As an advanced practice nurse, you will run into situations where a patient’s wishes about his or her health conflict with evidence, your own experience, or a family’s wishes. This may create an ethical dilemma. What do you do when these situations occur?

 

Case Study #2: 

CASE STUDY 2 A 49-year-old woman with advanced stage cancer has been admitted to the emergency room with cardiac arrest. Her husband and one of her children accompanied the ambulance.

Lab Assignment: Ethical Concerns

As an advanced practice nurse, you will run into situations where a patient’s wishes about his or her health conflict with evidence, your own experience, or a family’s wishes. This may create an ethical dilemma. What do you do when these situations occur?

In this Lab Assignment, you will explore evidence-based practice guidelines and ethical considerations for specific scenarios.

To Prepare

Review the scenarios provided by your instructor ( ABOVE)

· Based on the scenarios provided:

o Select one scenario, and reflect on the material presented throughout this course.

o What necessary information would need to be obtained about the patient through health assessments and diagnostic tests?

o Consider how you would respond as an advanced practice nurse. Review evidence-based practice guidelines and ethical considerations applicable to the scenarios you selected.

The Lab Assignment

Write a detailed one-page narrative (not a formal paper) explaining the health assessment information required for a diagnosis of your selected patient (include the scenario number). Explain how you would respond to the scenario as an advanced practice nurse using evidence-based practice guidelines and applying ethical considerations. Justify your response using at least three different references from current evidence-based literature.

Resources for reference

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 24, “Sports      Participation Evaluation”

    In this chapter, the authors describe the process of a sports      participation evaluation. The chapter also states the most common      conditions encountered in a sports participation evaluation.

  • Chapter 25, “Putting It All Together”

    In this chapter, the authors tie together the concepts introduced in      previous chapters. In particular, the chapter has a strong emphasis on the      patient-caregiver relationship.

Tingle, J. & Cribb, A. (2014). Nursing law and ethics (4th ed.). Chichester, UK: Wiley Blackwell. 

Furman , C. D., Earnshaw, L. A., Farrer, L. A. (2014). A case of inappropriate apolipoprotein E testing in Alzheimer’s disease due to lack of an informed consent discussion. American Journal of Alzheimer’s Disease & Other Dementias, 29(7), 590–595. doi:10.1177/1533317514525829.

Navarro-Illana, P., Aznar, J., & Díez-Domingo, J. (2014). Ethical considerations of universal vaccination against human papilloma virus. BMC Medical Ethics, 15(29). doi:10.1186/1472-6939-15-29. Retrieved from http://www.biomedcentral.com/1472-6939/15/29

Maron , B. J., Friedman, R. A., & Caplan, A. (2015). Ethics of preparticipation cardiovascular screening for athletes. Nature Reviews Cardiology, 12(6), 375–378. doi:10.1038/nrcardio.2015.21

May, K. H., Marshall, D. L., Burns, T. G., Popoli, D. M. & Polikandriotis, J. A. (2014). Pediatric sports specific return to play guidelines following concussion. The International Journal of Sports Physical Therapy, 9(2), 242–255. PMCID: PMC4004129. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4004129/ 

American Academy of Pediatrics. (2008). Recommendations for preventative pediatric health care (periodicity schedule). Retrieved from https://www.harmonyhpi.com/WCAssets/illinois/assets/IL_MedicaidProviderManual_PEM_AdultPHGsForProviders.pdf

This resource provides recommendations for preventative pediatric healthcare from infancy through adolescence. The periodicity schedule covers a variety of areas, from health history to measurements, developmental/behavioral screenings, physical exams, procedural screenings, and oral health.

Rourke, L., Leduc, D., & Rourke, J. (2017). Rourke Baby Record. Retrieved from http://rourkebabyrecord.ca/

This website provides information on the Rourke Baby Record (RBR). The RBR supplies guidelines on growth and nutrition, developmental surveillance, physical exam parameters, and immunizations for well-baby and child care.

As you build your project/presentation, be sure to provide the evidence/research in the literature that supports your evidence based PRIMARY LEVEL OF PREVENTION intervention. Provide the citation on the slide of your interventions that demonstrates the evidence. For example, education is not a solution unless you have research evidence that demonstrates that it solves your identified problem.  I look forward to all the great ideas you each have for solutions to your topics.

