Nursing

Assessing: Dark-skinned Patient
Assessing: Dark-skinned Patient
Question 1
A dark-skinned patient completes the health history questionnaire, which states that he identifies himself as Black American? According to Giger and Davidhizar’s Transcultural Assessment Model, which culture group could this patient belong to?
Black, African American, or “person of color”
Jamaican or other Caribbean nation of origin
Nigeria or other African nation of origin
Any of the above
Question 2
When caring for a patient from the Hispanic/Latino culture, a nurse would know that the patient respects the nurse’s knowledge and position by which action?
Shaking the nurse’s hand
Giving the nurse a big hug
Avoiding direct eye contact
Ensuring direct eye contact
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Question 3
Which of the following cultures views birth control methods other than rhythm as unacceptable because of their religious Catholic beliefs?
Hispanic
Mexican
Puerto Rican
South American
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Question 4
Which of the following responses might be expected from a Hispanic/Latino patient in pain?
Verbal and loud ensuring pain medication from the nurse
Stoic, therefore less likely be to acknowledged by the nurse
Assertively requesting pain medication when needed
Quiet which allows the nurse to ask the patient repeatedly if they want pain medication
Question 5
The major assumption within traditional African beliefs is that a person’s health or illness is directly influenced by her or his ___________________ with nature.
Concordance or Discordance
Agreement or Disagreement
Harmony or Disharmony
Balance and Imbalance
Question 6
Blacks Americans in the U.S. experience higher rates of mortality than any other racial or ethnic group in relation to heart disease, cancer and cerebrovascular disease. This indicates that _________________.
Blacks Americans enjoy greater health and fewer healthcare disparities than White Americans.
Black Americans suffer more from these problems than White Americans, which indicates a healthcare disparity.
White Americans suffer more from unequal access to healthcare resources than Black Americans.
Black Americans must engage in unhealthy lifestyles despite a focus on preventative care.
5 points
Question 7
Racial disparities between the White and Black population have continued to improve; however, large disparities in ______________ among the Black population persists.
Infant mortality
Smallpox infection
Influenza mortality
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Question 8
Which of the following languages are spoken by Black Americans in the United States?
English and various African languages
French
Spanish
All of the above
None, there are no differences
Question 9
A novice nurse assumes care of a patient in which the medical record section for “race/ethnicity” has been left blank. Which action by the nurse would be best indicated?
No action is needed as it does not affect the patient’s care.
Ask the patient how he/she prefers to be identified.
Ask the patient’s physician to avoid offending the patient.
Continue with the routine plan of care because you know that the social worker will collect this information prior to discharge.
Question 10
The U.S census data reveals remarkable growth of the Black American population in the United States. This is attributed to:
the birthrate among Blacks who are U.S. citizens.
immigration from Central and South America.
the high birthrate among immigrants from Africa and the Caribbean.
immigration from Africa, Latin America the Caribbean.
Question 11
Which of the following barriers do Mexican American cultures experience when utilizing the United States healthcare system?
Lack of access to adequate healthcare insurance
Lack of access or transportation to receive medical treatment
If Illegal or undocumented, do not quality for Medicare or Medicaid
All of the above
Question 12
Which of the following is a major obstacle that some Black Americans believe causes unfair treatment by health care providers?
Religious practices
The way English is spoken
Confrontational communication
Cultural insensitivity

Discussion: Evaluation of Marginalized Women
Discussion: Evaluation of Marginalized Women
Discussion: Evaluation of Marginalized Women
Purpose The purpose of this assignment is to Provide learners with the opportunity to integrate knowledge and skills learned throughout this course Directly apply principles and knowledge learned in the course to problem solving of population health problems in marginalized women. Course Outcomes This assignment enables the student to meet the following course outcomes: 1. Integrate current evidence based clinical practice guidelines in the care of childbearing and childrearing families. 2. Appropriately apply anticipatory guidance and health promotion in the care of childbearing and childrearing families. 3. Assess growth and developmental milestones in the care of childbearing and childrearing families. 4. Construct an evidence based reproductive health management plan. 5. Identify and address healthcare needs of marginalized childbearing and childrearing families Requirements This paper should clearly and comprehensively identify the disease or population health problem chosen. The problem must be an issue in your geographic area and a concern for the population you will serve upon graduation with your degree. The paper should be organized into the following sections: 1. Introduction with a clear presentation of the marginalized group as well as significance and a scholarly overview of the paper. 2. Background of the marginalized group/problem including description, current incidence and/or prevalence statistics current state, local, and national statistics pertaining to the problem. 3. Discuss the economic aspects of the marginalized group 4. Discuss social justice and its relationship to health disparities and health care of marginalized group. 5. Discuss ethical issues on marginalized group 6. Provide a brief plan of how you will address this marginalized group in your practice once you are finished with school. Provide three actions you will take along with how you will measure outcomes of your actions. 