reveal about the current state of knowledge on the question that you developed
· Point out inconsistencies and contradictions in the literature and offer possible explanations for inconsistencies.
· Preliminary conclusions on whether the evidence provides strong support for a change in practice or whether further research is needed to adequately address your inquiry
· Your literature review summary table with all references formatted in correct APA style
Note: Certain aspects of conducting a standard review of literature have not yet been covered in this course. Therefore, while you are invited to critically examine any aspect of the studies (e.g., a study’s design, appropriateness of the theoretic framework, data sampling methods), your conclusion should be considered preliminary. Bear in mind that five studies are typically not enough to reflect the full range of knowledge on a particular question and you are not expected to be familiar enough with research methodology to conduct a comprehensive evaluation of all aspects of the studies.
Part 2 of the Course Project is due by Day 7 of Week 5. It will also be a component in your portfolio assignment in this course, which is due by Day 7 of Week 10.
Course Project Part 3 – Translating Evidence Into Practice
Now that you have located available research on your PICOT question, you will examine what the research indicates about nursing practices. Connecting research evidence and findings to actual decisions and tasks that nurses complete in their daily practice is essentially what evidence-based practice is all about. This final component of the Course Project asks you to translate the evidence and data from your literature review into authentic practices that can be adopted to improve health care outcomes. In addition, you will also consider possible methods and strategies for disseminating evidence-based practices to your colleagues and to the broader health care field.
To prepare:
· Consider Parts 1 and 2 of your Course Project. How does the research address your PICOT question?
· With your PICOT question in mind, identify at least one nursing practice that is supported by the evidence in two or more of the articles from your literature review. Consider what the evidence indicates about how this practice contributes to better outcomes.
· Explore possible consequences of failing to adopt the evidence-based practice that you identified.
· Consider how you would disseminate information about this evidence-based practice throughout your organization or practice setting. How would you communicate the importance of the practice?
To complete:
In a 3- to 4-page paper:
· Restate your PICOT question and its significance to nursing practice.
· Summarize the findings from the articles that you selected for your literature review. Describe at least one nursing practice that is supported by the evidence in the articles. Justify your response with specific references to at least 2 of the articles.
· Explain how the evidence-based practice that you identified contributes to better outcomes. In addition, identify potential negative outcomes that could result from failing to use the evidence-based practice.
· Outline the strategy for disseminating the evidence-based practice that you identified throughout your practice setting. Explain how you would communicate the importance of the practice to your colleagues. Describe how you would move from disseminating the information to implementing the evidence-based practice within your organization. How would you address concerns and opposition to the change in practice?
Part 3 of the Course Project is due by Day 7 of Week 10. It should be combined with the other two components of the Course Project and turned in as your Portfolio Assignment for this course. Note: In addition, include a 1-page summary of your project.
For this final iteration you will need to:
· Submit your paper to Grammarly and Turnitin through the Walden Writing Center. Based on the Grammarly and Turnitin reports, revise your paper as necessary.
· Reminder: The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The School of Nursing Sample Paper provided at the Walden Writing Center provides an example of those required elements (available from the Walden University website found in this week’s Learning Resources). All papers submitted must use this formatting.
Note: The Course Project will be your Portfolio Assignment for this course.
© 2016 Laureate Education Inc. 2

6052 Assignment Part 2

This is a continuation of the Course Project presented in Week 2.
Before you begin, review the Course Project Overview document located in the Week 2 Resources area.
The literature review is a critical piece in the research process because it helps a researcher determine what is currently known about a topic and identify gaps or further questions. Conducting a thorough literature review can be a time-consuming process, but the effort helps establish the foundation for everything that will follow. For this part of your Course Project, you will conduct a brief literature review to find information on the question you developed in Week 2. This will provide you with experience in searching databases and identifying applicable resources.
· Review the information in Chapter 5 of the course text, focusing on the steps for conducting a literature review and for compiling your findings.
· Using the question you selected in your Week 2 Project (Part 1 of the Course Project), locate 5 or more full-text research articles that are relevant to your PICOT question. Include at least 1 systematic review and 1 integrative review if possible. Use the search tools and techniques mentioned in your readings this week to enhance the comprehensiveness and objectivity of your review. You may gather these articles from any appropriate source, but make sure at least 3 of these articles are available as full-text versions through Walden Library’s databases.
· Read through the articles carefully. Eliminate studies that are not appropriate and add others to your list as needed. Although you may include more, you are expected to include a minimum of five articles. Complete a literature review summary table using the Literature Review Summary Table Template located in this week’s Learning Resources.
· Prepare to summarize and synthesize the literature using the information on writing a literature review found in Chapter 5 of the course text.
To complete:
Write a 3- to 4-page literature review that includes the following:
· A synthesis of what the studies reveal about the current state of knowledge on the question that you developed
o Point out inconsistencies and contradictions in the literature and offer possible explanations for inconsistencies.
· Preliminary conclusions on whether the evidence provides strong support for a change in practice or whether further research is needed to adequately address your inquiry
· Your literature review summary table with all references formatted in correct APA style
Note: Certain aspects of conducting a standard review of literature have not yet been covered in this course. Therefore, while you are invited to critically examine any aspect of the studies (e.g., a study’s design, appropriateness of the theoretic framework, data sampling methods), your conclusion should be considered preliminary. Bear in mind that five studies are typically not enough to reflect the full range of knowledge on a particular question and you are not expected to be familiar enough with research methodology to conduct a comprehensive evaluation of all aspects of the studies.