 

As you build your project/presentation, be sure to provide the evidence/research in the literature that supports your evidence based PRIMARY LEVEL OF PREVENTION intervention. Provide the citation on the slide of your interventions that demonstrates the evidence. For example, education is not a solution unless you have research evidence that demonstrates that it solves your identified problem.  I look forward to all the great ideas you each have for solutions to your topics.

Tips for creating the powerpoint:

1.  Bullet points only, no complete sentences

2.  Do not use first person or vague pronouns

3.  Goals need to be outcomes focused on a pre/post measure of change related to your interventions

4.  Use pictures on the slides

You all have clearly discussed interventions at the community and system levels. How does this presentation on the web of causation help to expand on the complexity of your population?

THIS IS VERY IMPORTANT

Answer the following questions as you develop your evidence-based, culturally appropriate intervention for your community:

What health issue, problem, or disparity in health outcomes is of concern to you as a scholar practitioner in your community? What gaps in knowledge and care do you see as possible causes for the health issue? What does the health data tell you about the health issue? What does the literature tell you about the health issue? How can you learn about the health issue and about possible solutions from the viewpoint of families, community as a whole, and health professionals in your community? What evidence is there to support your proposal? What is one avenue you could advocate for improved health outcomes and know when a change has taken place?

Suggestions for the Project

Each week’s activities are geared to help you move along with your proposal. Use this time well and utilize some aspect of discussion and assignments in this course (e.g. windshield survey) to support your proposal as well. Read about the whole project before you start. 

Week 1: Identification of a Population in Your Community

Week 2: Practicum: Epidemiology: Define Your Population and Selected Problem

Week 3: Practicum: Population Cultural Considerations and Genetic Predisposition

Week 4: Evidence-Based Practice and Evaluation of the Project Through Measureable Goals

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    Identificationofpopulationinyourcommunityweek1.docx
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    PopulationCulturalConsiderationsandGeneticPredispositionweek3.docx
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    Evidence-BasedPracticeandEvaluationoftheProjectThroughMeasureableGoals.docx

Minimum of 250 words with at least 2 peer review reference in apa 6th edition style

Minimum of 250 words with at least 2 peer review reference in apa 6th edition style

 

History: A 35 year old nurse complained of nervousness, mood swings, weakness, and palpitations with exertion for the past 6 months. Recently, she noticed excessive sweating and wanted to sleep with fewer blankets than her husband. She used oral contraceptives and her menstrual periods were regular.

Physical examination: Pulse was 92/minute and BP was 130/60. She appeared anxious, with a smooth, warm, and moist skin, a fine tremor, a bounding cardiac apical impulse, and she couldn’t rise from a deep knee bend without aid. Her thyroid was diffusely enlarged, soft, mobile, without nodularity and there was no lymphadenopathy. Her eyes were not prominent (proptotic) and she had no focal skin thickening.

Laboratory studies: Serum T4=15.6 ug/dl and serum T3=210 ng/dl.

  1. What is the level of thyroid function in this patient? Are additional diagnostic tests necessary to define the level of thyroid function and if so which one(s)?
  2. What is the most likely cause of this patient’s illness? What tests are necessary to confirm its cause? Are antithyroid antibodies helpful?

Case Studies:  Students are required to complete case studies as they are assigned via Blackboard. The case study rubric will be posted on the Blackboard and will be available for viewing by students. After posting a critique of the article, students must also respond to 2 other original posts.

Case Studies:  Students are required to complete case studies as they are assigned via Blackboard. The case study rubric will be posted on the Blackboard and will be available for viewing by students. After posting a critique of the article, students must also respond to 2 other original posts.

  • Read the article, discuss the relevance to your current research agenda/problem.
  • Your identifiable problem. What is it?
  • Your proposed nursing theorist that most identifies with your research issue. Whom did you use?
  • Is there a direct correlation? Does the theorist support your research problem?
  • Is there a connection to nursing practice?
  • Does the research offer any diverse support or methodologies?
  • How will you use the outcomes in practice?

***Original Assignment must be written in APA 6th Edition, please include references and intext citations if used. All responses are submitted in the discussion board format. The assignment is worth 15 points.