7. Conclude in a clear manner with a brief overview of key points of the entire problem Preparing the Paper · Choose one topic from the following list: · Female Veterans · Incarcerated Women · Lesbians CHOOSE TOPIC FROM HIGHLIGHTED · Transgender Women PLEASE · Women with HIV · Women Sex Workers · Women with Mental Illness · Women Immigrants · Women with Past Sexual Assault · · · Paper Length: 5-6 pages, excluding title/cover and reference pages · APA format 6th edition · Directions and Grading Criteria Category Points Possible Points Earned Comments Scholarly Introduction (clear presentation of marginalized group) 20 Background and significance of the marginalized group (includes incidence or prevalence statistics) 20 Socio-Economic aspects of the marginalized group 20 Social justice and its relationship to health disparities and health care of marginalized group 20 Ethical issues of the marginalized group 25 Plan of action (includes at least three evidenced based actions, supported by literature, that the student will take in their own practice and how outcomes will be measured) 30 Conclusion 10 Mechanics of writing, APA 5 Total 150 Total Points earned = A quality paper will meet or exceed all of the criteria requirements. REFERENCES CANNOT BE MORE THAN 5YRS OLD PLEASE ! REAL SCHOLARLY ARTICLES NOT MADE UP. PLEASE DO EXACTLY AS RUBRIC AND GUIDELINES STATES PLEASE

Assignment: Contraceptive Choice Discussion
Assignment: Contraceptive Choice Discussion
Assignment: Contraceptive Choice Discussion
Week 2 Claudia is a 26-year-old mother of two G2P2, she recently delivered her last child 9 months ago, and has been using condoms for birth control for the last 7 months. Today she is requesting a more reliable birth control, she is not sure of her current pregnancy plans, however, she does not wish to discuss sterilization. No religious contraindications for treatment. Previous methods include condoms, and oral contraceptive pills. PMH: positive for mild hypertension with first pregnancy, seasonal allergies. Surgeries: Right inguinal hernia and tonsillectomy. Family history: Mother HTN and Father colon CA both living Social History: Denies tobacco use, wine one to two glasses a week, denies recreational drugs, exercises twice a week. Drug allergies-Sulfa causes a rash. Current medications-MVI with Fe, Calcium chews, prn Allegra for allergies. Height 65 inches, weight 137 pounds, BP 110/75, P 70, R 16. PAP collected today, breast exam WNL, urine pregnancy negative. Physical exam is normal. What are your treatment goals for Claudia today? What are two possible contraceptive methods for Claudia? Please give brief rationale for each. Pick one method and list five (5) patient-centered teaching points for the method you chose today. What would your contraceptive choice be if Claudia smoked 10-15 cigarettes per day? Explain your answ
Of the 6 million pregnancies that occur each year in the United States, approximately half are unintended. Among women who experience an unintended pregnancy, half report using a contraceptive method in the month when the pregnancy occurred. Because most women use a contraceptive method with adherence requirements, the majority of pregnancies result from incorrect or inconsistent method use rather than from method failure. Despite their proven safety, effectiveness, and cost-effectiveness less than 3% of women in the U.S. use a long-acting reversible method of contraception (LARC), which includes intrauterine contraception (IUC) and subdermal implants. Reasons for lack of use include women’s knowledge of and attitudes towards the methods,, practice patterns among providers,, and high initial up-front cost associated with these methods.
In response to the under-utilization of LARC, the Contraceptive CHOICE Project (CHOICE) was developed to promote the use of long-acting methods in the St. Louis region. Our primary objective is to provide no-cost contraception to a large number of women in our region and to promote the use of long-acting reversible contraception (LARC = intrauterine contraception (IUC) and the subdermal implant). To accomplish this objective, we sought to remove two major barriers to LARC use: financial obstacles and lack of patient awareness of LARC method safety and efficacy. By increasing the acceptance and use of LARC, CHOICE seeks to reduce unintended pregnancy at the population level in the St. Louis region. In this analysis, we describe baseline contraceptive method choice and the demographic, reproductive, and behavioral characteristics of the first 2,500 participants enrolled.
MATERIALS AND METHODS
The Contraceptive CHOICE Project is a prospective cohort study of 10,000 women in the St. Louis region. Each participant is provided the contraceptive method(s) of her choice at no cost to her for three years duration. The CHOICE protocol was approved by the Washington University in St. Louis School of Medicine Human Research Protection Office prior to initiation of participant recruitment.
CHOICE is a convenience sample of women in the St. Louis region. Participants are recruited at specific clinic locations and via general awareness about CHOICE through their medical providers, newspaper reports, study flyers, and word of mouth. Recruitment sites include university-affiliated clinics and providers, two facilities providing abortion services, and community clinics that provide family planning, obstetric, gynecologic, and/or primary care. Women are eligible to participate if they are 14-45 years of age, reside in or seek clinical services in designated recruitment sites in the St. Louis region, have been sexually active with a male partner in the past six months or anticipate sexual activity in the next six months, have not had a tubal ligation or hysterectomy, do not desire pregnancy in the next year, and are not currently using a contraceptive method or are interested in starting a new reversible contraceptive method.
Women are screened for eligibility in person at a recruitment site or on the telephone by calling the CHOICE telephone number. Every screening encounter is conducted by a trained staff person who provides a brief scripted introduction to LARC methods: levonorgestrel intrauterine contraception (LNG-IUC), copper intrauterine contraception (copper IUC), and the subdermal implant (See ). The screener asks a series of questions to determine eligibility and, when eligible, offers the opportunity to enroll in CHOICE. Using a standardized data collection form, the screener documents each eligibility criterion, the final eligibility status, and whether the woman enrolls in the project that day or is scheduled to enroll on a future date. For women scheduled to enroll, the screener collects contact information to facilitate reminder calls prior to the enrollment appointment. Thus, all women screened are introduced to LARC methods regardless of their initial contraceptive preference or whether they are ultimately enrolled.