Differential Diagnosis For Skin Conditions

Properly identifying the cause and type of a patient’s skin condition involves a process of elimination known as differential diagnosis. Using this process, a health professional can take a given set of physical abnormalities, vital signs, health assessment findings, and patient descriptions of symptoms, and incrementally narrow them down until one diagnosis is determined as the most likely cause.
In this Lab Assignment, you will examine several visual representations of various skin conditions, describe your observations, and use the techniques of differential diagnosis to determine the most likely condition.
To Prepare
Review the Skin Conditions document provided in this week’s Learning Resources, and select one condition to closely examine for this Lab Assignment.
Consider the abnormal physical characteristics you observe in the graphic you selected. How would you describe the characteristics using clinical terminologies?
Explore different conditions that could be the cause of the skin abnormalities in the graphics you selected.
Consider which of the conditions is most likely to be the correct diagnosis, and why.
Search the Walden library for one evidence-based practice, peer-reviewed article based on the skin condition you chose for this Lab Assignment.
Review the Comprehensive SOAP Exemplar found in this week’s Learning Resources to guide you as you prepare your SOAP note.
Download the SOAP Template found in this week’s Learning Resources, and use this template to complete this Lab Assignment.
The Lab Assignment
Choose one skin condition graphic (identify by number in your Chief Complaint) to document your assignment in the SOAP (Subjective, Objective, Assessment, and Plan) note format rather than the traditional narrative style. Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in this week’s Learning Resources for guidance. Remember that not all comprehensive SOAP data are included in every patient case.
Use clinical terminologies to explain the physical characteristics featured in the graphic. Formulate a differential diagnosis of three to five possible conditions for the skin graphic that you chose. Determine which is most likely to be the correct diagnosis and explain your reasoning using at least three different references, one reference from current evidence-based literature from your search and two different references from this week’s Learning Resources.
REQUIRED READINGS
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Chapter 9, “Skin, Hair, and Nails”
This chapter reviews the basic anatomy and physiology of skin, hair, and nails. The chapter also describes guidelines for proper skin, hair, and nails assessments.
Colyar, M. R. (2015). Advanced practice nursing procedures. Philadelphia, PA: F. A. Davis.
Credit Line: Advanced practice nursing procedures, 1st Edition by Colyar, M. R. Copyright 2015 by F. A. Davis Company. Reprinted by permission of F. A. Davis Company via the Copyright Clearance Center.
This section explains the procedural knowledge needed prior to performing various dermatological procedures.
Chapter 1, “Punch Biopsy”
Chapter 2, “Skin Biopsy”
Chapter 10, “Nail Removal”
Chapter 15, “Skin Lesion Removals: Keloids, Moles, Corns, Calluses”
Chapter 16, “Skin Tag (Acrochordon) Removal”
Chapter 22, “Suture Insertion”
Chapter 24, “Suture Removal”
Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.
Chapter 28, “Rashes and Skin Lesions”
This chapter explains the steps in an initial examination of someone with dermatological problems, including the type of information that needs to be gathered and assessed.
Note: Download and use the Student Checklist and the Key Points when you conduct your assessment of the skin, hair, and nails in this Week’s Lab Assignment.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Skin, hair, and nails: Student checklist. In Seidel’s guide to physical examination (9th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Skin, hair, and nails: Key points. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.
Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.
Chapter 2, “The Comprehensive History and Physical Exam” (Previously read in Weeks 1 and 3)
VisualDx. (n.d.). Clinical decision support. Retrieved June 11, 2019, from http://www.skinsight.com/info/for_professionals
This interactive website allows you to explore skin conditions according to age, gender, and area of the body.
Clothier, A. (2014). Assessing and managing skin tears in older people. Nurse Prescribing, 12(6), 278–282.
This document contains five images of different skin conditions. You will use this information in this week’s Discussion.
Document: Comprehensive SOAP Exemplar (Word document)
Comprehensive SOAP Exemplar
Purpose: To demonstrate what each section of the SOAP note should include. Remember that Nurse Practitioners treat patients in a holistic manner and your SOAP note should reflect that premise.
Patient Initials: _______ Age: _______ Gender: _______
SUBJECTIVE DATA:
Chief Complaint (CC): Coughing up phlegm and fever
History of Present Illness (HPI): Sara Jones is a 65 year old Caucasian female who presents today with a productive cough x 3 weeks and fever for the last three days. She reported that the “cold feels like it is descending into her chest”. The cough is nagging and productive. She brought in a few paper towels with expectorated phlegm – yellow/brown in color. She has associated symptoms of dyspnea of exertion and fever. Her Tmax was reported to be 102.4, last night. She has been taking Ibuprofen 400mg about every 6 hours and the fever breaks, but returns after the medication wears off. She rated the severity of her symptom discomfort at 4/10.
Medications:
1.) Lisinopril 10mg daily
2.) Combivent 2 puffs every 6 hours as needed
3.) Serovent daily
4.) Salmeterol daily
5.) Over the counter Ibuprofen 200mg -2 PO as needed
6.) Over the counter Benefiber
