Discuss necessary consults, referrals and follow-up suggestions for the patient.

You are an acute Care Nurse Practioner create a 10 slide PowerPoint presentation (not including title and references slides) that addresses a patient scenario related to the assigned DRT topic. Prepare your presentation by addressing the following:  

A patient with Obstructive Shock in the setting of a pulmonary embolus 

  1. Provide three differential diagnosis.
  2. Describe the management of the patient.
  3. Discuss necessary consults, referrals and follow-up suggestions for the patient.
  4. Discuss geriatric, legal or ethical considerations for the scenario.

APA reference in 7th edition apa style

Describe the role of the Senator, Representative, and Governor and their influence towards passing this Bill and the political process. Discuss this policy and its impact on nursing practice.   

The self-reflection final post MUST be 650 to 1500 words and MUST include the following: 

1. Summarize what you’ve learned about knowledge related to a) health promotion and disease prevention to address health disparities among diverse and vulnerable populations; b) discuss primary, secondary, and tertiary prevention; and c) discuss Healthy People 2030 and how its initiatives support current health issues. 

2. Reflect on a policy that you as an APN want to ensure passes as a law to improve health.  Detail the policy and members of the committee that will help pass this Bill.  

3. Describe the role of the Senator, Representative, and Governor and their influence towards passing this Bill and the political process. Discuss this policy and its impact on nursing practice.   

4. Provide an analysis of the processes that influence the development and implementation of health policy for application in health care environments. 

5. Discuss strategies to foster political action by advanced practice nurses (APN). Why is it important for APNs to get involved in the political process? 

6. Discuss economic variables that impact health policy and health promotion at the local, state, federal, and international levels. 

Explore the influence of Jean Watson’s Theory of Human Caring on your future role as an APN.

Explore the influence of Jean Watson’s Theory of Human Caring on your future role as an APN. The student will explore the concepts and Caritas processes from the Theory of Human Caring and present how these concepts may impact their future APN role. 

Directions:

1. The student will create a PowerPoint and include speaker notes that may be added to the speaker note section on each slide. 

2. The presentation should be limited to no more than 10 slides. See suggested slides below.

What are the benefits of this evidence to your selected audience?

Post your final EBP Presentation to Discussion Board

The Institute of Medicine has set a goal to have 90% of practice decisions to be based on Evidence by 2020 with the goal to improve care.

The intent of the dissemination of EBP results is that the information and intervention is aimed at a specific clinical practice audience.  The main objective of dissemination is to increase and advance knowledge regarding evidence-based interventions for greater application and patient outcomes.

In determining the best mode of EBP dissemination you must answer these questions:

  1. Who will benefit from receipt of this evidence?
  2. Where will this evidence have the greatest impact?
  3. What resources are needed?
  4. Who is the most appropriate audience?
  5. What are the benefits of this evidence to your selected audience?
  6. What are the potential risks of failing to disseminate this evidence?
  7. What are the barriers to the dissemination of evidence?

Choose one of the following modes of dissemination and discuss why it was chosen.  Assure you have attended to questions 1-7 above.

1.Powerpoint presentation
 

Your completed presentation will be posted to the assignment link in week 10.

Identify two selected EHR software solutions and describe three features of each software solution.

Conduct an online search for two different electronic health record (EHR) software solutions you view as beneficial to your healthcare setting. Examples may include, but are not limited to, the following: eClinicalWorks, McKesson, Cerner, Allscripts, Athena Health, GE Healthcare, Epic, Care360, Practice Fusion, OptumInsight, and NEXTGEN.

Then, address the following:

1. Identify two selected EHR software solutions and describe three features of each software solution.    (Cerner and Eclinical)

2. Compare and contrast the benefits of the two selected EHR software solutions. (Cerner and Eclinical)

3. Select an EHR software solution that is best suited for your workplace environment and provide the rationale for your selection. (Eclinical)

Discuss the difference you found between using therapeutic communication skills and conversational skills. 

Uses APA format to answer questions. 
Using the information learned in class today:
Share one thing about the class today that you didn’t know about mental health. Explain
Share one thing that you want to know more about. Explain.
Identify one thing that surprised you about mental health. Explain your answer. 
Practice your therapeutic communication skills this week on friends and colleagues . 
Discuss  the difference you found between using therapeutic communication skills  and conversational skills.  Discuss whether or not therapeutic  communication was difficult for you?  
What reaction from the other person did you notice? 

For this Assignment, as you examine the patient case study in this week’s Learning Resources, consider how you might assess and treat patients presenting with anxiety disorders.

Assessing and Treating Patients With Anxiety Disorders

Common symptoms of anxiety disorders include chest pains, shortness of breath, and other physical symptoms that may be mistaken for a heart attack or other physical ailment. These manifestations often prompt patients to seek care from their primary care providers or emergency departments. Once it is determined that there is no organic basis for these symptoms, patients are typically referred to a psychiatric mental health practitioner for anxiolytic therapy. For this Assignment, as you examine the patient case study in this week’s Learning Resources, consider how you might assess and treat patients presenting with anxiety disorders.