Enrollment in CHOICE occurs during a 1.5 to 2 hour in-person process. Prior to obtaining informed consent to participate in CHOICE, women undergo pregnancy testing to rule out pregnancy. Those identified with an occult pregnancy are counseled about options and offered the opportunity to participate in CHOICE after resolution of the pregnancy. Approximately 74% (1845/2500) of CHOICE enrollments occur at the university-based recruitment site. At this site contraceptive counseling is provided by research assistants who are trained contraceptive counselors. Among the remaining 26% (655/2500) of enrollments, clinic staff and or health care providers at the clinical facility provide the counseling. Our goal was to promote LARC, but to also offer the CHOICE Project to as many outpatient facilities in our region as possible. All women undergo contraceptive counseling prior to providing informed consent.
Given space constraints and logistical issues, research staff could not provide the counseling at all recruitment sites. Thus, the content of the contraceptive counseling session varies by recruitment site. The clinic staff that provides the counseling at the community clinic sites is not engaged in the research protocol; the counseling is considered part of routine family planning care that she receives during her clinic visit prior to enrollment in CHOICE. Counseling at the university-affiliated recruitment site includes a non-biased description of all contraceptive methods available including method effectiveness, advantages and disadvantages. To assist the participant in making an informed decision, research staff attempt to dispel misinformation or myths about contraceptive methods and to answer any questions or concerns regarding each method. During this session, the research assistant collects clinical information using a standardized form to identify contraindications or conditions that may influence the use of a particular contraceptive method. Once the woman has chosen her method, the counselor obtains the approval of the clinician for the chosen method regardless of recruitment location. If a method is medically contraindicated, the clinician consults with the participant to identify a more suitable contraceptive method; otherwise participants receive their initial method of choice.
After contraceptive counseling is completed, informed consent is obtained to participate in CHOICE by engaged research staff at the recruitment location. For women under the age of 18 years, we obtain their assent and the consent of one parent or legal guardian. For minors who do not know the whereabouts of their parent or legal guardian or are fearful of their parent or legal guardian’s knowledge of her seeking contraception, we have obtained Human Research Protection Office approval to waive parental consent. Emancipated minors are consented as adults.
Following informed consent, research staff administers a standardized survey instrument and collects detailed contact information. Comprehensive contact information (e.g., residence address, telephone, cell phone, email) is documented for the participant and two additional contacts (e.g., partner, relative, or friend) to increase the likelihood of sustained contact with the participant during the 3-year follow-up period. The participant is then screened for sexually transmitted infections (STIs; Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and syphilis) and HIV, and the chosen contraceptive method is provided. Participants are compensated for their time with a $15.00 gift card.
Once pregnancy is ruled out, women who choose a LARC method undergo insertion by a trained clinician at the time of enrollment. Emergency contraception is offered to patients who have had recent unprotected intercourse, and “bridge methods” such as oral contraceptive pills (OCPs), vaginal ring, transdermal patch, depo-medroxyprogesterone acetate (DMPA), or condoms are offered to women when pregnancy cannot be excluded. Participants are encouraged to immediately initiate their contraceptive method,– and can return in 3-4 weeks for a repeat pregnancy test and LARC insertion, if desired.
Following the enrollment session participants are interviewed by phone 3, 6, 12, 18, 24, 30, and 36-months post-enrollment using standardized survey instruments. They are compensated with a $10.00 gift card for every completed survey. Participants are initially notified by mail or e-mail two weeks prior to their next follow-up contact, and are then called to schedule the interview. Participants are screened again for C. trachomatis and N. gonorrhoeae at the 12, 24 and 36-month contacts.
The baseline and follow-up survey instruments collect comprehensive information on demographic characteristics, past and current reproductive history including contraceptive experience (e.g., continuation, side effects, reasons for discontinuation or non-compliance, and satisfaction), menstrual bleeding patterns, sexual behavior with male and female partners, main and casual sex partners, pregnancy, incident STI, and experiences of discrimination and violence. During both scheduled and interim contacts research staff also collect and record clinically relevant data including complaints, complications, side effects, method expulsions and removals, pregnancies and outcomes, and STI occurrence and treatment.
CHOICE provides all contraceptive methods at no cost to the participant through two processes. Women who choose a LARC method can receive the method at their enrollment site or can request that their regular healthcare provider insert the method. CHOICE has established a network of private providers who refer patients to CHOICE for enrollment. Research staff travels to these physician offices or recruitment sites with LARC methods and provide the clinician with the method for insertion.
CHOICE has partnered with two community affiliates to provide OCPs, vaginal ring, transdermal patch, or DMPA to participants. Following enrollment, every participant, regardless of method choice, receives a CHOICE prescription card that documents her participation in CHOICE and allows her to obtain her OCPs, vaginal ring, or transdermal patch on a monthly basis at a local pharmacy chain located throughout the St. Louis region. Participants who are established patients of the local family planning clinic may obtain their monthly refills or DMPA at selected family planning clinics in the St. Louis

Assignment: Oxybutynin for Overactive Bladder.
Assignment: Oxybutynin for Overactive Bladder.
Week 10 quiz
Question 1 A patient is being discharged from the hospital and will be taking oxybutynin (Ditropan) for overactive bladder. The nurse will instruct the patient that she will be taking a medication
Question 2 A nurse is working in a women’s hospital where she is caring for a new mother who is experiencing postpartum urinary retention. Bethanechol (Urecholine) has been ordered. The nurse will observe for which of the following?
Question 3 A patient is taking flavoxate hydrochloride (Urispas) to help control an overactive bladder. On a follow-up visit to the clinic, the nurse will question the patient about which of the following?