7.) Flonase 1 spray each night as needed for allergic rhinitis symptoms
Allergies:
Sulfa drugs – rash
Past Medical History (PMH):
1.) Emphysema with recent exacerbation 1 month ago – deferred admission – RX’d with outpatient antibiotics and an hand held nebulizer treatments.
2.) Hypertension – well controlled
3.) Gastroesophageal reflux (GERD) – quiet on no medication
4.) Osteopenia
5.) Allergic rhinitis
Past Surgical History (PSH):
1.) Cholecystectomy 1994
2.) Total abdominal hysterectomy (TAH) 1998
Sexual/Reproductive History:
Heterosexual
G1P1A0
Non-menstrating – TAH 1998
Personal/Social History:
She has smoked 2 packs of cigarettes daily x 30 years; denied ETOH or illicit drug use.
Immunization History:
Her immunizations are up to date. She received the influenza vaccine last November and the Pneumococcal vaccine at the same time.
Significant Family History:
Two brothers – one with diabetes, dx at age 65 and the other with prostate CA, dx at age 62. She has 1 daughter, in her 50’s, healthy, living in nearby neighborhood.
Lifestyle:
She is a retired; widowed x 8 years; lives in the city, moderate crime area, with good public transportation. She college graduate, owns her home and receives a pension of $50,000 annually – financially stable.
She has a primary care nurse practitioner provider and goes for annual and routine care twice annually and as needed for episodic care. She has medical insurance but often asks for drug samples for cost savings. She has a healthy diet and eating pattern. There are resources and community groups in her area at the senior center and she attends regularly. She enjoys bingo. She has a good support system composed of family and friends.
Review of Systems:
General: + fatigue since the illness started; + fever, no chills or night sweats; no recent weight gains of losses of significance.
HEENT: no changes in vision or hearing; she does wear glasses and her last eye exam was 1 ½ years ago. She reported no history of glaucoma, diplopia, floaters, excessive tearing or photophobia. She does have bilateral small cataracts that are being followed by her ophthalmologist. She has had no recent ear infections, tinnitus, or discharge from the ears. She reported her sense of smell is intact. She has not had any episodes of epistaxis. She does not have a history of nasal polyps or recent sinus infection. She has history of allergic rhinitis that is seasonal. Her last dental exam was 3/2014. She denied ulceration, lesions, gingivitis, gum bleeding, and has no dental appliances. She has had no difficulty chewing or swallowing.
Neck: no pain, injury, or history of disc disease or compression. Her last Bone Mineral density (BMD) test was 2013 and showed mild osteopenia, she said.
Breasts: No reports of breast changes. No history of lesions, masses or rashes. No history of abnormal mammograms.
Respiratory: + cough and sputum production (see HPI); denied hemoptysis, no difficulty breathing at rest; + dyspnea on exertion; she has history of COPD and community acquired pneumonia 2012. Last PPD was 2013. Last CXR – 1 month ago.
CV: no chest discomfort, palpitations, history of murmur; no history of arrhythmias, orthopnea, paroxysmal nocturnal dyspnea, edema, or claudication. Date of last ECG/cardiac work up is unknown by patient.
GI: No nausea or vomiting, reflux controlled, No abd pain, no changes in bowel/bladder pattern. She uses fiber as a daily laxative to prevent constipation.
GU: no change in her urinary pattern, dysuria, or incontinence. She is heterosexual. She has had a total abd hysterectomy. No history of STD’s or HPV. She has not been sexually active since the death of her husband.
MS: she has no arthralgia/myalgia, no arthritis, gout or limitation in her range of motion by report. No history of trauma or fractures.
Psych: no history of anxiety or depression. No sleep disturbance, delusions or mental health history. She denied suicidal/homicidal history.
Neuro: no syncopal episodes or dizziness, no paresthesia, head aches. No change in memory or thinking patterns; no twitches or abnormal movements; no history of gait disturbance or problems with coordination. No falls or seizure history.
Integument/Heme/Lymph: no rashes, itching, or bruising. She uses lotion to prevent dry skin. She has no history of skin cancer or lesion removal. She has no bleeding disorders, clotting difficulties or history of transfusions.
Endocrine: no endocrine symptoms or hormone therapies.
Allergic/Immunologic: this has hx of allergic rhinitis, but no known immune deficiencies. Her last HIV test was 10 years ago.
OBJECTIVE DATA
Physical Exam:
Vital signs: B/P 110/72, left arm, sitting, regular cuff; P 70 and regular; T 98.3 Orally; RR 16; non-labored; Wt: 115 lbs; Ht: 5’2; BMI 21
General: A&O x3, NAD, appears mildly uncomfortable
HEENT: PERRLA, EOMI, oronasopharynx is clear
Neck: Carotids no bruit, jvd or tmegally
Chest/Lungs: CTA AP&L
Heart/Peripheral Vascular: RRR without murmur, rub or gallop; pulses+2 bilat pedal and +2 radial
ABD: benign, nabs x 4, no organomegaly; mild suprapubic tenderness – diffuse – no rebound
Genital/Rectal: external genitalia intact, no cervical motion tenderness, no adnexal masses.
Musculoskeletal: symmetric muscle development – some age related atrophy; muscle strengths 5/5 all groups.
Neuro: CN II – XII grossly intact, DTR’s intact
Skin/Lymph Nodes: No edema, clubbing, or cyanosis; no palpable nodes
ASSESSMENT:
Lab Tests and Results:
CBC – WBC 15,000 with + left shift
SAO2 – 98%
Diagnostics:
Lab:
Radiology:
CXR – cardiomegaly with air trapping and increased AP diameter
ECG
Normal sinus rhythm
Differential Diagnosis (DDx):
1.) Acute Bronchitis
2.) Pulmonary Embolis
3.) Lung Cancer
Diagnoses/Client Problems:
1.) COPD
2.) HTN, controlled
3.) Tobacco abuse – 40 pack year history
4.) Allergy to sulfa drugs – rash
5.) GERD – quiet on no current medication
PLAN: [This section is not required for the assignments in this course, but will be required for future courses.]

