Client Questions

CS/SB 614 authorizes  an ARNP to prescribe, dispense, administer, or order any drug, which would include controlled substances. ARNP disciplinary sanctions are added to the bill in s. 456.072, F.S., (Section 5) to mirror a physician’s sanctions for prescribing or dispensing a controlled substance other in the course of professional practice or failing to meet practice standards. Additional acts for which discipline may be taken against an ARNP relating to practicing with controlled substances that are added to the Nurse Practice Act (Section 10) include: ? Presigning blank prescription forms. ? Prescribing a Schedule II for office use. ? Prescribing, dispensing, or administering an amphetamine or sympathomimetic amine drug, except for specified conditions. ? Prescribing, dispensing, or administering certain hormones for muscle-building or athletic performance. ? Promoting or advertising a pharmacy on a prescription form unless the form also states that the prescription may be filled at the pharmacy of your choice. ? Prescribing, dispensing, or administering drugs, including controlled substances, other than in the course of his or her professional practice. ? Prescribing, dispensing, or administering a controlled substance to himself or herself. ? Prescribing, dispensing, or administering laetrile. ? Dispensing a controlled substance listed in Schedule II or Schedule III in violation of the requirements for dispensing practitioners in the Pharmacy Practice Act. ? Promoting or advertising controlled substances. After reading the following news article http://c-hit.org/2015/04/06/high-prescribing-nurse-surrenders-drug-licenses/ Identify what issues may arise with prescriptive authority of controlled substances and how you may avoid these situations?

Topic 2: Economics of Health Care The cost of healthcare in the U.S. is often discussed by the press. Trends in healthcare spending are determined by public and private decisions about health care delivery and reflect the values and beliefs of society and policy makers. Compare the distribution of healthcare expenses for 2017. https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nationalhealthaccountshistorical (Nation’s health dollar – where it came from and where it went) with those of 2011 (see textbook). Write a summary of your findings and their meaning in terms of health care spending. please provide references in apa style.

The interpretation of research in health care is essential to decision making. By understanding research, health care providers can identify risk factors, trends, outcomes for treatment, health care costs and best practices. To be effective in evaluating and interpreting research, the reader must first understand how to interpret the findings. You will practice article analysis in Topics 2, 3, and 5. For this assignment: Search the GCU Library and find three different health care articles that use quantitative research. Do not use articles that appear in the Topic Materials or textbook. Complete an article analysis for each using the “Article Analysis 1” template. Refer to the “Patient Preference and Satisfaction in Hospital-at-Home and Usual Hospital Care for COPD Exacerbations: Results of a Randomised Controlled Trial,” in conjunction with the “Article Analysis Example 1,” for an example of an article analysis. While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center. This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

Respond to the Post that is bellow using one or more of the following approaches: Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives. Validate an idea with your own experience and additional sources. Make a suggestion based on additional evidence drawn from readings, or after synthesizing multiple postings.                                              Initial Discussion Post                                              Literature Searches           Nursing is a field filled with numerous  policies and procedures.  To understand these policies and procedures,  the practice of research and knowledge acquisition is essential.  The  method of incorporating proper research into daily practice is called  evidence-based practice (Polit & Beck, 2017).  The goal of using  evidence-based practice is to move away from traditions and ritual by  incorporating tested research evidence that supports clinical practices  (Polit & Beck, 2017). Summary of Article Search             Based on the  evidence hierarchy by Polit & Beck (2017), and the levels of  evidence presented in class I was able to evaluate research articles  (Walden University, 2018).  When looking for specific research for my  topic, I searched for the highest level of evidence.  There are three  types of research which are: primary, synthesized or secondary, and  others such as expert opinions or practice questions (Polit & Beck,  2017).              My PICOT  question is: In patients with acute pain in the emergency department,  what is the effect of Ketamine use for the reduction of pain compared to  opioid medications during their ED visit? To begin the search, I used  the keywords Ketamine, analgesia, sedation and emergency medicine.   Using these words, I was able to find 408 results.  I further limited my  search to ten years which yielded 297 results.  Finally, I used  systematic reviews, meta-analysis and randomized control trials (RCTs)  for my final search narrowing the articles to 111.  Upon examination of  the articles, I found the articles based on systematic reviews,  meta-analysis and RCTs provided detailed research including abstracts,  methods of trials, results, discussion, limitations, and conclusion.   Each of these sections specifies the purpose of the study in detail.            Using this framework for literature review  ensures relevant research is used to answer evidence seeking questions.   Davies (2011) comments, “detailed knowledge of the frameworks enables  the searcher to refine strategies to suit each particular situation  rather than trying to fit a search situation to a framework” (p. 79).   By using a timeframe such as the past ten years, it is easier to see the  relevance of the information to clinical practice today.  An active  literature search will yield the most appropriate information for the  question being posed. References 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 https://ejournals.library.ualberta.ca/index.php/EBLIP/article/viewFile/97418144 Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer. Walden University Library. (2018). Levels of evidence. Retrieved from http://academicguides.waldenu.edu/c.php?g=80240&p=52322

