Tag: Clinical-Nursing

  • Financial Accountability and Nursing’s Role in Decision-Making Paper

    Financial Accountability and Nursing’s Role in Decision-Making Paper

    This Financial Accountability and Nursing’s Role in Decision-Making Paper assignment broadens the students understanding and knowledge of the various roles financial management and nursing leaders play in the business of healthcare. Have you ever said to yourself “If we only did things this way, this department/unit would more efficiently and cost effective? Or, what about “I have an idea to improve care and save money?”

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    For this Financial Accountability and Nursing’s Role in Decision-Making Paper assignment, the student will identify a workplace/unit issue or concern. Create a plan related to the issue/concern that could help the unit become more efficient and cost effective. A major emphasis of this assignment is to focus upon on how to be more cost effective without compromising quality and safety. How can the plan improve the fiscalhealth of the department and/or unit?

    Areas and ideas to consider might include:

    · Charge for procedures not previously charged for

    · Changing brands of items

    · Creating a new department

    · Outsourcing procedures or personnel

    · Buying new or different equipment

    · Hiring personnel

    · Eliminating procedures, departments, supplies, etc.

    · Redesigning procedures, department layout, policy

    Assignment Criteria

    Develop a scholarly Financial Accountability and Nursing’s Role in Decision-Making Paper that addresses the following criteria:

    1. Identify and fully describe the problem or issue.

    2. Describe in detail why this is a problem/issue and how it affects patients, nursing, and the organization in terms of fiscal management. Be specific.

    3. Develop a plan or proposal related to the chosen problem on how to improve the fiscal health of the department/unit.

    4. Include a literature review supporting the plan.

    · Describe how the literature/evidence describes the problem/issue or supports the plan/ideas to resolve the problem/issue

    · Discuss specific goals and objectives for implementing this plan/proposal

    5. Identify specific strategies for solving this problem based on the readings and literature.

    6. Include a proposed budget that shows the anticipated cost savings.

    · Discuss the return on investment expected (when, who, how, etc.)

    · This can be described in (a) narrative format within the paper, (b) in a table within the paper, or (c) as an appendix

    7. Include a proposed time line for implementation.

    8. Describe how the proposal/plan effectiveness will be evaluated.

    9. The scholarly paper should be six to eight (6-8) pages excluding the title page, reference page, and appendices.

    10. Include level 1and 2 headings to organize the paper.

    11. The paper should begin with an introductory paragraph that includes the purpose statement.

    12. The paper should include a conclusion.

    13. Write the paper in third person and a scholarly manner. To clarify: I, we, you, me, our may not be used. In addition, describing yourself as the researcher or the author should not be used.

    14. Include a minimum of six (6) references from professional peer-reviewed nursing journals to support your paper.References should be from scholarly peer-reviewed journals (review in Ulrich Periodical Directory) and be less than five (5) years old.

    15. APA format is required (attention to spelling/grammar, a title page, a reference page, and in-text citations).

    16. Submit the Financial Accountability and Nursing’s Role in Decision-Making Paper assignment to TurnitinDirect
    prior
    to your final submission to the assignment drop box by the posted due date. Please be sure to review the originality report and make any needed changes prior to submitting to the assignment drop box.

    17. Submit to the assignment drop box by posted due date.

    Assignment 5: Financial Accountability and Nursing’s Role in Decision-Making Paper Grading Rubric
    (12 points
    )

    Assignment Criteria

    5 points

    4 points

    2 points

    1 point

    All topics/criteria addressed and all questions fully answered.

    All topics/criteria addressed and most questions fully answered.

    All topics/criteria addressed and most questions partially answered.

    One or more topics/criteria not addressed or completely answered.

    Quality/Accuracy of Information

    3 points

    2 points

    1 point

    0 points

    Information clearly relates to the main topic/criteria. It includes several supporting details and/or examples.

    Information clearly relates to the main topic/criteria. It provides supporting details and/or examples.

    Information clearly relates to the main topic/criteria. A few details and/or examples are given.

    Information has little or nothing to do with the main topic/criteria.

    Organization

    2 points

    1 point

    0.5 point

    0.25 point

    Information is very organized with well-constructed paragraphs and levels of heading.

    Information organized with well-constructed paragraphs and levels of heading.

    There is an attempt at organization but errors exist. No levels of heading.

    The information or overall structure appears disorganized.