FINANCE AND ECONOMICS IN HEALTH CARE DELIVERY

FINANCE AND ECONOMICS IN HEALTH CARE DELIVERY

FINANCE AND ECONOMICS IN HEALTH CARE DELIVERY

Assignment: Using Variance Analysis in Decision Making

Having a budget is critical for the financial stability of an organization. Keeping track of how well the organization is actually adhering to the budget, and subsequent identification of why the budget numbers are being missed is equally important. Without this critical “why” piece, it is difficult to make the necessary adjustments to the budget or to organizational behavior that might be promoting overspending.
A good budget is built with thoughtful consideration of future costs and revenue. Though your budget is formulated with expected figures in mind, the actual resulting values may vary considerably. This variance–from projected to actual–can be a pleasant surprise or a fiscal nightmare and can make financial decision making difficult. Fortunately, variance analysis can enable management to determine why variance occurred and what can be done to mitigate its effects.
For those not comfortable with the use of Microsoft Excel, this week’s Optional Resources suggest several tutorials.
To prepare:

• Review the information in this week’s Learning Resources dealing with variance analysis, how it is calculated, and how it can be used in decision making.
• View the video  Week 8 Application Assignment Tutorial: Variance Analysis, provided in this week’s Learning Resources.
• Use the Week 8 Application Assignment Template, provided in this week’s Learning Resources, to complete this assignment.   Carefully examine the information in each of the scenarios and provide the necessary calculations.  Using this information will help you answer the questions.