The assignment for this week consists of 3-5 pages paper evaluating consumer/patient health information on the web. You will be required to find a website that is designed to provide health information to the consumer/patient and analyze it according to the criteria described below. You are required to report your analysis in a formal course paper.

SOAP Note Assignment Click here to download and analyze the case study for this week. Create a SOAP note for disease prevention, health promotion, and acute care of the patient in the clinical case. Your care plan should be based on current evidence and nursing standards of care. Visit the online library and research for current scholarly evidence (no older than 5 years) to support your nursing actions. In addition, consider visiting government sites such as the CDC, WHO, AHRQ, Healthy People 2020. Provide a detailed scientific rationale justifying the inclusion of this evidence in your plan. Next determine the ICD-10 classification (diagnoses). The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-10-CM) is the official system used in the United States to classify and assign codes to health conditions and related information. Click here to access the codes. Download the SOAP template to help you design a holistic patient care plan. Utilize the SOAP guidelines to assist you in creating your SOAP note and building your plan of care. You are expected to develop a comprehensive SOAP note based on the given assessment, diagnosis, and advanced nursing interventions. Reflect on what you have learned about care plans through independent research and peer discussions and incorporate the knowledge that you have gained into your patient’s care plan.  If the information is not in the provided scenario please consider it normal for SOAP note purposes, if it is abnormal please utilize what you know about the disease process and write what you would expect in the subjective and objective areas of your note. Format Your care plan should be formatted as a Microsoft Word document. Follow the current APA edition style. Your paper should be no longer than 3-4 pages excluding the title and the references and in 12pt font. Name your document: SU_NSG6001_W2A2_LastName_FirstInitial.doc. Submit your document to the Submissions Area by the due date assigned.

