DUE REAL 2

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Name: Cara Jett
Age: 34 years
Provider: R. Mcbride NP
Allergies: NKA
Admit weight: 102 Ibs (46.3kg)
BMI: 17.5
Code status: full code

I just can’t eat. Every time I do, I have horrible pain in my stomach. My family keeps
accusing me of having an eating disorder. It’s not that I don't want to eat. It's that I can’t
without pain and diarrhea!

4/12
1345

Nursing Note: Client presents for ongoing stomach pain after eating. Current BMI of
17.5. Last recorded BMI from 3 years ago was 22.2. States pain has been ongoing for
several years, more severe as of late yesterday. Client skipped lunch today. Current
abdominal pain is 2/10. States that she has tried using over-the-counter pain relievers to
help with the abdominal pain, but this has not been successful. Rates 2/10 RLQ
abdominal pain.

4/12
1355

Neuro/Cognitive: Alert and oriented x4.

Cardiovascular: Regular heartbeat with S1 and S2 heard. No edema present. Capillary
refill <3 seconds. Bilateral pedal and radial pulses +3.

Respiratory: Lungs clear bilaterally.

Gastrointestinal: Abdomen flat, firm, hyperactive bowel sounds x 4 quadrants. Tender
in RLQ. Denies nausea. Last bowel movement was 1045 today. Loose, brown, mucous
looking – per client. Three loose stools today so far.

Genitourinary: Continent. No pain or burning when urinating

Musculoskeletal: Muscle atrophy present. +5 strengths for all extremities. Tenting
present on arm and collarbone.

Psychosocial: Anxious. Becomes tearful several times during visit. States her family is
accusing her of having an eating disorder.

5/7
1435

Nursing Note: Follow-Up Appointment with Gastrointestinal Specialist

Diagnosis: New Crohn’s disease.

Follow-up appointment after colonoscopy and upper GI procedure. Had a CT scan of the
abdomen completed after the procedure. Rates 4/10 abdominal pain. Client is taking
prednisone and metronidazole as prescribed by primary care provider for Crohn's
disease.

Date Temp HR RR BP SpO2 O2

4/12 1345 96.8 °F

(36.0 °C)

78 18 102/54 100% RA

5/1 0945 97.2 °F

(36.2 °C)

64 12 94/45 89% RA

5/1 1000 97.2 °F

(36.2 °C)

69 12 104/50 92% RA

5/1 1015 97.2 °F

(36.2 °C)

72 14 110/52 94% RA

5/7 1430 98.6 °F

(37.0 °C)

88 18 138/78 99% RA

Date Diagnostic Test Findings

5/1
1015

Upper GI
Colonoscopy

No abnormal findings.

Small ulcer found in the transverse portion of the large intestine with
evidence of more in the small intestine. Further testing, including an
MRI, is highly suggested.

5/5
1500

CT Scan of
Abdomen

Impression: Thickening of the wall of the small intestine present.
Three small abscesses noted by entrance to the colon correlating with
recent gastric studies. No fistula apparent.

5/1
0945

Endoscopy Center Nursing Note:

Client has completed an upper GI study and a colonoscopy with no noticeable
complications. Vitals stable. Drowsy but easily woken. Oriented x4.

5/1
1000

Endoscopy Center Nursing Note:

Vitals remain stable. Client drank 60mL of clear soda and two bites of graham cracker.
Swallow and gag reflex present. Mild 2/10 throat discomfort present. Driver present and
atbedside.

5/1
1015

Endoscopy Center Nursing Note:

Client discharged to home in care of mother, Nancy. Follow-up appointment made.

nur681 week1 case study

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Case 1: A 42-year-old female complains of progressive weight gain of 20 pounds over the last year, fatigue, postural dizziness, loss of memory, slow speech, deepening of her voice, dry skin, constipation, and cold intolerance. She claims her menses have been irregular x 1 year. She has an 18-year-old daughter, and has been attempting to have another child with her new partner. She has been unsuccessful. 

Nursing Chapter 14 Assignment

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  1. Complete the Staffing Table.
  2. Type your answers in the Staffing Table, save the file, and then upload the file.
  3. Upload your file by clicking “Upload File“.

assist week 6

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Week 6 – Assignment: Model Leadership in Quality Improvement

This week, you will prepare an executive brief for your Board of Trustees as the Chief Executive Officer of a healthcare organization. Your Executive Brief will demonstrate your leadership in initiating a quality improvement plan. Your Brief will contain a scorecard featuring the four key areas of organizational performance into which you have assigned the six Quality Aims into one of the four key areas. Your scorecard is available for download in your Weekly Resources.