    Sources

    2 points

    1 point

    0.5 point

    0.25 point

    All references are from a relevant professional peer-reviewed scholarly journal, within a 5-year timeframe, or a classic/ historical source.

    The majority of references are from a relevantprofessional peer-reviewed scholarly journal, within a 5-year timeframe or a classic/historical source.

    Some references are from non-peer-reviewed scholarly sources or older than 5-years.

    Majority of references are from non-peer-reviewed scholarly sources or older than 5-years.

    Earned Points

    Up to 20% of the assigned points (total points of assignment) can be deducted from the earned points for errors in APA style [title page, introduction, purpose statement, level heading, conclusion, references, citations, and format], spelling, and/or grammar.

  • Healthcare Organizations and Their Environments Essay

    Healthcare Organizations and Their Environments Essay

    You have been asked to prepare a speech to deliver to an industry group about the following topic:

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    1. The unabated continuation of the proliferation and fragmentation of the health professions.

    2. What are the desirable aspects of this fragmentation?

    3. And what is the undesirable aspects of this fragmentation?

    4. Should actions be taken to slow or stop this trend? If so, what should be done and how can it be achieved?

  • Your Policy Priority Issue Guidelines and Grading Rubric

    Your Policy Priority Issue Guidelines and Grading Rubric

    Purpose

    The purpose of this assignment is to: a) identify and reflect upon key concepts related to your planning a policymaker call b) provide empirical evidence to support new insights gained regarding your healthcare policy issue and the policymaking process, and c) present ideas in a clear, succinct, and scholarly manner.

    Course Outcomes

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

    (CO#1) Analyze application of theories to the development of policies that affect nursing and health care. (PO 9, 10)

    (CO#3) Communicate with policymakers to advocate for effective policies that affect nurses and nursing, consumers, or the health care system. (PO 2, 3, 10)

    (CO#4) Analyze the historical, ethical, and political contexts of healthcare policy and the consequences of policy implementation. (PO 6, 10)

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    (CO#6) Investigate the interrelationship between policy decisions and evidence-based practice. (PO 4, 7, 10)

    Due Date Sunday 11:59 p.m. MT at the end of Week 3

    Total Points: 175 points

    Requirements

    Assignment Criteria for Presentation:

    1. Provide an introduction to your healthcare policy-priority issue and the title or name of your legislator.

    2. Articulate key points under each of the Formulating a Healthcare Policy Ungraded Worksheet #1 sections.

    3. Provide an analysis of empirical evidence that supports your chosen healthcare policy-priority issue and analysis.

    4. Demonstrate the importance and impact of the chosen healthcare policy-priority issue to nursing.

    5. Provide concluding statements summarizing the content.

    6. The paper will be a minimum of 4 pages and a maximum of five pages in length, in APA format 6th edition, excluding the title and reference page.

    Preparing the Paper

    After completing Formulating a Healthcare Policy Ungraded Worksheet #1, address all areas on the worksheet in the body of a scholarly paper. Include a minimum of five (5) classic or current references published within the past 5 years.

    Category

    Points

    %

    Description

    Introduction and Conclusion

    35

    20

    Introduction clearly introduces your healthcare policy- priority issue and the title or name of your designated legislator.

    Concluding statements summarizing content.

    Key Points

    40

    23

    Identification of all key points of your healthcare policy-priority issue (review sections of Healthcare Policy Ungraded Worksheet) are clearly analyzed and fully articulated.

    Empirical Evidence

    40

    23

    Provide an analysis of empirical evidence that supports your chosen healthcare policy issue and analysis.

    Impact and Importance to Nursing

    35

    20

    Demonstrate the importance and impact of the chosen healthcare policy issue to nursing.

    APA Format

    10

    6

    Text, title page, and references are consistent with APA format.

    Writing Quality

    15

    8

    Rules of grammar, word usage, sentence, and paragraph format and punctuation.

    Total

    175

    100

    A quality assignment will meet or exceed all of the above requirements.

    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 = 150 Points

    Introduction clearly introduces your healthcare policy-priority issue. Concluding statements summarizing content are present.

    35 Points

    31 Points

    28 Points

    13 Points

    0 Points

    Introduction clearly introduces your healthcare policy-priority issue and the title or name of your designated legislator. Concluding statements summarizing content are present, clear, and well written.

    Introduction introduces your healthcare policy-priority issue and the name or title of your designated legislator. Concluding statements summarizing content are present. Minor clarity or detail issues.