Describe one type of drug used to treat the type of diabetes you selected, including proper preparation and administration of this drug. Be sure to include dietary considerations related to treatment. 

 Each year, 1.5 million Americans are diagnosed with diabetes (American Diabetes Association, 2019). If left untreated, diabetic patients are at risk for several alterations, including heart disease, stroke, kidney failure, neuropathy, and blindness. There are various methods for treating diabetes, many of which include some form of drug therapy. The type of diabetes as well as the patient’s behavior factors will impact treatment recommendations. 

To Prepare
  • Review the Resources for this module and reflect on differences between types of diabetes, including type 1, type 2, gestational, and juvenile diabetes.
  • Select one type of diabetes to focus on for this Discussion.
  • Consider one type of drug used to treat the type of diabetes you selected, including proper preparation and administration of this drug. Then, reflect on dietary considerations related to treatment.
  • Think about the short-term and long-term impact of diabetes you selected on patients, including the effects of drug treatments.

THE QUESTION

A brief explanation of the differences between the types of diabetes, including type 1, type 2, gestational, and juvenile diabetes. 

Describe one type of drug used to treat the type of diabetes you selected, including proper preparation and administration of this drug. Be sure to include dietary considerations related to treatment. 

Then, explain the short-term and long-term impact of this type of diabetes on patients. including effects of drug treatments. Be specific and provide examples.

A research critique demonstrates your ability to critically read an investigative study. For this assignment, choose a research article related to nursing.

A research critique demonstrates your ability to critically read an investigative study. For this assignment, choose a research article related to nursing.

·         Articles used for this assignment cannot be used for the other assignments (students should find new research articles for each new assignment).

·         The selected articles should be original research articles. Review articles, concept analysis, meta-analysis, meta-synthesis, integrative review, and systemic review should not be used.

·         Mixed-methods studies should not be used.

·         Dissertations should not be used.

Your critique should include the following:

Research Problem/Purpose

·         State the problem clearly as it is presented in the report.

·         Have the investigators placed the study problem within the context of existing knowledge?

·         Will the study solve a problem relevant to nursing?

·         State the purpose of the research.

Review of the Literature

·         Identify the concepts explored in the literature review.

·         Were the references current? If not, what do you think the reasons are?

·         Was there evidence of reflexivity in the design (qualitative)? 

Theoretical Framework

·         Are the theoretical concepts defined and related to the research?

·         Does the research draw solely on nursing theory or does it draw on theory from other disciplines?

·         Is a theoretical framework stated in this research piece?

·         If not, suggest one that might be suitable for the study.

Variables/Hypotheses/Questions/Assumptions (Quantitative)

·         What are the independent and dependent variables in this study?

·         Are the operational definitions of the variables given? If so, are they concrete and measurable?

·         Is the research question or the hypothesis stated? What is it?

Conceptual Underpinnings, Research Questions (Qualitative)

·         Are key concepts defined conceptually?

·         Is the philoosoophical basis, underlying tradition, conoceptual framework, or ideological orientation made explicit and is it appropriate for the problem?

·         Are research questions explicitly stated? Are the questions consistent with the study’s philosophical basis, underlying tradition, conceptual framework, or ideological orientation?

Methodology

·         What type of design (quantitative, qualitative, and type) was used in this study?

·         Was inductive or deductive reasoning used in this study?

·         State the sample size and study population, sampling method, and study setting.

·         Did the investigator choose a probability or non-probability sample?

·         State the type of reliability and the validity of the measurement tools (quantitative only)

Qualitative studies (answer the following questions in addition to those above except the last bulleted item)

·         Were the methods of gathering data appropriate?

·         Were data gathered through two or more methods to achieve triangulation?

·         Did the researcher ask the right questions or make the right observations and were they recorded in an appropriate fashion?

·         Was a sufficient amount of data gathered?

·         Was the data of sufficient depth and richness?

Were ethical considerations addressed? Were appropriate procedures used to safeguard the rights of study participants?

Data Analysis

·         What data analysis tool was used?

·         Was saturation achieved? (qualitative)

·         How were the results presented in the study?

·         Were the data management (e.g., coding) and data analysis methods sufficiently described? (qualitative)

·         Identify at least one (1) finding.

Summary/Conclusions, Implications, and Recommendations

·         Do the themes adequately capture the meaning of the data?

·         Did the analysis yield an insightful, provocative and meaningful picture of the phenomenon under investigation?

·         Were methods used to enhance the trustworthiness of the data (and analysis) and was the description of those methods adequate?

·         Are there clear explanation of the boundaries/limitations, thick description, audit trail?

·         What are the strengths and limitations of the study?

·         In terms of the findings, can the researcher generalize to other populations? Explain.

·         Evaluate the findings and conclusions as to their significance for nursing (both qualitative and quantitative).

The body of your paper should be 4–6 double-spaced pages plus a cover page and a reference page. The critique must be attached to the article and follow APA guidelines.

The client is a 26-year-old woman of Korean descent who presents to her first appointment following a 21-day hospitalization for onset of acute mania. She was diagnosed with bipolar disorder.

