EVIDENCE-BASED PROJECT, PART 2: ADVANCED LEVELS OF CLINICAL INQUIRY AND SYSTEMATIC REVIEWS

To Prepare:

  • Develop a PICO(T) question to address the clinical issue of interest you identified for the “search database Assignment” This PICOT question will remain the same for the entire course.
  • Use the key words from the PICO(T) question you developed and search at least four different databases in the Walden University Library. Identify at least four relevant systematic reviews or other filtered high-level evidence, which includes meta-analyses, critically-appraised topics (evidence syntheses), critically-appraised individual articles (article synopses). The evidence will not necessarily address all the elements of your PICO(T) question, so select the most important concepts to search and find the best evidence available.
  • Reflect on the process of creating a PICO(T) question and searching for peer-reviewed research.

The Assignment (Evidence-Based Project)

Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews

Create a decorative 6- to 7-slide PowerPoint presentation in which you do the following:

  • Identify and briefly describe your chosen clinical issue of interest.
  • Describe how you developed a PICO(T) question focused on your chosen clinical issue of interest.
  • Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected.
  • Provide APA citations of the four relevant peer-reviewed articles at the systematic-reviews level related to your research question. If there are no systematic review level articles or meta-analysis on your topic, then use the highest level of evidence peer reviewed article.
  • Describe the levels of evidence in each of the four peer-reviewed articles you selected, including an explanation of the strengths of using systematic reviews for clinical research. Be specific and provide examples.

553

 Post your cost comparison document from Unit 2. Assuming you might prescribe this drug for your patient, how would you minimize cost or assist the patient in getting the medication at the lowest cost possible. What resources are available to reduce drug costs? Find at least 2 resources for free or reduced cost medications. Respond to two other student posts as per the discussion board rubric.

Instructions: APA format discussion. 1 page length is fine. 3 references at least. nothing less. I posted the assignment from unit 2 below. 

Professional Development Plan

Assistance please.

case study week 8

2

Insomnia
31-year-old Male

76-year-old Iranian Male

 

BACKGROUND

This week, we examine a 31-year-old male who presents to the office with a chief complaint of insomnia.

SUBJECTIVE

Patient is a 31-year-old male. He states that his insomnia has gotten progressively worse over the past 6 months. Per the patient, he has never been a “great sleeper” but is now having difficulty both falling asleep and staying asleep at night. The problem began approximately 6 months ago after the sudden loss of his fiancé. The patient states this is affecting his ability to perform his job, which is a forklift operator at a local chemical company. The patient states he has used diphenhydramine in the past to sleep but does not like the way it makes him feel the morning after. He states he has fallen asleep on the job due to lack of sleep from the night before. The patient's medical record from his previous physician states that he has a history of opiate abuse, which began after he broke his ankle in a skiing accident and was prescribed hydrocodone/apap (acetaminophen) for acute pain management. The patient has not received a prescription for an opiate analgesic in 4 years. The patient states recently he has been using alcohol to help him fall asleep, approximately four beers prior to bed.

MENTAL STATUS EXAM

The patient is alert and oriented to person, place, time, event. He makes good eye contact and is dressed appropriately for time of year. He denies auditory/visual hallucinations. Judgement, insight, and reality contact are all intact. Patient denies suicidal/homicidal ideation, and is future oriented.

Decision Point One

Select what you should do:

Zolpidem: 10 mg daily at bedtime

Trazodone 50 mg po at bedtime

Hydroxyzine: 50 mg daily at bedtime

Examine
 Case Study: Pharmacologic Approaches to the Treatment of Insomnia in a Younger Adult. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.

At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.

Introduction to the case (1 page)

· Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.

Decision #1 (1 page)

· Which decision did you select?

· Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

· Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #2 (1 page)

· Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

· Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #3 (1 page)

· Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

· Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Conclusion (1 page)

· Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.

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Fundamental M5

Assignment Content

1. Complete the
ATI Systems Disorder template for your assigned respiratory topic. Every box on the template must be completed, a citation is needed for every box, and your reference list must be included (APA). 

see below

see below

Patho week 4 Case study

 Scenario: 76-year-old female patient complains of weight gain, shortness of breath, peripheral edema, and abdominal swelling. She has a history of congestive heart failure and admits to not taking her diuretic, as it makes her “have to get up every couple hours to go to the bathroom.” She now must sleep on two pillows to get enough air. 

Resources to use:

  • Cance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.
    • Chapter 32: Structure and Function of the Cardiovascular and Lymphatic Systems; Summary Review
    • Chapter 33: Alterations of Cardiovascular Function (stop at Dysrhythmias); Summary Review
    • Chapter 35: Structure and Function of the Pulmonary System; Summary Review 
    • Chapter 36: Alterations of Pulmonary Function (stop at Disorders of the chest wall and pleura); (obstructive pulmonary diseases) (stop at Pulmonary artery  hypertension); Summary Review
  • Inamdar, A. A. & Inamdar, A. C. (2016). Heart failure: Diagnosis, management, and utilizationLinks to an external site., 5(7). doi:10.3390/jcm507006

Pneumonia

In your Case Study Analysis related to the scenario provided, explain the following:

  1. The cardiovascular and cardiopulmonary pathophysiologic processes result in the patient presenting these symptoms.
  2. Any racial/ethnic variables that may impact physiological functioning.
  3. How these processes interact to affect the patient.

A paragraph or two per question asked in the scenario and at least three current primary references are needed to support your points (peer-reviewed current articles, classroom textbook)

Discussion week 5

Week 5 Discussion: Gastrointestinal Alterations (USLOs 1, 2, 3, 4)

You are caring for 39-year-old Kali Kim-Collins who arrived for follow-up care at her primary physician's office after being discharged from the emergency department with peptic ulcer disease. Mrs. Collins went to the emergency department after experiencing severe gastric pain for three days. She reported the pain was relieved after eating.

Based on this information, your prior knowledge of this client (refer to medical card from the Collins-Kim family tree interactive), and your knowledge of the pathophysiology of peptic ulcer disease, respond to the following prompts:

1. Thoroughly explain the pathophysiology of peptic ulcer disease. Use a 
scholarly or 
authoritative source to support your answer.

2. Examine each of the following three factors related to this disease process. 
Support all three with a scholarly source.

1. cultural

2. financial

3. environmental implications

3. Identify 3-5 priority nursing interventions for the client after discharge home.

4. Describe labs and diagnostic testing you would anticipate monitoring for the client upon follow-up with her PCP. What are critical indicators? 
Support with a scholarly source.

5. What members of the interdisciplinary team need to be included for holistic patient-centered care? 
Provide a rationale and support with a scholarly source.

ethical arguments

Choose a case from the https://journalofethics.ama-assn.org/cases and take a position. For this assignment you will evaluate the ethical arguments for or against the issue. Identify the potential legal arguments (consider current federal guidelines), indicate any potential professional code conflicts you foresee, and support your position with an explanation of your own ethical/moral foundation.

  • Identify the issue and state your ethical position.
  • How might this scenario play out or impact you in your role as a nurse practitioner? 
  • Defend your position with legal, ethical, and professional evidence.
  • As part of your position, propose strategies and solutions for addressing the issues.
  • What other ethical issues does this case bring to light, if any?

Support your position with at least one scholarly source.  Be sure to cite the article you choose, use APA format, and include a title page and reference page.