    Introduction and conclusion are included; could include more details such as a specific healthcare policy-priority issue that a legislator could act upon or the name or title of the legislator; clarity or improvement of format.

    Lacking introduction or conclusion.

    No attempt made at introduction or conclusion.

    Identification of all key points of your healthcare policy-priority issue are clearly analyzed and fully articulated.

    40 Points

    35 Points

    32 Points

    15 Points

    0 Points

    Key points are well described, and analysis is fully articulated.

    Key points are described with some lack of clarity, and/or analysis is lacking detail or clarity.

    Key points are not well described, and/or analysis is lacking detail or clarity.

    Key points or analysis is missing.

    Key points and analysis is missing.

    Empirical evidence supporting your healthcare policy-priority issue is clearly analyzed.

    40 Points

    35 Points

    32 Points

    15 Points

    0 Points

    Empirical evidence supporting your healthcare policy- priority issue is clearly analyzed in a comprehensive and accurate manner.

    Empirical evidence supporting your healthcare policy- priority issue is analyzed but lacking clarity or not substantive.

    Empirical evidence supporting your healthcare policy- priority issue is noted but not analyzed.

    Empirical evidence supporting your healthcare policy priority issue is lacking.

    No attempt made at providing empirical evidence.

    Your healthcare policy- priority issue clearly demonstrates the impact and or importance of your issue to nursing or the intended impact to patient outcomes.

    35 Points

    31 Points

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    28 Points

    13 Points

    0 Points

    Impact to patient outcomes or nursing practice is thoroughly discussed.

    Impact to patient outcomes or nursing practice has rare inaccuracy.

    Impact to patient outcomes or nursing practice lacks occasional important elements or specificity.

    Impact to patient outcomes or nursing practice has multiple instances of inaccuracies.

    Impact to patient outcomes or nursing practice has multiple instances of inaccuracies and is vague.

    Content Subtotal _____of 150 points

    Format Possible Points = 25 Points

    APA Format: Text, title page, and reference page(s) are completely consistent with APA format 6th edition.

    10 Points

    9 Points

    8 Points

    4 Points

    0 Points

    Paper is free from APA errors throughout.

    There are 1-2 APA format errors in the text, title page, and/or reference page(s)

    There are 3-4 APA format errors in the text, title page, and/or reference page(s)

    There are 5 APA format errors in the text, title page, and/or reference page(s)

    There are 6 or more APA format errors in the text, title page, and/or reference page(s)

    Writing Quality: Paper is appropriate in length. References include a minimum of 5 scholarly references excluding the course text. Rules of grammar, spelling, word usage, and punctuation are consistent with formal written work.

    15 Points

    13 Points

    12 Points

    6 Points

    0 Points

    Paper is appropriate in length. References include more than the minimum number of scholarly references, excluding the course text. Rules of grammar, spelling, word usage, and punctuation are consistent with formal written work.

    Paper is short/long in length and/or contains a minimum of scholarly references excluding course text, or references utilized are not scholarly. Rules of grammar, spelling, word usage, and punctuation are consistent with formal written work with1-2 exceptions.

    Paper is short/long in length and contains only 1 scholarly reference. Additional references are not scholarly. Rules of grammar, spelling, word usage, and punctuation are consistent with formal written work with 3-4 exceptions.

    Paper is short/long two or more pages in length and does not contain scholarly references. References utilized are not scholarly. Rules of grammar, spelling, word usage, and punctuation are not followed with 5 errors.

    Paper is short/long two or more pages in length and does not contain scholarly references. References utilized are not scholarly. Rules of grammar, spelling, word usage, and punctuation are not followed with 6 or more errors.

    Format Subtotal _____of 25 points

    Total Points _____of 175 points

  • Essay on appropriate public health model for a targeted intervention

    Essay on appropriate public health model for a targeted intervention

    Healthcare of Population

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    1. How do you select an appropriate public health model for a targeted intervention?