Please review the following article (there is an attachment). Here is the article and its citation:

FNU Nursing Theory_Situation Specific Theories_Philosophical Roots_Properties and Approach.pdf

. According to the AAFP/CDC Guidelines, what antifungal medication(s) should this patient be prescribed, and for how long? Write her complete prescriptions using the prescription writing format in your textbook.

DERMATOLOGY CASE STUDY

Chief complaint:  “ My right great toe has been hurting for about 2 months and now it’s itchy, swollen and yellow. I can’t wear closed shoes and I was fine until I started going to the gym”.

HPI: E.D a 38 -year-old Caucasian female presents to the clinic with complaint of pain, itching, inflammation, and “yellow” right great toe. She noticed that the toe was moderately itching after she took a shower at the gym. She did not pay much attention. About two weeks after the itching became intense and she applied Benadryl cream with only some relief.  She continued going to the gym and noticed that the itching got worse and her toe nail started to change color. She also indicated that the toe got swollen, painful and turned completely yellow 2 weeks ago. She applied lotrimin  AF cream and it did not help relief her symptoms. She has not tried other remedies.

Denies associated symptoms of fever and chills.

PMH: Diabetes Mellitus, type 2.

Surgeries: None

Allergies: Augmentin

Medication: Metformin 500mg PO BID.

Vaccination History:  Immunization is up to date and she received her flu shot this year.

Social history: College graduate married and no children. She drinks 1 glass of red wine every night with dinner. She is a former smoker and quit 6 years ago.

Family history:Both parents are alive. Father has history of DM type 2, Tinea Pedis. mother alive and has history of atopic dermatitis, HTN.

ROS:

Constitutional: Negative for fever. Negative for chills.

Respiratory: No Shortness of breath. No Orthopnea

Cardiovascular: Regular rhythm.

Skin: Right great toe swollen, itchy, painful and discolored.

Psychiatric: No anxiety. No depression.

Physical examination:

Vital Signs

Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 130/70 T 98.0, P 88 R 22, non-labored

HEENT: Normocephalic/Atraumatic, Bilateral cataracts; PERRL, EOMI; No teeth loss seen. Gums no redness.

NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.

LUNGS: No Crackles. Lungs clear bilaterally. Equal breath sounds. Symmetrical respiration. No respiratory distress.

HEART: Normal S1 with S2 during expiration. Pulses are 2+ in upper extremities. 1+ pitting edema ankle bilaterally.

ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.

GENITOURINARY: No CVA tenderness bilaterally. GU exam deferred.

MUSCULOSKELETAL: Slow gait but steady. No Kyphosis.

SKIN: Right great toe with yellow-brown discoloration in the proximal nail plate. Marked periungual inflammation. + dryness. No pus. No neuro deficit.

PSYCH: Normal affect. Cooperative.

Labs: Hgb 13.2, Hct 38%, K+ 4.2, Na+138, Cholesterol 225, Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98.

Assessment:

Primary Diagnosis: Proximal subungual onychomycosis

Differential Diagnosis:  Irritant Contact Dermatitis, Lichen Planus, Nail Psoriasis

Special Lab:

Fungal culture confirms fungal infection.

As an NP student, you need to determine the medications for onychomycosis.

1. According to the AAFP/CDC Guidelines, what antifungal medication(s) should this patient be prescribed, and for how long? Write her complete prescriptions using the prescription writing format in your textbook.

2.  What labs for baseline and follow up of therapy would you order for this patient? Give rationale.

Interview someone from a different cultural background than your own to learn how he or she perceives illness, including the meaning, causes, treatment, and feelings associated with both acute and chronic illnesses. Determine how his or her culture tends to view nurses

Topic 1

Interview someone from a different cultural background than your own to learn how he or she perceives illness, including the meaning, causes, treatment, and feelings associated with both acute and chronic illnesses. Determine how his or her culture tends to view nurses. In your discussion:

Discuss how the perceptions of the interviewee influence his or her health behavior, including when he or she seeks help and the type of practitioner he or she consults.

Describe how his or her perceptions differ from your own.

Describe the strategies you could employ to promote the delivery of culturally competent care.

Topic 2

Which philosophy/conceptual framework/theory/middle-range theory describes nursing in the way you think about it? Discuss how you could utilize the philosophy/conceptual framework/theory/middle-range theory to organize your thoughts for critical thinking and decision making in nursing practice.