Question 4 A nurse is performing patient education for a woman who has just been prescribed a bisphosphonate. Which of the following diagnostic and history findings would have prompted the woman’s care provider to prescribe a bisphosphonate?
Question 5 A nurse is providing patient education to a 50-year-old woman who is taking methotrexate (MTX) for breast cancer. The nurse will instruct the patient to avoid which of the following drugs?
Question 6 A nurse is providing patient education to a 23-year-old woman who is starting the norelgestromin/ethinyl estradiol transdermal system (Ortho Evra). Because this is the patient’s first time to use the birth control patch, the nurse will instruct her to apply the patch
Question 7 After 6 months of unsuccessfully trying to conceive, a 31-year-old woman and her husband have sought a referral to a fertility specialist in order to explore their options. A nurse at the clinic should recognize that the woman may benefit from
Question 8 A nurse practitioner is reviewing the prepregnancy medication regimen of a patient who has just had a positive pregnancy test. The nurse should be aware of which of the following changes in pharmacokinetics that accompanies pregnancy?
Question 9 A nurse is working with a 16-year-old pregnant teen and assessing for behavior that may put the baby at risk. The most important assessment the nurse can make is
Question 10 A 36-year-old woman with a history of dysmenorrhea has begun treatment with progesterone, which she will be receiving by the intramuscular route. The nurse participating in the woman’s care should prioritize which of the following potential nursing diagnoses?
Question 11 A female patient has been prescribed estrogen therapy. Which of the following will the nurse advise the patient is a common adverse effect of estrogen therapy?
Question 12 A 56-year-old woman will soon begin treatment of her overactive bladder with tolterodine (Detrol). What patient teaching should the nurse provide to this woman?
Question 13 A nurse is caring for a patient who is at 28 weeks’ gestation and is receiving terbutaline (Brethine) to control preterm labor. Which of the following assessment parameters should the nurse prioritize?
Question 14 A woman is receiving magnesium sulfate for intrapartum eclampsia. The patient is perspiring and her blood pressure is 88/50. The serum magnesium level is 10 mg/dL. The nurse will interpret these manifestations as
Question 15 A woman who is in the second trimester of her first pregnancy has been experiencing frequent headaches and has sought advice from her nurse practitioner about safe treatment options. What analgesic can the nurse most safely recommend?
Question 16 The nurse has established peripheral IV access and begun an infusion of magnesium sulfate on a 29-year-old antepartum patient who is 35 weeks pregnant. Which of the following assessment findings most likely prompted the patient’s physician to order magnesium sulfate for this patient?
Question 17 A 51-year-old female patient has been receiving doxorubicin (Adriamycin) for metastatic breast cancer. Her medical record indicates she has cardiomyopathy and a cumulative dose of 300 mg/m2 of doxorubicin. Which of the following measures would help limit the severity of the cardiomyopathy in this patient?
Question 18 A man is prescribed ciprofloxacin to treat a sexually transmitted infection. The nurse will instruct the patient to
Question 19 A patient is receiving radiotherapy for an overactive thyroid gland and asks whether her milk is safe for her baby. If her treatment cannot be discontinued, what should the nurse recommend?
Question 20 A woman is receiving prolonged drug therapy during her complicated pregnancy, and it may pose a risk to both the mother and the fetus. The primary care physician has made dosage adjustments to minimize adverse effects and prevent toxicity. The nurse should make sure
Question 21 A male patient is trying to decide if he should use finasteride (Proscar) to treat benign prostatic hypertrophy (BPH). When providing information about the drug, the nurse will include which of the following as a risk associated with finasteride therapy?
Question 22 A female patient is taking oral cyclophosphamide therapy for breast cancer. Because of possible adverse effects of the drug, the nurse will instruct the patient to do which of the following?
Question 23 Which of the following would the nurse include in a teaching plan about the signs and symptoms of thrombophlebitis and thromboembolism that should be reported by a patient taking estrogen?
Question 24 A male patient is taking finasteride for BPH. Which of the following will the nurse evaluate at each clinic visit?
Question 25 The nurse recognizes that the potential for teratogenic drug effects is not static throughout the prenatal and postnatal periods. The potential for teratogenic effects is highest during
Question 26 A 36-year-old patient comes to the clinic and tells the nurse that she suspects that she is pregnant. During the initial assessment, the nurse learns that the patient is currently taking medications for diabetes, hypertension, and a seizure disorder. The nurse would be most concerned about which of the following medications?
Question 27 A patient is pregnant and is at 7 weeks’ gestation. She has type 1 diabetes and has been taking insulin since she was 13 years old. She asks the nurse if the insulin will be harmful to her baby. The best response to the patient by the nurse would be
Question 28 A patient is taking etoposide for a testicular tumor refractory to treatment. The nursing assessment reveals that he is also taking warfarin. The nurse must carefully monitor for which of the following?
Question 29 On the advice of her sister, a 52-year-old woman has visited her nurse practitioner to discuss the potential benefits of hormone replacement therapy in controlling the symptoms of menopause. Which of the following responses by the nurse is most appropriate?
Question 30 A pregnant patient asks the nurse what over-the-counter medication she can take for recurring headaches. The nurse should recommend
Question 31 A pregnant patient who has diabetes has been admitted to the hospital to begin labor. Since the patient has diabetes, the physician has decided to use oxytocin (Pitocin) to initiate labor contractions. When talking to the patient about the adverse effects of the drug, the nurse should understand that the most common adverse effects of the drug include
Question 32 A 20-year-old woman will soon begin taking oral contraceptives for the first time. What advice should the nurse provide to this patient?