    2. What is the importance of conducting a needs assessment?

    3. How does one establish intervention priorities?

  • Essay Assignments: NURS 6560 – Advanced Practice Care of Adults in Acute Care Settings

    Essay Assignments: NURS 6560 – Advanced Practice Care of Adults in Acute Care Settings

    Students in this course will advance their clinical competence in the care of patients in acute care settings by building on knowledge and skills gained in the NURS 6550. Through clinical practice, students will build confidence as they begin the transition from student to advanced practice nurse. Classroom activities and case studies will enable students to explore the complex healthcare system including multiple governmental, social and personal resources available to acutely ill adults across the age continuum. Clinical experiences in hospital settings will provide students with the continued opportunity to develop, implement, and evaluate management plans for adults and older adults with complex acute, critical, and chronic illness. The application of knowledge in the management of patients and the collaboration between the advanced practice nurse and the patient, family, and interprofessional healthcare team are emphasized.

    Week 1 discussion

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    Discussion Part I: Scope of Practice, Credentialing, and Negotiation

    Note: In this course, some Discussions will have two parts:

    Part I will consist of a specific topic related to the week’s content.

    Part II will consist of a pharmacology review of approximately 250 words. Please submit each posting separately but within the same Discussion thread.

    You will be assessed on your posting and responses to both parts.

    As medical care evolves, so does the role and scope of practice of the advanced practice nurse in acute care settings. When providing patient care, however, you, as an advanced practice nurse, must always ensure that you are working within the scope of practice outlined by your state’s laws and institution’s regulations. For this Discussion, you examine these laws and regulations and consider how they might affect your future clinical practice, consider the credentialing process for your area, and discuss negotiation techniques you may use in a job search.

    To prepare:

    Locate a collaborative practice agreement. Based on this agreement, consider the scope of practice of an advanced practice nurse in your state.

    Locate and select at least two hospitals where you would be interested in working at once you obtain your licensure.

    Locate the hospitals’ credentialing documents and investigate the scope of practice at each hospital.

    Note: All hospitals do not have the same scope of practice even if they are located within the same city and state.

    Consider how the laws and regulations of the state and hospitals might affect your practice with medical and surgical patients in acute care settings.

    Think about how you would negotiate your first Advanced Practice role. Consider issues such as salary range, Continueing Medical Education (CME), license and DEA costs, insurance, hours, on call requirements, etc.

    Post on or before Day 3 an explanation of the scope of practice of advanced practice nurses, as outlined in the collaborative practice agreement. Then, identify the two hospitals of interest that you selected. Based on the credentialing documents, explain the scope of practice for acute care advanced practice nurses at each hospital. Explain how this might affect your practice in terms of caring for medical and surgical patients in acute care settings (i.e., medical treatments, procedures you can perform, interpreting diagnostics, etc.). Finally, describe job negotiation considerations.

    Note: To support your Discussion post, you must include references (with URL links) from the state and the hospitals you selected.

    Read a selection of your colleagues’ responses.

    Respond on or before Day 6 to at least two of your colleagues on 2 different days who selected a different state or hospital from yours. Share additional insights or alternative perspectives.

    Discussion Part II: Pharmacology

    Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

    To prepare:

    Read the following articles to enhance your knowledge of commonly prescribed medications:

    Chalikonda, S. A. (2009). Alpha2-adrenergic agonists and their role in the prevention of perioperative adverse cardiac events. AANA Journal, 77(2), 103–108.

    Retrieved from the Walden Library databases.

    Frankenstein, L., Katus, H. A., Grundtvig, M., Hole, T., de Blois, J., Schellberg, D., … Agewall, S. (2013). Association between spironolactone added to beta-blockers and ACE inhibition and survival in heart failure patients with reduced ejection fraction: A propensity score-matched cohort study. European Journal of Clinical Pharmacology, 69(10), 1747–1755.

    Retrieved from the Walden Library databases.

    Hao, G., Wang, Z., Guo, R., Chen, Z., Wang, X., Zhang, L., & Li, W. (2014). Effects of ACEI/ARB in hypertensive patients with type 2 diabetes mellitus: A meta-analysis of randomized controlled studies. BMC Cardiovascular Disorders, 14, 148.

    Retrieved from the Walden Library databases.

    Levy, P. D., Laribi, S., & Mebazaa, A. (2014). Vasodilators in acute heart failure: Review of the latest studies. Current Emergency and Hospital Medicine Reports, 2(2), 126–132.

    Shi, C. (2013). Blood pressure lowering efficacy of alpha blockers for primary hypertension. International Journal of Evidence-Based Healthcare, 11(3), 204–205.

    Retrieved from the Walden Library databases.

