Client Questions

Practice Location: Rehab center  Population: geriatric patients  10 week entry needed  You should briefly address these experiences throughout the weeks:  -Intraprofessional Collaboration -Ethical Considerations -Population health concerns -Health policy -Role of technology improving health care outcomes -Evidence-based practice (Most important to touch upon)  I will attach a few examples for you, so that your have an idea. Please do not copy it.  I need it before 4 pm tomorrow 1/20/19. Thank you.

I need a response to this assignment zero plgiarism three references Initials: J.S    Age: 42     Sex: Male   Race: African American  S. CC:  “I am experiencing lower back pain that radiates to my left leg” HPI:  Mr. Smith is a 42-year-old African American male who reports to the clinic complaining of lower back pain that periodically radiates to his left leg.  The pain started about one month ago.  The character of the pain is shooting and stabbing. It appears to get worse when sitting for an extended period of time, bending over and during strenuous physical activity. The severity of the pain is 8/10 without medications but relieves to about 3/10 after taking Tylenol and getting some rest.   Location: Lower back Onset: 1 month Character: Shooting and Stabbing Associated signs and symptoms: nausea, vomiting, photophobia. Timing: Sitting for extended periods, bending over and strenuous physical activity.  Exacerbating/ relieving factors: Tylenol and rest makes the pain tolerable, but not completely better. Severity: 8/10 pain scale Current Medications:  Metoprolol 100 mg tablet, PO once daily.  Acetaminophen 500 mg tabs, 1-2 PO q 6 hrs, PRN for pain. (not to exceed 3 g in 24 hr). PMHx: Diagnosis: Hypertension Surgical Hx: Laparotomy, 02/2000 Immunizations: Childhood immunizations completed. Tetanus and Flu shots are up-to-date. Soc Hx: Unemployed. Lives alone and never married. Has one brother and both parents are alive. Performs physical exercise regularly at the gym, and uses seat belts all the time when driving. Denies tobacco and alcohol use. Fam Hx: Father has a stroke and heart disease, Mother has hypertension, Brother has diabetes. Maternal and Paternal grandparents died of a stroke 2 years ago. ROS:  BP – 140/90 L arm,  P – 86, T – 98.1 oral,  RR – 18,  Ht. – 5’10”, Wt. – 200 lbs. BMI 28.7 GENERAL:   No weight loss, fever, chills, weakness or fatigue. HEENT:  Eyes:  No visual loss, blurred vision, doubles vision or yellow sclerae.  Ears, Nose, Throat:  No hearing loss, sneezing, congestion, runny nose or sore throat. Skin: No rash or itching. No skin lesions or moles that are new or suspicious.   CARDIOVASCULAR:  No chest pain, chest pressure or chest discomfort. No palpitations or edema. No pleurisy pain, no hx of a heart murmur. No EKG on record. No peripheral edema or claudication. BP controlled with medication.  RESPIRATORY:  No cough, sputum or SOB. No DOE, hemoptysis. Chest X-rays – 3 years ago.  GASTROINTESTINAL:  No anorexia, nausea, vomiting or diarrhea. No abdominal pain or blood. No unintentional weight loss or gain. No change in bowel habits. GENITOURINARY:  No penile discharge or erectile dysfunction. No nocturia, dribbling, or incontinence. NEUROLOGICAL:  No headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control. No reports of numbness or tingling to the left leg since the onset of lower back pain. MUSCULOSKELETAL: Reports lower back pain that sometimes radiate to the left leg. No edema noted.  HEMATOLOGIC:  No hx of Blood transfusions. No anemia, bleeding or bruising.  