By Day 7

Note: For those Assignments in this course that require you to perform calculations you must:

• Use the Excel spreadsheet template for the Week 8 assignment
• Show all your calculations and formulas in the spreadsheet.
• Answer any questions included with the problems (as text in the Excel spreadsheet).

A title and reference page are NOT needed in this assignment. Put your name and assignment at the top of the Excel spreadsheet.
Use the Week 8 Application Assignment Template for the Week 8 assignment

Salary Variance Scenario

For this Assignment run a variance analysis. Based on the information you obtain: assess the results of the analysis, suggest potential causes of the budget variances and an explanation for addressing the situation.
Using the following performance data calculate the volume adjusted labor rate variance and volume adjusted efficiency variance. Your Variable Expense Factor is 40% and your Volume Change Factor is 50%.

Note: Submit the Excel spreadsheet containing your Salary Variance Scenario calculations to the Assignment submission link.

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ADDITIONAL INSTRUCTIONS FOR THE CLASS

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• Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, including a minimum of one scholarly source, and be at least 250 words. Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source. One or two-sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words. I encourage you to incorporate the readings from the week (as applicable) into your responses.

• Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately. In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies. Participation posts do not require a scholarly source/citation (unless you cite someone else’s work). Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

• APA Format and Writing Quality

Familiarize yourself with the APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required). Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation. I highly recommend using the APA Publication Manual, 6th edition.

• Use of Direct Quotes

I discourage over-utilization of direct quotes in DQs and assignments at the Master’s level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source.

• LopesWrite Policy

For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me. Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes. Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own? Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for tips on improving your paper and SI score.

• Late Policy

The university’s policy on late assignments is a 10% penalty PER DAY LATE. This also applies to late DQ replies. Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances. If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect. I do not accept assignments that are two or more weeks late unless we have worked out an extension. As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

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Communication is so very important. There are multiple ways to communicate with me: Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class. Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

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WEEK 10 SOAP NOTE

2 to 3 PAGES SOAP NOTE
 
Select a pediatric patient that  presented to the clinic, who you examined as a nurse practitioner/ provider during the last 4 weeks. With this patient in mind, address the following in a SOAP Note:
 
•Subjective: What details did the patient or parent provide regarding the personal and medical history? Include any discrepancies between the details provided by the child and details provided by the parent, as well as possible reasons for these discrepancies./nurs-6002-week-4-discussion-using-the-walden-library-summer-2020/
 
•Objective: What observations did you make during the physical assessment? Include pertinent positive and negative physical exam findings. Describe whether the patient presented with any growth and development or psychosocial issues.
 
•Assessment: What were your differential diagnoses? Provide a minimum of three possible diagnoses. List them from highest priority to lowest priority. What was your primary diagnosis and why?
 
•Plan: What was your plan for diagnostics and primary diagnosis? What was your plan for treatment and management? Include pharmacologic and non-pharmacologic treatments, alternative therapies, and follow-up parameters to the clinic , as well as a rationale for this treatment and management plan.
 
•Reflection notes: What was your “aha” moment? What would you do differently in a similar patient evaluation?
 
References
 
•Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., & Blosser, C. G. (2013). Pediatric primary care (5th ed.). Philadelphia, PA: Elsevier.
 
◦Chapter 34, “Genitourinary Disorders” (pp. 809–843)
 
◦Chapter 35, “Gynecologic Disorders” (pp. 844–876)
 
 
 
American Academy of Pediatrics, Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management. (2011). Urinary tract infection: Clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics, 128(3), 595–610. Retrieved from http://pediatrics.aappublications.org/content/128/3/595.full?sid=cc35023c-502d-474a-9856-bfb5e38eed54
 