Question 33 The nurse practitioner has recommended that a breast-feeding woman take her prescribed medications just before her infant takes his longest nap of the day. The woman does not understand and asks the nurse to explain. The nurse will tell the woman that the recommendation was made to
Question 34 A man has a demonstrated history of androgen deficiency and the consequences of this health problem include an inability to maintain an erection. Which of the following medications would best address this patient’s erectile dysfunction (ED)?
Question 35 A 73-year-old woman has osteoporosis and is prescribed alendronate. She takes calcium and vitamin D supplements, drinks lots of water, and has just quit smoking. The nurse should advise the patient to also
Question 36 A male patient with a medical background tells the nurse that he is not satisfied with the oral synthetic testosterone that has been prescribed for him and he would like to try a natural form of oral testosterone. Which of the following would be an appropriate response by the nurse?
Question 37 A 59-year-old man with a recent history of erectile dysfunction has been assessed and prescribed sildenafil (Viagra). When providing patient education to this man, the nurse should tell him which of the following?
Question 38 Alendronate (Fosamax) is prescribed for a 67-year-old postmenopausal woman. In order to help prevent gastrointestinal distress, the nurse will advise the patient to
Question 39 A 68-year-old man is being treated for benign prostatic hypertrophy (BPH) and began treatment with finasteride (Proscar) 3 months ago. When planning the care of this patient, what desired outcome should the nurse prioritize?
Question 40 A 71-year-old man has just been prescribed finasteride (Proscar). Which of the following complaints by this patient most likely indicated a need for this drug?
Assignment: Oxybutynin for Overactive Bladder.

Assignment: Technology and Informatics
Assignment: Technology and Informatics
Assignment: Technology and Informatics
Week 1 discussion Discussion Prompt 1 Review the major tenets of the HIMSS position paper Transforming Nursing Practice Through Technology and Informatics by clicking on the link here or in the required resources for this week. Contrast it to a healthcare setting familiar to you. Describe your organization’s status in regards to the position paper Discussion Prompt 2 Nursing informatics is dynamic and continues to evolve over time. What information technology (e.g., bar coding, EHR, mobile devices) have you witnessed that positively affected and supported safe patient care? Share specific examples and explain why and how you feel they have supported patient safety.
Technical informatics is a subclass of that combines general with technology. Particularly in the field of , it has numerous correlations with the engineering sciences. However, the perspective of technical informatics is not marked by the technical disciplines alone but the focus is rather on giving special emphasis to typical aspects of informatics in order to find more general and universal solutions.
This discipline is usually taught at up to a master’s degree level.Health informatics (also called Health Information Systems) uses informationtechnology to organize and analyze health records to improve healthcareoutcomes. Health Informatics deals with the resources, devices and methods to utilize acquisition, storage, retrieval, and use of information in health and medicine.Health informatics makes the necessary coordination possible. The most important way in which informatics is changing health care is in improved outcomes. Electronic medical records result in higher quality care and safer care as coordinated teams provide better diagnoses and decrease the chance for errors.

Assignment: Patient Encounters Discussion
Assignment: Patient Encounters Discussion
Assignment: Patient Encounters Discussion
Week 4 assignment SOAP Note and CORE Entries Each week, you are required to enter your patient encounters into CORE. Your faculty will be checking to ensure you are seeing the right number and mix of patients for a good learning experience. You will also need to include a minimum of one complete SOAP note using this template . The SOAP note should be related to the content covered in this week, and the completed note should be submitted to the Submissions Area. When submitting your note, be sure to include the reference number from CORE. Submission Details: By the due date assigned enter your patient encounters into CORE and complete at least one SOAP note in the template provided. Name your SOAP note document SU_NSG6340_W4_SOAPLastName_FirstInitial.doc. Include the reference number from CORE in your document. Submit your document to the Submissions Area by the due date assigned.
WHAT KINDS OF PATIENTS do hospitalists spend their days seeing? According to data from the 2014 Today’s Hospitalist Compensation & Career Survey, about half of hospitalists’ daily encounters are with existing patients, and about three-quarters are billed as admissions (vs. observation status). And the number of patients in the hospital being seen by hospitalists, as opposed to primary care physicians and specialists, is large and growing. Here’s a look at the type of patients full-time hospitalists who treat adults are seeing.
A breakdown of encounters
When we asked hospitalists to identify what types of patient encounters make up their day, the clear winner was not exactly a surprise. Existing patients accounted for just under half of hospitalists” day-to-day patient interactions. New patients, by comparison, accounted for 16% of patient encounters, while admissions accounted for 19% of encounters and discharges accounted for 18%.
But not all the patients that hospitalists bill for are inpatients. According to our data, more than one-quarter (26%) of patients seen by hospitalists are billed on an outpatient basis as observation patients.
Who’s admitting?
Of patients with inpatient status, hospitalists are admitting the vast majority of them. Respondents to our survey said that primary care physicians and subspecialists admit just under 20% of patients to their hospitals, with hospitalists admitting more than 80%.
Three years earlier, in 2011, by comparison, our survey found that hospitalists were responsible for admitting 70% of their hospitals’ inpatients. And in 2013, our survey found that 74% of inpatients were admitted by hospitalists, not other specialties. The data from our surveys seem to show that hospitalists are admitting more and more of the patients coming to their hospitals, but we need more data from future surveys to substantiate that conclusion.