    Tocci, G., Battistoni, A., Passerini, J., Musumeci, M. B., Francia, P., Ferrucci, A., & Volpe, M. (2015). Calcium channel blockers and hypertension. Journal of Cardiovascular Pharmacology and Therapeutics, 20(2), 121–130.

    Retrieved from the Walden Library databases.

    Toppen, W., Sareh, S., Satou, N., Shemin, R., Hunter, C., Buch, E., & Benharash, P. (2014). Do preoperative ?-blockers improve postoperative outcomes in patients undergoing cardiac surgery? Challenging societal guidelines. American Surgeon, 80(10), 1018–1021.

    Retrieved from the Walden Library databases.

    Wang, A. (2012). Efficacy of class III antiarrhythmics and magnesium combination therapy for atrial fibrillation. Pharmacy Practice, 10(2), 65–71.

    Retrieved from the Walden Library databases.

    All of the following groups of medications are commonly prescribed in the acute care setting. Choose one of the topics below to discuss. If it is a medication group, select a specific drug within that group. (This is a good way to prepare for clinical practice, because you will get to know the drugs you will prescribe for patients.). Focus your discussion on the hospital or ICU setting and IV usage.

    Alpha agonists

    Alpha blockers

    Beta blockers

    Antiarrhythmics

    Calcium channel

    Vasodilators

    ACE versus BBlocker with spironolactone in CHF

    ACE versus ARB

    Note: When sharing your initial post, select a topic that has not yet been discussed. If all topics have been discussed, then you may select that topic again, but select a different drug within the medication group.

    For this Discussion, address 1 of the following options. Post by Day 3:

    Option 1: Post a description of a patient you have taken care of (inpatient as an RN, or as an NP student) who has been prescribed the medication you selected. Include the scenario, indication, dosing, complications, and outcome. Then explain whether or not you would have ordered the same drug and same dose.

    Option 2: Conduct an evidence-based drug search on the drug you selected and post an explanation of any possible issues. Are there any drug interactions? Any black box warnings? To what type of patient would you prescribe this medication?

    Option 3: Post an explanation of the properties of the drug you selected, including usages and dosing in the hospital or ICU. Describe a patient to whom you would prescribe this medication.

    Week 2 discussion – Essay Assignments: NURS 6560 – Advanced Practice Care of Adults in Acute Care Settings 

    Discussion Part I: Limitations and Challenges

    From providing ongoing assessments to monitoring for complications and facilitating recovery, advanced practice nurses who care for patients in perioperative environments experience a unique set of limitations and challenges. Reflecting on your experiences in this complex and critical environment will help you develop your professional competency and prepare you for your future role as an advanced practice nurse. In this week’s Discussion, you consider limitations and challenges of clinical practice in perioperative care settings.

    To prepare:

    Reflect on this week’s clinical experiences.

    Consider one limitation or challenge you encountered.

    Think about how you overcame this limitation or challenge and how this might affect your future practice in pre- and post-operative care settings.

    Post on or before Day 3 a description of at least one limitation or challenge you encountered during your clinical experience this week. Explain how you overcame this limitation or challenge and how this might affect your future practice.

    Note: If you refer to a patient in your Discussions or Assignments, be sure to use a pseudonym or other false form of identification. This is to ensure the privacy and protection of the patient.

    Read a selection of your colleagues’ responses.

    Respond on or before Day 6 to two colleagues by sharing additional insights or alternative perspectives.

    Discussion Part II: Pharmacology

    Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

    To prepare:

    Read the following articles to enhance your knowledge of commonly prescribed medications:

    Ando, S., Yasugi, D., Matsumoto, T., Kanata, S., & Kasai, K. (2014). Serious outcomes associated with overdose of medicines containing barbiturates for treatment of insomnia. Psychiatry Clinical Neuroscience, 68(9), 721.

    Dassanayake, T. L., Jones, A. L., Michie, P. T., Carter, G. L., McElduff, P., Stokes, B. J., & Whyte, I. M. (2012). Risk of road traffic accidents in patients discharged following treatment for psychotropic drug overdose: A self-controlled case series study in Australia. CNS Drugs 26(3), 269–276.

    Retrieved from the Walden Library databases.

    Kulick, D., & Deen, D. (2011). Specialized nutrition support. American Family Physician, 83(2), 173–183. Retrieved from http://www.aafp.org/afp/2011/0115/p173.html

    Martini, D. I., Nacca, N., Haswell, D., Cobb, T., & Hodgman, M. (2015). Serotonin syndrome following metaxalone overdose and therapeutic use of a selective serotonin reuptake inhibitor. Clinical Toxicology 53(3), 185–187.