In your written Executive Brief, be sure to address the following:

 Provide an overview of the value of using scorecards in assessing organizational performance. Be sure to cite your references.

 Insert your completed scorecard that contains the six (6) quality aims.

 Indicate how you propose to measure future performance for each of the 6 quality aims.
Hint: Timeliness can be measured by wait times in service departments (i.e., emergency, radiography).

 Explain why these six (6) quality aims are important measures for your quality improvement initiative. Be sure to cite your references.

 Close your Executive Brief document with your next steps following the Board's approval.

Be creative with this assignment and enjoy its real-world applicability. While it is not a requirement for this assignment, you may wish to embellish your Executive Brief by using a Business Report template in the MS Word templates. Click
File at the top of your Word document, then click
More Templates. Click
Business under Suggested Templates and select the Business Report template.

Length: A minimum of 2-3 pages, not including the title page or reference page

Nursing

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Diabetes Mellitus Medications 

Insulin  

Type                     Name                    Onset          Peak Action      Duration      

Rapid Acting             

Insulin              

 

Short Acting               

Insulin                

                

Intermediate    

Acting Insulin

 

 


Long Acting                        

Insulin                                                                                                 

          

          

 

Ultra Long          

Acting Insulin           


Option Bank:

30-90 min 36+hrs 3-5 hrs        15-30 min 5-7 hrs Peakless 1-2 hrs

2-3 hrs No Peak 6 hrs 24 hrs 30-60 mins 1 hr 4-6 hrs

14-24 hrs

Glargine (Lantus)/Detemir (Levemir Glargine u-300(Toujeo)

Insulin Isophane/Humulin N/ Novolin N Regular Insulin/Humulin R/Novolin R

Human insulin/ lispro (Humalog)/Novolog 

EVIDENCE BASED TABLE

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Use the PICO question to look for 2 articles and  complete the evidence based table i have attached.  

  

PICO question: In individuals diagnosed with Parkinson’s disease (P), does the implementation of complementary supportive therapies in conjunction with standard practice (I) improve quality of life (O) compared with standard practice alone (C)?

Discussion: Social Determinant of Health

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Discussion

Purpose

The purpose of the graded collaborative discussions is to engage faculty and students in an interactive dialogue to assist the student in organizing, integrating, applying, and critically appraising knowledge regarding advanced health assessment. Meaningful dialogue among faculty and students fosters the development of a learning community as ideas, perspectives, and knowledge are shared.

Course Outcomes

This discussion enables the student to meet the following course outcomes:

  • CO 1: Apply advanced practice nursing knowledge to collecting health history information and physical examination findings for various patient populations. (POs 1, 2)
  • CO 4: Adapt health history and physical examination skills to the developmental, gender-related, age-specific, and special population needs of the individual patient. (POs 1, 2)
  • CO 5: Conduct focused and comprehensive health histories and examinations for various patient populations. (POs 1, 2)

Due Dates

Initial posts are due to the discussion board by Wednesday at 11:59 p.m. MT. Instructor and peer responses are due by Sunday at 11:59 p.m. MT. Students must post on a minimum of two separate days. A 10% late penalty will be imposed for discussions posted after the deadline Wednesday at 11:59 p.m. MT, regardless of the number of days late. NOTHING will be accepted after 11:59 p.m. MT on Sunday (i.e., the student will receive an automatic 0).

Total Points Possible

The total points possible for this assignment is 75.

Preparing the Discussion

Follow these guidelines when completing each component of the discussion. Contact your course faculty if you have questions.

This week, you will consider assessment questions and appropriate interventions related to social determinants of health. Healthy physical, social, and economic environments strengthen the potential to achieve health and well-being. The nurse practitioner (NP) must assess all facets of clients’ health during a comprehensive health history. Identify the assigned topics listed by the first letter of your first name. For example, if your first name is Gilda then your assigned topic is education access and quality. Select an objective related to your assigned social determinant from the Healthy People website.