And this year’s data uncovered an interesting regional trend in the percentage of patients that hospitalists admit.
The Pacific region leads the pack, with hospitalists there saying they admit more than 90% of their facilities’ patients. In the Midwest, Mountain and Southwest regions, by comparison, hospitalists report admitting less than 80% of the patients in their hospitals.

Assignment: Medication Refill
Assignment: Medication Refill
Assignment: Medication Refill
Week 2: ACC/AHA Guidelines Discussion No unread replies.No replies. Please review the following case. Chief complaint: medication refill “ran out of medicine” HPI: BJ, a 68-year-old AA female presents to the clinic for prescription refills. The patient also indicates that she has noticed shortness of breath which started about 3 months ago. The SOB gets worse with activity, especially when she is playing with her grandchildren but it goes away once she sits down to rest. She reports that she is also bothered by shortness of breath that wakes her up at night, but it resolves after sitting upright on 3 pillows. She also has lower leg edema which started 1 week ago. She also indicates that she often feels light headed and faint while going up the stairs, but it subsides after sitting down to rest. She has not tried any OTC medications at home. She never filled her prescriptions, which she received at her checkup 6 months ago, she did not think it was important. PMH: Hypertension Previous history of MI in 2010 Surgeries: 2010-Left Anterior Descending (LAD) cardiac stent placement Allergies: Amoxicillin Vaccination History: She receives an annual flu shot. Last flu shot was this year Has never had a Pneumovax Has not had a Td in over 20 years Has not had the herpes zoster vaccine Social history: High school graduate, a widow with one son who loves out of state. She drinks one 4-ounce glass of red wine daily. She is a former smoker that stopped 20 years ago. Family history: Both parents are deceased. Father died of a heart attack; mother died of natural causes. She had one brother who died of a heart attack 20 years ago at the age of 52. ROS: Constitutional: Lightheaded and faint with exertion. Respiratory: Shortness of breath with exertion (playing with grandchildren and stairs). + Orthopnea Cardiovascular: + leg and ankle swelling x 1 week Psychiatric: Not taking medications for 6 months – “ran out” Physical examination: Vital Signs Height: 5 feet 2 inches Weight: 163 pounds BMI: 29.8 BP 150/86 T 98.0 po P 100 R 22, non-labored; Ur HEENT: normocephalic, symmetric. Bilateral cataracts; PERRLA, EOMI; Upper and lower dentures in place a fitting well. No tinnitus NECK: Neck supple; non-palpable lymph nodes; no carotid bruits. Thyroid non-palpable LUNGS: inspiratory crackles HEART: Normal S1 with S2 split during expiration. An S4 is noted at the apex; systolic murmur noted at the right upper sternal border without radiation to the carotids. ABDOMEN: Normal contour; active bowel sounds all four quadrants; no palpable masses. PV: Pulses are 2+ in upper extremities and 1+ in pedal pulses bilaterally. 2+ pitting edema to her knees noted bilaterally GENITOURINARY: no CVA tenderness; not examined MUSCULOSKELETAL: Heberden’s nodes at the DIP joints of all fingers and crepitus of the bilateral knees on flexion and extension with tenderness to palpation medially at both knees. Kyphosis and gait slow, but steady. PSYCH: normal affect; her Mini-Cog Score is 3. Her PHQ-9 score is 22. SKIN: Sparse hair noted on lower legs and feet bilaterally with dry skin on her ankles and feet. Labs:: Hgb 12.2, Hct 37%, K+ 4.2, Na+140, Cholesterol 230, Triglycerides 188, HDL 37, LDL 190, TSH 3.7, glucose 98 A: Primary Diagnosis: Congestive Heart Failure (CHF) (150.9) Secondary Diagnoses: Primary Hypertension (I10) Depression F32.3: Obesity (E66): Osteoarthritis (OA) (715.90) Differential Diagnosis: Peripheral Vascular Disease (PVD) (173.9) P: Medications: Sertraline 25 mg. Take 1 tab PO QD disp#30, 1 refill Tylenol 650 mg PO Q4 hours as needed for arthritis pain Labs: UA; Brain natriuretic peptide (BNP); LFTs and TSH. 12-lead EKG, Chest X-ray; Initial 2D echo with Doppler; Ankle-brachial index Education: Congestive heart failure is caused by the inability of your heart to pump blood effectively enough to meet the demands of your body. If you think of your body as any other pump, if fluid does not move well through the system, then it will back up into other spaces. When blood backs up it puts a lot of pressure on the blood vessels, which forces fluid to leak out into the nearby tissue. With CHF, this fluid usually moves into your lungs, legs, or abdomen. The signs of worsening CHF include decreased energy level, shortness of breath during your normal routine, increased swelling to your legs and feet, your clothes feel tight, or a wet sounding cough. Call the office if these symptoms occur. Weigh yourself every morning at the same time. If you have a 3 pound weight gain in 24 hours, or a 5 pound weight gain over a week, you should call the office. Exercise and maintaining a normal weight is very important. You should try to exercise at least 20-30 minutes a day, more if possible. Start slow with walking. Decrease your salt intake. Do not add any extra salt to foods. Salt makes you retain fluid, and it makes you want to drink more fluid. Avoid fast food and prepared food as they are usually very high in sodium. If you notice your legs swelling, elevate them up and rest. Do not drink alcohol and continue to avoid smoking or second hand smoke. Take your medications as directed, with water. Do not stop them abruptly or skip doses. I have started you on a medication for depression. It can take 2 weeks to start to feel it working and up to a month until you can fell the real benefits. If you start to feel more depressed, like you want to harm yourself or others, please contact me right away or got to the ER. Referrals: may refer based on lab results Follow up: return to office in 2 weeks Additional lab results: Echo results: LVEF 39% BNP – 682 pg/ml Questions: You determine the medications for CHF/ASCVD · According to the ACC/AHA Guidelines, what is BJ’s heart failure stage? · According to the ACC/AHA Guidelines, what medications should BJ be prescribed? Does she need medication given her history of MI? Write her complete prescriptions using the prescription writing format.