    Robinson, A., & Wermeling, D. P. (2014). Intranasal naloxone administration for treatment of opioid overdose. American Journal of Health-System Pharmacy, 71(24), 2129–2135.

    Retrieved from the Walden Library databases.

    Thomas, D. R. (2013). Total parenteral nutrition (TPN). In The Merck Manual Professional Edition. Retrieved from http://www.merckmanuals.com/professional/nutritional_disorders/nutritional_support/total_parenteral_nutrition_tpn.html

    All of the following groups of medications are commonly prescribed in the acute care setting. Choose one of the topics below to discuss. If it is a medication group, select a specific drug within that group. (This is a good way for you to prepare for clinical practice, because you will get to know the drugs you will prescribe for patients.). Focus your discussion on the hospital or ICU setting and IV usage.

    KPhos, bicarb, calcium, magnesium

    Iron, folic acid, B12

    Diamox

    Macrolides

    Muinolones/mluoroquinolone

    Cephalosporins, 4th and 5th generation

    Aminoglycosides

    Carbapenems

    Lipopeptide

    Tigecycline

    Note: When sharing your initial post, select a topic that has not yet been discussed. If all topics have been discussed, then you may select that topic again, but select a different drug within the medication group.

    For this Discussion, address 1 of the following options. Post by Day 3:

    Option 1: Post a description of a patient you have taken care of (inpatient as an RN, or as an NP student) who has been prescribed the medication you selected. Include the scenario, indication, dosing, complications, and outcome. Then explain whether or not you would have ordered the same drug and same dose.

    Option 2: Conduct an evidence-based drug search on the drug you selected and post an explanation of any possible issues. Are there any drug interactions? Any black box warnings? To what type of patient would you prescribe this medication?

    Option 3: Post an explanation of the properties of the drug you selected, including usages and dosing in the hospital or ICU. Discuss a patient to whom you would prescribe this medication.

    Week 4 discussion – Essay Assignments: NURS 6560 – Advanced Practice Care of Adults in Acute Care Settings 

    Discussion Part I: Assessment and Care of Patients With Cardiovascular Conditions

    Many cardiac disorders such as myocardial infarctions are a common problem in the acute care setting. Thus it is essential for you, as the advanced practice nurse caring for acute patients, to identify potential signs and symptoms of complications. Although some cardiac disorders require outpatient treatment and management, other procedures such as CABGs or valve replacements are more common and frequently require major interventions. In your role with acute cardiac patients, you must evaluate symptoms and determine how to treat patients. For this Discussion, consider potential diagnoses, treatment, and/or referral options for the patients in the following 3 case studies.

    Case Study 1: Tom is 56-year-old African American male who presented to the ED with chest pain radiating to his back. The pain has been continuous for 1 hour. The patient complains of shortness of breath. The pain has not been relieved with rest. The patient’s vitals are: 99.1-98-18-198/110. The patient’s cardiac enzymes are negative. Labs results are as follows:

    Na 134

    K 4.1

    Cr 1.8

    BUN 42

    Glucose 248

    WBC 13.1

    Hbg 14.1

    Hct 44.2

    Plt 236

    EKG sinus rhythm no ekg changes

    Case Study 2: Liz is a 79-year-old female with a history of aortic stenosis and hypertension. The patient underwent elective aortic valve replacement yesterday. This AM during rounds, the patient is sitting up in the chair. Vital signs: 99.4-54-20-85/50. Pa 29/13, CVP10. Urine output 20 ml/hr for the last 3 hours. Cardiac output 3.9, cardiac index 1.8. Patient’s preop ef was 50%. Labs are as follows:

    K 4.0

    Cr 1.5

    BUN 42

    Hgb 9.8

    Hct 29.1

    Plt 138

    Postoperative chest X-ray normal

    Case Study 3: Arvid is a 69-year-old male you are seeing in CCU 1 hour after he had a CABG × 4. The patient is intubated. VS: 97.1-78-14-90/50. PA 30/13, CVP 12. ABG 7.21-49-98-19.6-99%- -6 base deficit. Mixed venous O2 sat 68. Hgb 10.2, Hct 32.1. The patient is sedated. Vent settings FiO2 50%, IMV 12, PEEP 5, tidal volume 550.