•Cox, A. M., Patel, H., & Gelister, J. (2012). Testicular torsion. British Journal of Hospital Medicine, 73(3), C34–C36. Retrieved from the Walden Library Databases.
SOAP ANALYSIS FOR A NOSE DISORDER 1
Week 7 SOAP : Analysis for a Nose Disorder
Gloria Okoye
Walden University
Primary Care of Adolescents & Children -NURS – 6541N – 1
07/16/2016
SUBJECTIVE DATA:
Chief Complaint (CC): A 3-year-old African American female infant presented with her mother to the clinic complaining of a cough. Mother reports that the patient has been coughing constantly every night and complaining that her throat hurts for 1 week now. The patient has also been experiencing fever up to 100.5 and she has been getting her Tylenol and Motrin, but the patient has not been responding to the drugs (Fried,M..P, 2015). . Mother states that her daughter has no developmental delays or problem, goes to day-care all day. Denies any nausea, vomiting, diarrhea, shortness of breath, wheezing, retractions or any other symptoms.
History of present conditions: The patient has been experiencing the cough for a week now and it has been occurring during the night only. The coughs can be described as wet and blocking the breathing pipes. Congestion of the nose and pain in the chest areas is a dominant characteristic. The patient’s cough improved after medication with antihistamine syrup, but after three days it worsened completely.
Medications: None
Allergies: No general known allergies
Immunization: Up to date
Past Medical History (PMH):
None in this case
SH: Lives with both parents and two siblings
Past Surgical History (PSH):
None in this case
Sexual/Reproductive History:
Not applicable in the case
Significant Family History: The parent has a chronic asthma condition
Review of Systems:
General: Discomfort in breathing, sneezing, nasal congestion and high fever
HEENT: The patient has a normal body physique, normal development pattern, functioning body organs, normal digestion process, normal blood pressure and body temperature and no documented diseases.
OBJECTIVE DATA: Physical exam:
Vital indication B/P 113 /70; P 77 and regular; T 98.9 orally; RR 20; non-labored; Wt.: 40 lbs.; Ht: 36,5 inches; BMI 16.7 which [puts this child in the 79th percentile
General: A&O x3, NAD, appears mildly uncomfortable
Chest/Lungs: CTA AP&L
Heart/Peripheral Vascular: RRR without murmur, rub, or a gallop; pulses+2 bilat pedal and +2 radial
Neuro: CN II – XII wholly integral, DTR’s integral
BD: benign, nabs x 4, no organomegaly; slight suprapubic sensitivity – diffuse – no rebound
Musculoskeletal: symmetric muscle development (Burns, C. E, et al, 2013)
ASSESSMENT:
Differential Diagnosis (DDx):
1. Respiratory Tract Infection
2. Rhinitis
3. Sinusitis
Diagnostics:
Laboratory
· RSV and Strep throat : Negative
The primary diagnostic is the nasal endoscopy to test the probability of second and third differential diagnostics. The case of RTI is also probable, especially a common cold or flu.
PLAN:
Diagnostic and treatment: The plan was to diagnose the patient with RTI and treat both rhinitis and sinusitis. There is no cure for common cold especially with children, antibiotic is not recommended unless in severe cases. This child is not currently running any fever so we advised the mother to continue to monitor her at home, a lot of rest and taking on fluids in plenty because fluid helps with moist the air passages moist which helps her cough out the mucus. We also recommended nasal saline drops or spray to each nostril to ease the nose congestion and for easy breathing; she can also be taken to the bathroom with running hot water the stem for 10 to 15 mins or use of cool mist humidifier in the child’s room when sleeping. Continue with Tylenol or Motrin that will lower the fever are advised as well (Bradley, et al, 2011).
. To manage the disease, the patient will have to consider a high level of hygiene to prevent the spread of the disease and maintaining a warm clothing routine (NHSChoices, 2014). Provided the mother information on critical signs and symptoms of worsening condition to watch for and when to call her provider.
F/u in 2 to 3 days if symptoms does not improve.
REFLECTION
The “aha” moment is when the patient explained that she was having nasal congestion and high fever accompanied by sneezing in the morning and in the evening. Through this, I recalled the symptoms of influenza, common cold, and flu under the envelope of Respiratory Tract infections (RTIs). Using the fact that the patient has no record of allergies that may be mistaken for RTI, the patient was probably suffering from RTI.
References
Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., & Blosser, C. G. (2013). Pediatric primary care (5th ed.). Philadelphia, PA: Elsevier
Fried, M. P. (2015). Introduction to Nose and Sinus Disorders. Merck Manual.
NHSChoices. (2014). Respiratory Tract Infections. NHS Health A-Z
Bradley, J. S., Byington, C. L., Shah, S. S., Alverson, B., Carter, E. R., Harrison, C., … & St Peter, S. D. (2011). The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clinical Infectious Diseases, cir531.
 