Assessment: Pharmacology and Health
Assessment: Pharmacology and Health
Case Study Assignment
Guidelines & Scoring Rubric
Purpose
The purpose of the Case Study assignment is to help students apply and integrate pathophysiology, pharmacology, and health (physical) assessment into simulations of nursing care. Note that case studies such as this can be used as a class discussion and as a case study for various forms of simulation.
Due Date: Sunday 11:59 p.m. MT at the end of Week 5
Requirements:
Students will develop a case study that represents a complex health problem of their choice and that could be used in a high-fidelity simulation lab. Your topic should have been approved by your instructor in Week 2. Provide details in your case study related to the (1) modifiable and unmodifiable risk factors represented in your patient, (2) presenting signs and symptoms the patient displays, (3) psychosocial factors, (4) prescribed pharmaceutical and non-pharmaceutical interventions, and (5) laboratory and other diagnostic tests.
The case study should start with objectives for the simulation, stated as what the student will do or display and by when (see below). Thereafter, the patient should be presented, along with three questions you will ask your students about the case.
Preparing the case study
1. Identify a complex health problem that could be used in a high-fidelity simulation lab to teach undergraduate nursing students good clinical reasoning and critical thinking skills. Your topic should have been approved by your instructor in Week 4
2. Use the NR526 Case Study Template to develop your assignment. Your focus is on developing a case study rather than on developing a simulation.
3. Provide at least five (5) objectives for your case study, corresponding with the major lessons you plan for your students.
a. The objectives should begin with- “At the end of this simulation, the learner will ….” Or “At the end of this simulation, the student will ….”
b. The objectives should be specific, measurable, attainable, relevant, and time specific. When you examine your objectives, ask yourself how you will know your students have met them. For example, “learn” and “understand” are not specific or measurable. A search on “Bloom’s taxonomy” will yield a multitude of action verbs that you can use instead.
4. Use the NR526 Case Study Template and provide the following:
a. The modifiable and unmodifiable risk factors represented in your patient
b. Presenting signs and symptoms the patient displays
c. Psychosocial factors, such as the patient’s family structure and function
d. Prescribed pharmaceutical and non-pharmaceutical interventions
e. Laboratory and other diagnostic tests.
5. Provide three questions that will elicit good clinical reasoning and critical thinking in your undergraduate students as well as rationale for each question that is based on peer-reviewed sources.
Faculty Feedback Table
Category
Possible Points
Points Awarded
Description
Objectives
Case Study – Risk Factors
Case Study – Signs & Symptoms
Case Study – Psychosocial Factors
Case Study – Interventions
Case Study – Lab and Other Diagnostic Tests
Questions
Rationale and peer-reviewed resources
Rules of grammar, word usage, spelling, punctuation are followed.
Reference list and APA
Total:
___ points
Grading Rubric
Assignment Criteria
Exceptional
(100%)
Outstanding or highest level of performance
Exceeds
(88%)
Very good or high level of performance
Meets
(80%)
Competent or satisfactory level of performance
Needs Improvement
(38%)
Poor or failing level of performance
Developing
(0)
Unsatisfactory level of performance
Content
Possible Points = Points
Objectives
Provides 5 well-designed and relevant objectives
Provides 4 well-designed and relevant objectives
Provides 3 well-designed and relevant objectives
Provides only 1 or 2 well-designed and relevant objectives
Does not provide objectives
Case Study – Risk Factors
Fully incorporates accurate modifiable and unmodifiable risk factors in case study
Incorporates accurate modifiable and unmodifiable risk factors in case study but is missing one or two
Incorporates accurate modifiable and unmodifiable risk factors in case study but is missing more than two
Incorporates inaccurate modifiable and unmodifiable risk factors in case study
Does not Incorporate modifiable and unmodifiable risk factors in case study
Case Study – Signs & Symptoms
Fully and accurately incorporates signs and symptoms in case study
Incorporates accurate signs and symptoms in case study but is missing one or two
Incorporates accurate signs and symptoms in case study but is missing more than two
Incorporates inaccurate signs and symptoms in case study
Does not Incorporate signs and symptoms in case study
Case Study – Psychosocial Factors
Fully incorporates psychosocial factors in case study
Describes patient’s family, work, important activities
Partially incorporates psychosocial factors in case study
Barely incorporates psychosocial factors in case study
Only one psychosocial factor is included in case study
Does not Incorporate psychosocial factors in case study
Case Study – Interventions
Fully and accurately incorporates interventions in case study
Incorporates accurate interventions in case study but is missing one or two
Incorporates accurate interventions in case study but is missing more than two
Incorporates inaccurate or unlikely interventions in case study
Does not Incorporate interventions in case study
Case Study – Lab and Other Diagnostic Tests
20 Points
18 Points
16 Points
8 Points
0 Points
Fully and accurately incorporates labs and other diagnostic tests in case study
Incorporates accurate labs and other diagnostic tests in case study but is missing one or two
Incorporates accurate labs and other diagnostic tests in case study but is missing more than two
Incorporates a few labs and other diagnostic tests in case study but is missing an important one.