In this Discussion, you will consider different socioeconomic, spiritual, lifestyle, and other cultural factors that should be taken into considerations when building a health history for patients with diverse backgrounds. Case 1 JC, an at-risk 86-year-old Asian male is physically and financially dependent on his daughter, a single mother who has little time or money for her father’s health needs. He has a hx of hypertension (HTN), gastroesophageal reflux disease (GERD), b12 deficiency, and chronic prostatitis. He currently takes Lisinopril 10mg QD, Prilosec 20mg QD, B12 injections monthly, and Cipro 100mg QD. He comes to you for an annual exam and states “I came for my annual physical exam, but do not want to be a burden to my daughter.”   Case 2 TJ, a 32-year-old pregnant lesbian, is being seen for an annual physical exam and has been having vaginal discharge. Her pregnancy has been without complication thus far. She has been receiving prenatal care from an obstetrician. She received sperm from a local sperm bank. She is currently taking prenatal vitamins and takes Tylenol over the counter for aches and pains on occasion. She a strong family history of diabetes. Gravida 1; Para 0; Abortions 0. Case 3 MR, a 23-year-old Native American male comes in to see you because he has been having anxiety and wants something to help him. He has been smoking “pot” and says he drinks to help him too. He tells you he is afraid that he will not get into Heaven if he continues in this lifestyle. He is not taking any prescriptions medications and denies drug use. He has a positive family history of diabetes, hypertension, and alcoholism. To prepare: · Reflect on your experiences as a nurse and on the information provided in this week’s Learning Resources on diversity issues in health assessments. · Select one of the three case studies. Reflect on the provided patient information. · Reflect on the specific socioeconomic, spiritual, lifestyle, and other cultural factors related to the health of the patient you selected. · Consider how you would build a health history for the patient. What questions would you ask, and how would you frame them to be sensitive to the patient’s background, lifestyle, and culture? Develop five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks. · Think about the challenges associated with communicating with patients from a variety of specific populations. What strategies can you as a nurse employ to be sensitive to different cultural factors while gathering the pertinent information? Post Post an explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you selected. Explain the issues that you would need to be sensitive to when interacting with the patient, and why. Provide at least five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.  This work should have Introduction and conclusion – This work should have at 3 to 5current references (Year 2013 and up) – Use at least 2 references from class Learning Resources The following Resources are not acceptable: 1. Wikipedia 2. Cdc.gov- nonhealthcare professionals section 3. Webmd.com CLASS LEARNING RESOURCES **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. Chapter 1, “The History and      Interviewing Process” (pp. 1-20) This chapter highlights history and interviewing processes. The authors explore a variety of communication techniques, professionalism, and functional assessment concepts when developing relationships with patients. Chapter 2, “Cultural      Competency” (pp. 21–29) This chapter highlights the importance of cultural awareness when conducting health assessments. The authors explore the impact of culture on health beliefs and practices. **Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby. Chapter 2, “Evidenced- Based Health Screening”      (pp. 6-9) **Melton, C., Graff, C., Holmes, G., Brown, L., & Bailey, J. (2014). Health literacy and asthma management among African-American adults: An interpretative phenomenological analysis. Journal of Asthma, 51(7), 703–713. doi: 10.3109/02770903.2014.906605 Retrieved from the Walden Library Databases. The authors of this study discuss the relationship between health literacy and health outcomes in African American patients with asthma. **Centers for Disease Control and Prevention (2015). Cultural competence. Retrieved from https://npin.cdc.gov/pages/cultural-competence This website discusses cultural competence as defined by the Center for Disease Control and Prevention (CDC). Understanding the difference between cultural competence, awareness, and sensitivity can be obtained on this website.  **United States Department of Human & Health Services. Office of Minority Health. (2016). A physician’s practical guide to culturally competent care. Retrieved from https://cccm.thinkculturalhealth.hhs.gov/ From the Office of Minority Health, the Website offers CME and CEU credit and equips health care professionals with awareness, knowledge, and skills to better treat the increasingly diverse U.S. population they serve. **Espey, D., Jim, M., Cobb, N., Bartholomew, M., Becker, T., Haverkamp, D., & Plescia, M. (2014). Leading causes of death and all-cause mortality in American Indians and Alaska Natives. American Journal of Public Health, 104(S3), S303-S311.  The authors of this article present patterns and trends in all-cause mortality and leading cause of death in American Indians and Alaskan Natives. **Wannasirikul, P., Termsirikulchai, L., Sujirarat, D., Benjakul, S., Tanasugarn, C. (2016). Health literacy, medication adherence, and blood pressure level among hypertension older adults treated at primary health care centers. Southeast Asian J Trop Med Public Health., 47(1):109-20. The authors of this study explore the causal relationships between health literacy, individual characteristics, literacy, culture and society, cognitive ability, medication adherence, and the blood pressure levels of hypertensive older adults receiving health care services at Primary Health Care Centers.

The field of nursing has changed over time. In a 750-1,000 word paper, discuss nursing practice today by addressing the following: Explain how nursing practice has changed over time and how this evolution has changed the scope of practice and the approach to treating the individual. Compare and contrast the differentiated practice competencies between an associate and baccalaureate education in nursing. Explain how scope of practice changes between an associate and baccalaureate nurse. Identify a patient care situation and describe how nursing care, or approaches to decision-making, differ between the BSN-prepared nurse and the ADN nurse. Discuss the significance of applying evidence-based practice to nursing care and explain how the academic preparation of the RN-BSN nurse supports its application. Discuss how nurses today communicate and collaborate with interdisciplinary teams and how this supports safer and more effective patient outcomes. Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.  You are required to submit this assignment to turnitin Please refer to the directions in the Student Success Center.