Common Models In Health Informatics Evaluation

Common Models in Health Informatics Evaluation
Have you ever watched a movie in which the same scene was shown several times but as viewed by different individuals? Or, have you watched a detective show in which the witnesses all had differing accounts? The same can hold true for conducting an evaluation of a health information technology project. How you plan and conduct the evaluation is largely dependent on the viewpoint you assume and the perspective with which you approach the evaluation.
Consider a new patient discharge protocol at a small hospital. Do you want to know how the patient feels about the process? Do you want to gather the opinions of nurses who are using this process? Perhaps you want to determine if it is saving the hospital money by freeing up bed space in a more timely fashion. Obtaining each of these viewpoints would require a different approach. Depending on the goal of your evaluation, the model and viewpoint you opt to use will likely vary.
In this Discussion, determine which evaluation model would be most effective for evaluating the health information technology described in one of the scenarios below. Your Instructor will assign a specific scenario by Day 1 of this week.

• Scenario 1: You have recently provided a training program to help nurses and physicians become proficient in the use of a new bedside medication verification (BMV) system.

• Scenario 2: The Chief Medical Officer at your hospital is interested in finding out the impact of a new decision support system on the number of adverse events occurring in the past year.

• Scenario 3: You are helping with the design of a new outpatient surgery center to be built adjacent to the hospital. You are tasked with evaluating the opinions of physicians, nurses, and the general public toward this facility.

To prepare:

• Review the information on the types of evaluation models covered in this week’s Learning Resources.
• Determine which model would be most appropriate to use for evaluation in the scenario to which you were assigned.
• Consider why the viewpoint of the scenario or situation would impact the model used.
• View the scenario from a different viewpoint, and consider how a different model might be used.
• Reflect on the importance of basing an evaluation on a model.

By tomorrow 12/13/2016 at 9pm, post a minimum of 550 words in APA format with a minimum of 3 references from the list below, which include the level one headings as numbered below:
1)      Post which scenario (1, 2, or 3) you were assigned and two different models that could be utilized to approach the evaluation.
2)      Explain why you selected those models and how you would use them.
3)       Explain why it is important to consider the intended goal of the evaluation and the viewpoint that is selected.
4)      Finally, assess the importance of basing an evaluation on a model. Justify your response.
 
 
 
 
Required Readings
 
Technology Acceptance Model
 
Kowitlawakul, Y. (2011). The Technology Acceptance Model: Predicting nurses’ intention to use telemedicine technology (eICU). Computers, Informatics, Nursing, 29(7), 411–418.
Retrieved from the Walden Library databases.
Nurses encounter a variety of technological tools that are used in their field. This article explores the technology acceptance model and how it applies to nurses’ intention to use telemedicine technology.
 
    Pai, F.-Y., & Huang, K. (2011). Applying the Technology Acceptance Model to the introduction of healthcare information systems. Technological Forecasting and Social Change, 78(4), 650–660.
Retrieved from the Walden Library databases.
This article focuses on the attempt to develop a model that will assist nurses in mastering the use of health information technology (HIT), thus enabling them to spend more time on patient care and less on clerical-type duties. The authors also studied how the use of HIT could increase patient safety.
 
    Rippen, H. E., Pan, E. C., Russell, C., Byrne, C. M., & Swift, E. K. (2013). Organizational framework for health information technology. International Journal of Medical Informatics, 82(4), e1–e13.
Retrieved from the Walden Library databases.
In this article, the authors highlight results of a literature review on the implementation of health information technology and the related theories and models. Based on their research, the authors developed a framework of key areas that provides a structure to organize and capture information on the use of health IT.
 
    Mohamed, A. H., Tawfik, H. M., Al-Jumeily, D., & Norton, L. (2011). MoHTAM: A Technology Acceptance Model for mobile health applications. Developments in E-systems Engineering (DeSE) Conference, 13–18.
Retrieved from the Walden Library databases.
In this article, the authors highlight a model they developed to determine how the decision to use a mobile health application is influenced by the design of the technology, the perceived ease of using it, and the perceived usefulness of the technology.
 
Diffusion of Innovations
 
Barnett, J., Vasileiou, K., Djemil, F., Brooks, L., & Young, T. (2011). Understanding innovators’ experiences of barriers and facilitators in implementation and diffusion of healthcare service innovations: A qualitative study. BMC Health Services Research, 11, 342.
Retrieved from the Walden Library databases
In this article, the authors describe the experiences of innovators in the medical field and the barriers that they have experienced in the implementation and diffusion of health care service innovations.
 
    Kaissi, A. (2012). “Learning” from other industries: Lessons and challenges for health care organizations. Health Care Manager, 31(1), 65–74.
Retrieved from the Walden Library databases.
 