First Letter of Your First NameTopicA – EEconomic stabilityF – JEducation access and qualityK – OHealth care access and qualityP – SNeighborhood and built environmentT – ZSocial and community context

Complete the following requirements:

  1. Application of Course Knowledge: Answer all questions/criteria with explanations and detail.
    1. Correctly identify your assigned social determinant. Briefly define the determinant and describe how it impacts healthcare outcomes.
    2. Select an objective related to your assigned social determinant from the Healthy People website linked above. Identify the status of the objective and the population to whom the objective applies.
    3. Provide at least three appropriate questions related to the chosen objective that the NP could incorporate into the health history and interview to assess the client and family.
    4. Identify at least two online, national, or local resources and explain how the resources could help meet the chosen objective for at-risk clients or families.
  2. Integration of Evidence: Integrate relevant scholarly sources as defined by program expectations.
    1. Cite a scholarly source in the initial post.
    2. Cite a scholarly source in one faculty response post.
    3. Cite a scholarly source in one peer post.
    4. Accurately analyze, synthesize, and/or apply principles from evidence with no more than one short quote (15 words or less) for the week.
    5. Include a minimum of two different scholarly sources per week. Cite all references and provide references for all citations.
  3. Engagement in Meaningful Dialogue:Engage peers and faculty by asking questions, and offering new insights, applications, perspectives, information, or implications for practice:
    1. Peer Response: Respond to at least one peer on a topic other than the initially assigned topic.
    2. Faculty Response: Respond to at least one faculty post.
    3. Communicate using respectful, collegial language and terminology appropriate to advanced nursing practice.
  4. Professionalism in Communication:Communicate with minimal errors in English grammar, spelling, syntax, and punctuation.
  5. Reference Citation: Use current APA format to format citations and references and is free of errors.
  6. Wednesday Participation Requirement:Provide a substantive response to the graded discussion topic (not a response to a peer or faculty), by Wednesday, 11:59 p.m. MT of each week.
  7. Total Participation Requirement: Provide at least three substantive posts (one to the initial question or topic, one to a student peer, and one to a faculty question) on two different days during the week.

Directions: Case Study

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due 10-7-23 @10am

Quadruple AIm

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Healthcare organizations continually seek to optimize healthcare performance. For years, this approach was a three-pronged one known as the Triple Aim, with efforts focused on improved population health, enhanced patient experience, and lower healthcare costs.

More recently, this approach has evolved to a Quadruple Aim by including a focus on improving the work life of healthcare providers. Each of these measures are impacted by decisions made at the organizational level, and organizations have increasingly turned to EBP to inform and justify these decisions.

 

  • Reflect on how EBP might impact (or not impact) the Quadruple Aim in healthcare.
  • Consider the impact that EBP may have on factors impacting these quadruple aim elements, such as preventable medical errors or healthcare delivery.

To Complete:

Write a brief analysis (no longer than 2 pages) of the connection between EBP and the Quadruple Aim.

Your analysis should address how EBP might (or might not) help reach the Quadruple Aim, including each of the four measures of:

  • Patient experience
  • Population health
  • Costs
  • Work life of healthcare providers

 References include:

Response

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respond to the discussion using APA format and two scholarly references

 

The suggested disease in the case study is protein malnutrition. It is a condition where the patient does not have adequate protein intake. Genetic disorders can cause protein malnutrition. For instance, cystic fibrosis can lead to pancreatic insufficiency, limiting the production of digestive enzymes necessary for protein digestion (Montoro-Huguet et al., 2021). Celiac disease can lead to malabsorption of many nutrients. Hartnup can hinder the absorption of Tryptophan, which is necessary for protein synthesis (Schmidt-Kastner & Kravetz, 2022). However, these genetic factors may not be adequate to cause protein malnutrition. Other health conditions and poor dietary intake may also play an important role.

          The patient presents with generalized edema of extremities and abdomen due to low levels of albumin (a plasma protein), which causes the leakage of fluids from the blood vessels into the surrounding tissues due to low osmotic pressure. The physiologic response to the stimulus is an attempt for the body to maintain homeostasis amid the lack of adequate protein. The body breaks down muscle tissues to release amino acids necessary for several cellular processes. The process causes muscle wasting and exacerbates protein deficiency.

          Liver cells (hepatocytes) are involved in protein malnutrition. Hepatocytes synthesize plasma proteins, including albumin. Due to inadequate protein, these cells do not produce adequate albumin. Therefore, oncotic pressure in the blood vessels decreases, leading to edema (Grüngreiff et al., 2021). Another characteristic that would change the response is gender influence. The female elderly patient may have low levels of estrogen that would cause hormonal imbalance. Therefore, there would be a decrease in muscle mass and protein synthesis, a possible cause of protein malnutrition. The patient’s progesterone levels may also fluctuate due to menopause, leading to poor nutrient intake and loss of appetite. These gender-based factors may cause protein malnutrition.