Reply to this student post adding extra  information related with this student post  less than 20 % similarity.    1.         Biologic variations refer to traits of genetic disease common to a cultural group, among these traits we can mention thalassemia, a form of anemia is found in the Mediterranean’s populations, that can present in two forms, one is asymptomatic and produces mild anemia and the other is lethal and requires intense treatment from a very early age. On the populations of Asian descent is common to find lactose intolerance, that has to be considered to adapt nutrition during pregnancy and lactation period. (London et al, 2017) The African American population has a higher incidence of sickle cell disease, which is an anomaly of the hemoglobin cell, diabetes and essential hypertension are also in high prevalence in this population. On the Ashkenazi Jewish population there is the possibility of Tay-Sachs disease (fatal neurodegenerative disorder). (https://www.drugtopics.com, n.d.)   Knowledge of possible conditions related to the cultural background of the patients is important to have, this will enable the nurse to educate the parents on the genetic risk of the pregnancy and offer genetic testing that would help determine any conditions the fetus may have. Also the knowledge of prevalence of conditions like diabetes and hypertension among certain culture groups should help guide the prenatal care that the mother receives, helping her to make better dietary choices and modifications that are both culturally appropriate and that will help with a healthier pregnancy. (London et al, 2017) 2.         Depending of the origin of the family, the nurse needs to keep in mind their beliefs about the possible causes of the cord accident. For example for the Mexican population it is believed that the cord can wrap around the baby’s neck if the mom raises her arms overhead during pregnancy. If they are of Cuban origin they may believe that the cord wrapped around the baby’s neck because the mother wore a necklace during pregnancy or she raised her arms overhead during gestation. This is an important knowledge to have in order to plan appropriate nursing interventions for the situation, including education about the incidence and causes of cord accidents. Additionally proper assessment for the mother feeling of guilt and possible depression or suicidal ideations need to be implemented, this mother may be tormented by feelings that the death of the child is only her fault. Also it would be important to prepare space for the mourning, given that most Hispanic families will mourn together, accommodations should be made for them to have room and privacy to grief. 3.         Prescriptive beliefs are those that suggest to the mother what to do for a successful pregnancy and a healthy baby, for example in the Cuban culture they expect he mother to eat for two, (Purnell, 2014). This is culturally accepted belief to have a positive result to the pregnancy, but given the biologic variations of this particular population that includes hypertension, diabetes and obesity, this belief could cause unnecessary risk during pregnancy because over eating and excessive weight gain may happen, besides it will increase risks of pre-eclampsia and gestational diabetes. Education should be provided to the mother to dispel this beliefs. Restrictive beliefs are those that tell the mother what not to do in order to have a healthy child. For example in the Puerto Rican population some women believe that having intimate relationships after the first trimester may directly harm the fetus or cause preterm labor. (Purnell, 2014). As a nurse you can provide education to dispel this belief but being always respectful the patient desires, further instructions can be provided on sexual positions that maybe more comfortable for the mother if she so desires. Other popular prescriptive belief is that raising arms overhead will result in the strangulation of the child with the umbilical cord. (Purnell, 2014). This is a belief that should be addressed early in the pregnancy and being careful of not diminishing the cultural belief of the parents more information about causes and incidence of this happening should be provided. 4.         Many Asian cultures believe that the mother should avoid cold up to a month postpartum, to help decrease the ying or cold energy, this includes not drinking or eating cold food or beverage and also includes not exposing the body to cold air or cold showers (Purnell, 2014). These practices should be supported and respected as long as they don’t represent a risk for the mother. Among the nursing interventions that maybe put in place are raising the room temperature so the mother feels safe uncovering herself for assessments or interventions, offering teas and warm beverages to keep the mother properly hydrated. Always being respectful to the mother’s belief and remembering that they may also refuse to bath for the first month of postpartum, in which case instructions about perineal care should be given in order to avoid infections. References https://www.drugtopics.com. (n.d.). Retrieved June 1, 2020, from https://www.drugtopics.com/top-news/common-health-problems-selected-minority-ethnic-and-cultural-groups London, M. L., Ladewig, P. W., Davidson, M. R., Bindler, R. C., Ball, J. W., & Cowen, K. J. (2017). Maternal and Child Nursing Care. Philadelphia, PA, PA: Pearson Education, Incorporated. Purnell, L. D. (2014). Guide to Culturally Competent Health Care. Philadelphia, PA, PA: F.A. Davis Company

Write a 1000-1500 word essay addressing each of the following points. Be sure to completely answer all the questions for each bullet point. There should be two main sections, one for each bullet below. Separate each section in your paper with a clear heading that allows your professor to know which bullet you are addressing in that section of your paper. Support your ideas with at least three (3) sources using citations in your essay. Make sure to cite using the APA writing style for the essay. The cover page and reference page in correct APA do not count towards the minimum word amount. Review the rubric criteria for this assignment. Explain how cannabis works in the body by including information regarding the endocannabinoid system (ECS) and endocannabinoid deficiency syndrome. Describe four different delivery routes patients may use cannabis, the onset of action for each, and one pro and one con of each route. Assignment Expectations: Length: 1000-1500 words; answers must thoroughly address the prompts in a clear, concise manner. Structure: Include a title page and reference page in APA format.  These do not count towards the minimum word count for this assignment. Your essay must include an introduction and a conclusion. References: Use appropriate APA style in-text citations and references for all resources utilized to answer the questions.  A minimum of three (3) scholarly sources and the textbook are required. Rubric: This assignment uses a rubric for scoring. Please review it as part of your assignment preparation and again prior to submission to ensure you have addressed its criteria at the highest level. Format: Save your assignment as a Microsoft Word document (.doc or .docx) or a PDF document (.pdf) File name: Name your saved file according to your first initial, last name, and the assignment number