 
 
In this paper, the author explores how diffusion of innovations occurs in a variety of different industries and how these lessons can be adapted for use in the health care industries.
 
Thakur, R., Hsu, S. H. Y., & Fontenot, G. (2012). Innovation in healthcare: Issues and future trends. Journal of Business Research, 65(4), 562–569.
Retrieved from the Walden Library databases.
The medical field is a constantly evolving and improving. This article explores important innovations in the health care industry while highlighting certain issues and trends that may affect the future of the field.
 
    Dickinson, A. D., & Scott, M. (2012). Diffusion of innovations in the National Health Service: A case study investigating the implementation of an electronic patient record system in a UK secondary care trust. In UK Academy for Information Systems (UKAIS) 17th Annual Conference, 27–28 March 2012, New College, Oxford. Retrieved from http://nrl.northumbria.ac.uk/6223/2/UKAIS_2012_paperDD_MS.pdf
This article examines a case study that focuses on the implementation of an electronic patient record system in a UK secondary care trust. In particular, the study highlights how new users adopt the system.
 
Valente, T. W., & Rogers, E. M. (1995). The origins and development of the diffusion of innovations paradigm as an example of scientific growth. Science Communication, 16(3), 242–273.
Copyright 1995 by Sage Publications Inc. Reprinted by permission of RISage Publications Inc. via the Copyright Clearance Center.
In this article, Valente and Rogers explore the origins and development of the diffusion of innovations paradigm. Through examining the different stages, it is possible to better understand how innovations are spread, accepted, and adopted within a health care organization.
 
Disruptive Innovation
 
Christensen, C. M., Bohmer, R., & Kenagy, J. (2000). Will disruptive innovations cure health care? Harvard Business Review, 78(5), 102–112.
 
Retrieved from the Walden Library databases
The health care field is constantly in need of new technologies to fill specific needs and niches. In this article, the authors discuss the role disruptive innovations could play in the development of the needed technologies.
 
Dhar, M., Griffin, M., Hollin, I., & Kachnowski, S. (2012). Innovation spaces: Six strategies to inform health care. Health Care Manager, 31(2), 166–177.
Retrieved from the Walden Library databases.
In this article, the authors use the disruptive innovation model as the framework to examine how innovation occurs in health care organizations. They determined six strategies to encourage innovation: dedicated times, formal teams, outside ideas, idea-sharing platforms, company/job goals, and incentives.
 
    Poll, W. (2011). Derision is the sweet spot of adoption: Unleashing disruptive growth.  Hospital Topics, 89(1), 23–25.
Retrieved from the Walden Library databases.
It is common that many people look at change and new technologies with a hint of disdain or distrust. The author of this article discusses how new ideas and disruptive innovations can be effectively presented to a somewhat hesitant organizations.
 
Sociotechnical Theory Models
 
    Ancker, J. S., Kern, L. M., Abramson, E., & Kaushal, R. (2012). The Triangle Model for evaluating the effect of health information technology on healthcare quality and safety. Journal of American Medical Informatics Associations, 19(1), 61–65.
Retrieved from the Walden Library databases.
The authors of this article explain the Triangle Model for designing studies on the safety and quality outcomes of health information technology projects. The article focuses on the predictors of the model, including attributes of the technology in question, the technology provider, the organizational setting, and the population involved.
 
    Currie, L., Sheehan, B., Graham, P., Stetson, P., Cato, K., & Wilcox, A. (2009). Sociotechnical analysis of a neonatal ICU. Studies In Health Technology and Informatics, (146), 258–262.
Retrieved from the Walden Library databases.
In this article, the authors provide a brief overview of sociotechnical theory. The authors also describe the results of a sociotechnical analysis of a neonatal intensive care unit.
 
    Molleman, E., & Broekhuis, M. (2001). Sociotechnical systems: Towards an organizational learning approach. Journal of Engineering and Technology Management, 18(3), 271–294.
Retrieved from the Walden Library databases.
The authors of this article explore the application of sociotechnical systems (STS) theory for designing work processes to improve organizational performance. The authors examine the application of STS with four organizational performance indicators: price, quality, flexibility, and innovation.
 
    Scott‐Findlay, S., & Estabrooks, C. A. (2006). Mapping the organizational culture research in nursing: A literature review. Journal of Advanced Nursing, 56(5), 498–513.
Retrieved from the Walden Library databases.
This article provides an empirical review of the nursing literature on organizational culture and its influence on practitioners.