LYMPHATICS:  No hx of splenectomy. No enlarged lymph nodes. PSYCHIATRIC:  No hx of depression or anxiety. ENDOCRINOLOGIC:  No reports of sweating, cold or heat intolerance. No polyuria or polydipsia. No heat or cold intolerance. ALLERGIES:  NKFA, NKDA O. Physical exam:  General: Alert & Oriented x3. Appears well-nourished but exhibits a slight limp due to left leg pain. Cardiovascular: Regular heart rate and rhythm, normal heart sounds and intact pulses. No murmurs, gallops or pericardial friction rub. Pulm/chest: No respiratory distress. Lung Sounds clear to auscultation in all fields. Abdomen: Soft, non-tender, Bowel sounds present x4 quadrants. Musculoskeletal: Decreased mobility with lower back pain. Limited ROM with lumbar flexion. Gait disturbances, leaning to the right side on examination. Muscle spasms noted. Hip flexion/ extension and strength against resistance indicates weakness to left gluteus maximus and L5 nerve root involvement. No hip or joint instability, knees equal in height Neurological:  Bilateral L3-S1 dermatomes reactive to touch, no decrease in sensation. Deep tendon reflexes are symmetrical.  Knee jerk reflex positive and symmetrical bilaterally.  Diagnostic results:  Urinalysis: Negative, Light-yellow urine. A. Differential Diagnoses:  Low back pain & sciatica – Shooting pain in the lower back, that radiates down to one leg. Degenerative disc – The gradual deterioration of the disc between the vertebrae.  Lumbar radiculopathy – Nerve irritation caused by damage to the discs b/w the vertebrae.  Herniated disk -Signs and symptoms include arm/leg pain, numbness/tingling, and weakness.  The presenting low back pain symptoms indicate a sciatic nerve involvement since the pain is radiating down the posterior aspect of the left leg. The X-rays show lesions most likely at the L-5. Further tests that may be ordered include; Schober test. This test measures the ability of a patient to flex his lower back. The patient is asked to touch his toes while keeping the knees straight. A positive test will be less than 4 cm between the 2 marks indicating decreased lumbar mobility. A Straight Leg Raise (SLR) test can be used to determine if the patient has true sciatica. A positive SLR test usually indicates S1 or L5 root irritation. A FABER test can be used to rule out Sacroiliac (SI) Joint Pain and sacroiliitis. It is considered positive if movements reproduce pain or cannot be completed due to limited range-of-motion. Nerve testing of the lower extremities can be used to detect nerve irritation, while disc herniation can be detected with radiology testing, such as CT scan or MRI scan (McCance et al., 2014). According to El Barzouhi et al., (2013), patients with sciatica frequently experience disabling back pain. Sciatica or lumbar spine pain with nerve root involvement results in low back pain and leg pain. The condition generally resolves within a period of 8 weeks. If the low back pain does not resolve within 8 weeks, then consider using imaging techniques such as; CT scan or MRI (El Barzouhi et al., 2014).                          Diagnostic testing is not usually recommended within the first four weeks of the onset of low back pain, with no neurological symptoms, according to national practice guidelines (Dains, Baumann, & Scheibel, 2012). Evidence shows that unnecessary or routine imaging (X-ray, MRI, CT scans) for low back pain is not associated with improved outcomes. Patients who have early imaging had much greater health care use and costs, but they did not have better outcomes (AHRQ, 2015).  References Agency for Healthcare Research and Quality (2015). Back pain? Hold the MRI, new research says. Retrieved from https://www.ahrq.gov/news/newsletter/e-newsletter/464.html Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby. Dains, J. E., Baumann, L. C., & Scheibel, P. (2012). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St.Louis, Missouri: Elsevier. El Barzouhi, A., Vleggeert-Lankamp, C. L. A. M., van der Kallen, B. F., Lycklama à Nijeholt, G. J., van den Hout, W. B., Koes, B. W., & Peul, W. C. (2014). Back pain’s association with vertebral end-plate signal changes in sciatica. The Spine Journal, 14(2), 225–233. https://doi-org.ezp.waldenulibrary.org/10.1016/j.spinee.2013.08.058 McCance , K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2014). Pathophysiology: The biologic basis for disease in adults and children (7th ed.). St. Louis, MS: Elsevier.