Does not Incorporate labs and other diagnostic tests in case study
Critical Thinking Questions
30 Points
26 Points
24 Points
11 Points
0 Points
Provides three questions related to the case that, as a whole, fully integrate principles from pathophysiology, pharmacology, and health (physical) assessment.
Provides three questions related to the case but is missing at least one crucial, priority principle from pathophysiology, pharmacology, and health (physical) assessment.
Provides three questions related to the case but is missing at least two crucial, priority principles from pathophysiology, pharmacology, and health (physical) assessment.
Provides three questions related to the case but the questions do questions do not relate to principles from pathophysiology, pharmacology, and health (physical) assessment.
Does not provide three questions related to the case.
Rationale for Critical Thinking Questions
70 Points
53 Points
48 Points
23 Points
0 Points
Provides well-researched, well-referenced rationale for asking each of the three questions.
*Provides at least two peer-reviewed articles as references
Provides rationale for asking each of the three questions but only one peer-reviewed article as a reference.
Provides rationale for asking each of the three questions but references are not peer-reviewed.
Provides very superficial rationale for asking each of the three questions or rationale with no references.
Does not provide rational for asking each of the three questions
*Note: “Peer-reviewed” means that the material has been reviewed by people with like credentials as the author. Generally, this means articles from professional journals that you find in the Chamberlain Library.
Format Possible Points (25 points)
15 Points
13 Points
12 Points
6 Points
0 Points
Grammar, word usage, spelling, and punctuation
Student follows rules of grammar, word usage, spelling, and punctuation.
Student follows rules of grammar, word usage, syntax, and punctuation, with 1-2 exceptions.
Student follows rules of grammar, word usage, syntax, and punctuation, with 3-4 exceptions.
Student follows rules of grammar, word usage, syntax, and punctuation. with 5-6 exceptions.
Student follows rules of grammar, word usage, syntax, and punctuation, with 7 or more exceptions.
Reference list and APA
10 Points
9 Points
8 Points
4 Points
0 Points
Student follows APA format in citations and references.
Student follows APA format in citations and references, with 1 exception.
Student follows APA format in citations and references, with 2 exceptions.
Student follows APA format in citations and references, with 3 or more.
Student follows APA format in citations and references, with 4 or more exceptions.

Assignment: An Anxious Patient
Assignment: An Anxious Patient
Assignment: An Anxious Patient
Week 3 discussion Breathing, Heart, and Lungs An anxious patient is having rapid and shallow breathing. After a few moments, he complains of a tingling sensation. What could be the causes of this tingling sensation? What are the various patterns of respiration and their significance? Ethnicity and culture influence risk factors for heart disease. Do you agree? Why or why not? What is the technique of percussion and palpation of the chest wall for tenderness, symmetry, bulges, fremitus, and thoracic expansion? Explain. Would you anticipate hearing hyper-resonance on a patient with a history of tobacco use? Why or why not? What are the mechanics of breathing with reference to lung borders and the anatomical structure of the lungs and diaphragm? 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.
The one thing that most people can agree on about a hospital is that virtually nobody really wants to be there; patients would rather be at home and healthy.
This leads to stress, anxiety, pain, and fear in the hospital setting and unfortunately are all common emotions experienced not only by patients and families, but healthcare workers as well.
Below are seven tips that I’ve found work well with dealing with particularly anxious patients and family members both as a travel nurse and a charge nurse.

Assignment: HIT project Discussion
Assignment: HIT project Discussion
Assignment: HIT project Discussion
Week 7 discussion Discussion Prompt 1 After reviewing the required resources this week on quality measures, discuss a quality outcome measure that you could apply to your HIT project. Be specific on how you would determine the success or failure of the outcome with the implementation of the tool. Discussion Prompt 2 Discuss the importance of a well-defined project timeline and the risks of not having a project timeline.
Risk assessment rating and analysis techniques help us better understand the magnitude of the risk and its potential consequences. The degree of severity of the risk’s consequence is the driver to plan a response and be ready for action if the event actually happens.
Qualitative risk is a nonnumeric (subjective) estimate of the chance of a risk happening and an analysis of the best methods for countermeasures. The input to this method comes from the subject matter experts (SME), and from historical evidence found in documentation and lessons learned from previous engagements. The long-term value of this method comes from repeated measures and trending, which tends to give results that are more accurate.
Quantitative risk analysis focuses more on numeric methods and attempt to use repeated measures to derive estimates. Examples would be Monte Carlo simulation technique, decision tree analysis, and sensitivity analysis.
Quantitative risk analysis usually follows qualitative. The decision to use one method versus the other, or use both methods, depends on the need and the comfort level of the PM practitioner. The key element in these analyses is to be able to decide, with the team, on the risks faced, their potential impact, rank, and priority, then move on to plan the responses. It is important that the team do not dwell on these processes; however, it is important to revisit the issues and repeat the process at regular intervals. Once a quarter is often enough on a large project to stay current. Putting data in a table format is advisable. An example is provided in Appendix A. Templates and helpful examples in publications and books can be used as references (Cooke & Tate, 2005 and Mulcahy, 2003).