Bipolar Therapy

BACKGROUND INFORMATION

The client is a 26-year-old woman of Korean descent who presents to her first appointment following a 21-day hospitalization for onset of acute mania. She was diagnosed with bipolar I disorder.

Upon arrival in your office, she is quite “busy,” playing with things on your desk and shifting from side to side in her chair. She informs you that “they said I was bipolar, I don’t believe that, do you? I just like to talk, and dance, and sing. Did I tell you that I liked to cook?”

She weighs 110 lbs. and is 5’ 5”

SUBJECTIVE

Patient reports “fantastic” mood. Reports that she sleeps about 5 hours/night to which she adds “I hate sleep, it’s no fun.”

You reviewed her hospital records and find that she has been medically worked up by a physician who reported her to be in overall good health. Lab studies were all within normal limits. You find that the patient had genetic testing in the hospital (specifically GeneSight testing) as none of the medications that they were treating her with seemed to work.

Genetic testing reveals that she is positive for CYP2D6*10 allele.

Patient did well enough on Lithium to be discharged from the hospital but admits she has not been taking it as prescribed. When further questioned on the subject, she provides no additional details.

MENTAL STATUS EXAM

The patient is alert, oriented to person, place, time, and event. She is dressed quite oddly- wearing what appears to be an evening gown to her appointment. Speech is rapid, pressured, and tangential. Self-reported mood is euthymic. Affect broad. Patient denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment is grossly intact, but insight is clearly impaired. She is currently denying suicidal or homicidal ideation.

The Young Mania Rating Scale (YMRS) score is 22

RESOURCES

§ Chen, R., Wang, H., Shi, J., Shen, K., & Hu, P. (2015). Cytochrome P450 2D6 genotype affects the pharmacokinetics of controlled-release paroxetine in healthy Chinese subjects: comparison of traditional phenotype and activity score systems. European Journal of Clinical Pharmacology, 71(7), 835-841. doi:10.1007/s00228-015-1855-6

Decision Point One

Select what the PMHNP should do:

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/DT/week_04/img/pill-red.pngBegin Lithium 300 mg orally BID

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/DT/week_04/img/pill-blue.pngBegin Risperdal 1 mg orally BID

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/DT/week_04/img/pill-yellow.png Begin Seroquel XR 300 mg orally at HS

Decision Point One

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/DT/week_04/img/pill-yellow.png Begin Seroquel XR 300 mg orally at HS

RESULTS OF DECISION POINT ONE

 Client returns to clinic in four weeks

 Client is reporting that she sleeps a bit more at bedtime

 Client states that she has gained about 2 or 3 pounds, which she does not like

 Client also reports that she has been constipated since starting this medication

 Client is also complaining of dry mouth which she does not like.

 Client’s score on the Young Mania Rating Scale has decreased from a 22 to an 18

 Client is reporting really good mood, but is asking for a different medication because of the weight gain

Decision Point Two

Select what the PMHNP should do:

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/DT/week_04/img/pill-red.pngIncrease Seroquel XR to 400 mg orally at HS

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/DT/week_04/img/pill-blue.pngDiscontinue Seroquel and start Geodon 40 mg orally BID. Administer with 500 calorie meal

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/DT/week_04/img/pill-yellow.pngContinue same dose of Seroquel and counsel client regarding ways to prevent constipation

Decision Point Two

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/DT/week_04/img/pill-blue.pngDiscontinue Seroquel and start Geodon 40 mg orally BID. Administer with 500 calorie meal

RESULTS OF DECISION POINT TWO

Client returns to clinic in four weeks

Client demonstrates a 50% decrease in score on the Young Mania Rating Scale (from 22 to 11)

Client denies any additional weight gain and denies any additional side effects

Decision Point Three

Select what the PMHNP should do:

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/DT/week_04/img/pill-red.pngContinue same dose and reassess in 4 weeks

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/DT/week_04/img/pill-blue.pngIncrease Geodon to 60 mg orally BID with a 500 calorie meal

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/DT/week_04/img/pill-yellow.pngAugment with Lithium sustained release 300 mg orally BID

Decision Point Three

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/DT/week_04/img/pill-red.pngContinue same dose and reassess in 4 weeks

Guidance to Student

The PMHNP should provide counseling to the client about this side effect and encourage increased fluids and fiber in the diet to combat constipation. Hard candies or gum can be used to prevent dry mouth. This is another issue as the drug can cause dental problems as a result of dry mouth.

Changing to Geodon clearly helped with symptoms and arrested weight gain in this client. The PMHNP could wait 4 weeks and see if any changes in Young Mania Rating Scale are noted, or increasing to 60 mg orally BID in an attempt to hasten symptom improvement. Increasing dose may be associated with side effects.

Augmentation with Lithium may be appropriate if the goal of therapy is to discontinue antipsychotic therapy and treat with Lithium monotherapy. Lithium was problematic for this client but changing formulation to the extended release may overcome the difficulties she was experiencing with side effects. The PMHNP would need to educate client regarding side effects of medication and need to maintain compliance