Citations should conform to APA guidelines. You may use this APA Citation Helper as a convenient reference for properly citing resources or connect to the APA Style website through the APA icon below.

In a 6- to 7-page paper in APA format describe your personal approach to professional nursing practice. Be sure to address the following

Personal Philosophy of Nursing

In a 6- to 7-page paper in APA format describe your personal approach to professional nursing practice. Be sure to address the following:

  • Which philosophy/conceptual framework/theory/middle-range theory describes nursing in the way you think about it? Discuss how you could utilize the philosophy/conceptual framework/theory/middle-range theory to organize your thoughts for critical thinking and decision making in nursing practice.
  • Formulate and discuss your personal definition of nursing, person, health, and environment.
  • Discuss a minimum of two beliefs and/or values about nursing that guide your own practice.
  • Analyze your communication style using one of the tools presented in the course. In your paper, discuss the strengths and weaknesses associated with your style of communication and the impact on your ability to collaborate as part of an interdisciplinary team.
  • On a separate references page, cite all sources using APA format.

Human trafficking, extreme poverty, preventable diseases, the opioid crisis and the lack of adequate low-income housing are a few current societal concerns worthy of social change. Nurses and healthcare leaders are in a good position to shape and influence health care policy. 

Population Health Advocacy

Human trafficking, extreme poverty, preventable diseases, the opioid crisis and the lack of adequate low-income housing are a few current societal concerns worthy of social change. Nurses and healthcare leaders are in a good position to shape and influence health care policy.

Think of a cause you believe in strongly. Access the website of your elected officials either at the local, state, or federal level using the following link: https://www.usa.gov/elected-officials/ or use the website of your choice. Explore some of the issues and committees your legislators are involved in and select at least one that interest you or align with your beliefs. You may also contact your legislator’s office and speak to his or her legislative assistant by calling the U.S. Capitol switchboard operator at (202) 224-3121 for the Senate and (202) 225-3121 for the House. Legislator assistants are very knowledgeable about the legislator’s agenda and can provide a wealth of information.

This assignment will be at least 1500 words or more. This week reflect on advocacy, collaborative partnerships with other health care practitioners and stakeholders, and the policy making process and write a paper that addresses the following:

  • Describe the policy issue, policy problem of interest or a particular bill that your legislator has introduced
  • Elaborate on why the policy matters and what you can possibly do to strengthen the policy?
  • Briefly define the role you would play as an advocate for the healthcare consumer and healthcare professionals.
  • Explain how the policy impacts the public at large or a particular population.
  • What stakeholders would you collaborate with to promote the cause?

Assignment Expectations

Length: 1500-2000 words in length

Structure: Include a title page and reference page in APA format. These do not count towards the minimal word amount for this assignment.  Your essay must include an introduction and a conclusion.

References: Use the appropriate APA style in-text citations and references for all resources utilized to answer the questions. A minimum of two (2) scholarly sources are required for this assignment.

Format: Save your assignment as a Microsoft Word document (.doc or .docx).

File name: Name your saved file according to your first initial, last name, and the module number (for example, “RHall Module 1.docx”)

Submission: Submit to the D2L dropbox for grading

Use California state as model state

The ACA was meant to provide quality health care coverage for all yet a coverage gap for some populations especially in states that oppose Medicaid expansion. Based on what you have learned so far in this course, create a PowerPoint presentation that addresses the coverage gap problem, who is impacted by the coverage gap, the role the ACA plays in the coverage gap, why the coverage gap should be closed, and solutions/ recommendations for closing the gap. Address the following in your PowerPoint:

Healthcare Coverage Gap

The ACA was meant to provide quality health care coverage for all yet a coverage gap for some populations especially in states that oppose Medicaid expansion. Based on what you have learned so far in this course, create a PowerPoint presentation that addresses the coverage gap problem, who is impacted by the coverage gap, the role the ACA plays in the coverage gap, why the coverage gap should be closed, and solutions/ recommendations for closing the gap. Address the following in your PowerPoint:

  • Select one state opposed to Medicaid expansion and describe why. Then, consider your own state. What are the benefits and drawbacks to Medicaid expansion in your state?
  • Define what the coverage gap is (problem/issue)
  • Discuss how the coverage gap impact low income healthcare consumers population.
  • What role does the ACA have in widening or closing the coverage gap?
  • Why is it important to close the gap (implications for positive social change)?
  • What are some solutions to closing the coverage gap and how can healthcare equity help close the gap? Include recommendations and/or solutions.