Richard is a 40-year-old man with a history of 4 weeks of cluster headache once each year. These began when he was 35 years old. His cluster periods occur in the fall. The cluster period begins slowly, increasing over 1 week, reaching a peak where Richard has two or three severe cluster attacks each day. They occur from 10 p.m. to 3 a.m. Each cluster headache lasts from 40 to 90 minutes, and the headaches are severe. The pain is always on the right side, with eye tearing and nasal congestion.  Richard comes into our office 1 week into this fall’s cluster series. The headaches are increasing in intensity, and he is miserable with the pain. Please complete the following questions:  Describe Cluster Headache and its epidemiology. What would be your goals for therapy for Richard? Give rationale with evidence from articles.  Please limit your posts to the above 2 questions.  using APA 6th ed. Work must be supported by peer-reviewed article published within 5 years.

Choose one recent (within last 2 years) news story about genetic or genomic technology. Describe the issue presented. From the perspective as an RN or APRN, describe the ethical, cultural, religious, legal, fiscal, and societal implication.

Competency Analyze leadership and management roles in change management Evaluate different change management models. Examine various roles in change management. Analyze methods for understanding and mapping change in an organization. Critique strategies for removing barriers to change. Examine leadership’s role in executing successful change. Instructions Delta Pacific Case Study You serve as the change leader for Delta Pacific Company (DPC). Up until this point, the organizational culture has been one of a traditional culture as the company had a manufacturing environment.  DPC has undergone an extensive change from manufacturing to consulting, including  new employee roles and responsibilities, training, and resources. However, there have been organizational barriers and employee resistances to the changes, resulting in a declining profitability.  You have decided to design a Change Leadership Strategy plan to present to the  leaders of DPC to meet their goal of changing the culture from the more  traditional manufacturing environment to one of a contemporary consulting  environment. To complete your Leading Change Plan, please include the following: 3 page minimum  An APA-formatted title page. Breakdown of the current issues that Delta Pacific are facing. Analyzation of change leadership strategy to be implemented. Classify what type of leader mindset is needed to create a new environment. Compare and contrast advantages and disadvantages of two popular change models. Include at least three similarities and three  differences. Choose the one that you feel best compliments your strategy . Explain how the change model you decided to use will ensure the most effective and efficient process of changing an organizational culture. Construct a leadership team. Explain the importance of the leader’s position within each area of the change plan.  Include examples of what the leaders should expect during the change process. Continue with your plan to explain at least two specific organizational barriers and at least two specific employee resistance behaviors that are most likely to occur during an organizational culture change. Design strategies to combat those barriers and resistance behaviors. Discuss the behaviors that DPC’s leaders need to exhibit to ensure a positive and successful cultural shift for the long-term. Include the top mistakes leaders make during an organizational culture change and your recommendations to avoid those mistakes (module 6). Please include an APA-formatted reference page to document the sources used for your research. Make sure that your sources are credible.

Research the delivery, finance, management, and sustainability   methods of the U.S. health care system. Evaluate the effectiveness of   one or more of these areas on quality patient care and health   outcomes. Propose a potential health care reform solution to improve   effectiveness in the area you evaluated and predict the expected   effect. Describe the effect of health care reform on the U.S. health   care system and its respective stakeholders. Support your post with a   peer-reviewed journal article.

1. Use patient care technologies, communication techniques, and electronic charting systems competently when providing safe, quality care to adults and older adults who require illness and disease management. (FYI can you please pick either , central line dressing, . NG TUBE  specimen collection or any clinical activities that happen in a nursing home.)

Provide individualized education to diverse patient populations in a variety of health care settings. Based on the feedback offered by the provider, identify the best approach for teaching. Prepare a presentation based on the Teaching Work Plan and present the information to your community. Options for Delivery Select one of the following options for delivery and prepare the applicable presentation: PowerPoint presentation – no more than 30 minutes Pamphlet presentation – 1 to 2 pages Audio presentation Poster presentation Selection of Community Setting These are considered appropriate community settings. Choose one of the following: Public health clinic Community health center Long-term care facility Transitional care facility Home health center University/School health center Church community Adult/Child care center

what are your thoughts?? Organizational culture (OC) includes norms, systems, vision, assumptions, beliefs, philosophy, and values that hold together, and is expressed in its self-image, affects the way people and groups interact with each other, with clients, and future expectations. The culture within an organization is very important, playing a large role in whether it is a happy and healthy environment in which to work. In communicating and promoting the organizational ethos to employees, their acknowledgement and acceptance of it can influence their work behavior and attitudes. When the interaction between the leadership and employees is good, the latter will make a greater contribution to team communication and collaboration, and will also be encouraged to accomplish the mission and objectives assigned by the organization, thereby enhancing job satisfaction (Lluch, 2011). The major barriers resulting from organizational culture are communication barriers, employee resistance to change and management problems. In an organizational setting, cultural and language differences can hinder effective communication. Workers who are not fluent in the primary language used in the workplace may have difficulty expressing their needs or responding to requests from colleagues. Different cultures have developed their own language as a part of their heritage. People are comfortable communicating in their own language whereas have to work hard to learn new languages (Businesstopia in Communication, 2018). Communication barriers can make nurses leaders feel powerless because they cannot communicate their needs requirements and might as a result express difficulty giving commands and leading advocacy strategies for their staff as well as the patients. Also, an environment that where people cannot interact and relate with each other is prone to causing resistance to change. Most employees from different backgrounds who cannot interact with others to understand the need for change might be opposed to change, hence leading to a dysfunctional organizational culture.

Post a description of one or more significant ways in which Walden’s and the School of Nursing’s perspectives (i.e., vision, mission, social change message, and outcomes) relate to your professional and academic goals and to your becoming a scholar-practitioner. Include how you plan to incorporate social change into your professional and academic goals. Support your Discussion assignment with specific resources used in its preparation using APA formatting. You are asked to provide a reference for all resources, including those in the Learning Resources for this course.