Your PowerPoint presentation should include/address:

  • Title Slide (1 slide)
  • Objectives Slide (1 slide)
  • Medicaid expansion (1-2 slides)
  • Coverage gap – define/problem/issue (1-2 slides)
  • Coverage gap impact on low income healthcare consumers (2-3 slides)
  • Role ACA has in widening or closing the coverage gap (1-2 slides)
  • Close the gap (1-2 slides)
  • Solutions to closing the coverage gap and how can healthcare equity help close the gap? (2-3 slides)
  • Reference slide (1-2 slides).

Assignment Expectations

Length: 9-14 slides (in addition to the title slide and reference slides)

Structure: Include a title slide and reference slide in APA format.  These do not count towards the minimum slide count for this assignment.  Your presentation must include an objectives slide.  Be sure to fully explain all slides in the Speaker Notes.

References: Use the appropriate APA style in-text citations and references for all resources utilized to answer the questions. A minimum of three (3) scholarly sources are required for this assignment.

Format: Save your assignment as a Microsoft PowerPoint document (.pptx) or a PDF document (.pdf).

File name: Name your saved file according to your first initial, last name, and the module number (for example, “RHall Module 1.docx”)

Submission: Submit to the D2L dropbox for grading

please use California as model state

 Respond to all the questions and include the questions and answers in the Paper work. APA style and 3 references.   this is the course book:Seidel’s Guide to Physical Examination 8th 

Respond to all the questions and include the questions and answers in the Paper work. APA style and 3 references.   this is the course book:Seidel’s Guide to Physical Examination 8th

  • W hat comprises the lymphatic system
  • Which set of lymph nodes is a common site of metastatic disease, and why?
  • Mrs. Kline, a postoperative patient who has just undergone a right modified mastectomy, is found to have edema of the right arm. What is the cause of the edema, and what teaching is necessary to help Mrs. Kline?
  • Mr. Jackson is a 76-year-old nursing home patient who has persistent wound infections and upper respiratory infections. What is the cause of Mr. Jackson’s recurring infections?
  • Describe the correct way to examine the lymphatic system
  • Define lymphedema
  • Provide the differential diagnosis of mumps versus cervical adenitis
  • What is elephantiasis?

JS is a 17-year-old adolescent who presents to the office with complaints of fatigue and overall body aches. He states that several of his classmates have been home sick as well. His past medical history is negative for medical illness, but he had myringotomy tubes placed when he was 5 years old. The patient lives with his mother, stepfather, and two siblings.

What is the most common cause of his diagnosis?

During the history, what positive findings will be in the HPI?

On physical examination of JS, what positive assessment results would you expect to find?

Name the primary muscles of respiration.

What is a normal rate of respiration per minute in an adult?

Prepare a teaching pamphlet on the effects of smoking on the chest and lungs.

Define the following terms and discuss when the examiner might see these conditions:

  1. Dyspnea
  2. Orthopnea
  3. Apnea
  4. Paroxysmal nocturnal dyspnea
  5. Platypnea
  6. Tachypnea
  7. Bradypnea
  8. Hyperpnea
  9. Kussmaul breathing
  10. Hypopnea
  11. Periodic breathing (Cheyne-Stokes)
  12. Air trapping
  13. Biot respiration
  14. Ataxia
  15. Retractions

what they would expect to find when assessing children or adolescents with the assigned condition.

  • Cystic fibrosis
  • Epiglottis
  • Croup
  • Tracheomalacia
  • Bronchiolitis
  • Respiratory distress syndrome

Differentiate between a pneumothorax and a hemothorax.

List risk factors associated with respiratory disability.

HG is a 62-year-old man with a significant history of COPD and emphysema. He has a positive PMH of frequent episodes of pneumonia. His social history includes cigarette smoking for 45 years. Identify your findings on HG and the emphysema.

What is the primary etiology of the emphysema?

What are the expected findings on inspection, palpation, percussion, and auscultation?

What are the subjective and objective findings in HG’s presentation?