    To prepare:

    Review and select 1 of the 3 case studies provided. Analyze the patient information.

    Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.

    Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or nonpharmacologic treatments.

    Consider strategies for educating patients and families on the treatment and management of the cardiac disorder.

    Post on or before Day 3 an explanation of the differential diagnosis for the patient in the case study you selected. Explain which is the most likely diagnosis for the patient and why. Include an explanation of unique characteristics of the disorder you identified as the primary diagnosis. Then, explain a treatment and management plan for the patient, including appropriate dosages for any recommended treatments. Finally, explain strategies for educating patients and families on the treatment and management of the cardiac disorder.

    Read a selection of your colleagues’ responses.

    Respond on or before Day 6 to at least two of your colleagues on 2 different days in both of the ways listed below. Respond to colleagues who selected different case studies from yours.

    Describe how a patient factor such as age, gender, ethnicity or culture might affect the diagnosis, management, and follow-up care of patients with the cardiac disorders your colleagues discussed.

    Based on your personal and/or professional experiences, expand on your colleagues’ postings by providing additional insights or different perspectives.?

    Discussion Part II: Pharmacology

    To prepare:

    Read the following article to enhance your knowledge of commonly prescribed medications:

    Kalil, A., & Bailey, K. L. (2014, October 20). Septic shock medication. Retrieved from http://emedicine.medscape.com/article/168402-medication

    All of the following groups of medications are commonly prescribed in the acute care setting. Choose one of the topics below to discuss. If it is a medication group, select a specific drug within that group. (This is a good way for you to prepare for clinical practice, because you will get to know the drugs you will prescribe for patients.). Focus your discussion on the hospital or ICU setting and IV usage.

    All of the following groups of medications are commonly prescribed in the acute care setting. This Discussion will focus on CABG patients. Choose one of the topics below to discuss in terms of management of a post-CABG patient. Focus your discussion on the hospital or ICU setting and IV usage.

    Amicar

    Epinephrine

    Vasopressin

    Nitroglycerin

    Cardene

    Insulin drip

    Dopamine

    Dobutamine

    Norepinephrine

    Phenylephrine

    Note: When sharing your initial post, select a drug that has not yet been discussed. If all drugs have been discussed, then you may select that drug again.

    For this Discussion, address 1 of the following options. Post by Day 3:

    Option 1: Post a description of a patient you have taken care of (inpatient as an RN, or as an NP student) who has been prescribed the medication you selected. Include the scenario, indication, dosing, complications, and outcome. Then explain whether or not you would have ordered the same drug and same dose.

    Option 2: Conduct an evidence-based drug search on the drug you selected and post an explanation of any possible issues. Are there any drug interactions? Any black box warnings? To what type of patient would you prescribe this medication?

    Option 3: Post an explanation of the properties of the drug you selected, including usages and dosing in the hospital or ICU. Describe a patient to whom you would prescribe this medication.

    Week 9 discussion

    Discussion Part I: Assessment and Care of Patients With Adrenal and Urogynecologic Conditions

    Many genitourinary (GU) disorders such as kidney disease start developing during adolescence (Johns Hopkins Children’s Center, 2010). This early onset of disease makes it essential for you, as the advanced practice nurse caring for adolescent patients, to identify potential signs and symptoms. Although some adolescent GU disorders require long-term treatment and management, other disorders such as urinary tract infections are more common and frequently require only minor interventions. In your role with adolescent patients, you must evaluate symptoms and determine whether to treat patients or refer them for specialized care. For this Discussion, consider potential diagnoses, treatment, and/or referral options for the patients in the following 3 case studies.

    Case Study 1: Alicia is an 18-year-old female who is brought into urgent care by her mother. She is complaining of dizziness. She recently started to lift weights for softball season. She has been healthy up to this point. Vitals are: temp 101.9°F, HR 120, RR 24, BP 90/54. She has lower extremity edema and decreased skin turgor. She states that her shoulders, thighs, and lower back hurt. She is having trouble moving her arms and legs. She also complains of vague abdominal pain, with nausea and vomiting. Labs came back with CK 10,000, uric acid 40 mg/dl, WBC 14.3, BUN:creatinine ratio 6:1, K 5.8. Urinalysis shows a presence of myoglobin of more than 25.

    Case Study 2: Mark is a 15-year-old male with a complaint of acute left scrotal pain with nausea. The pain began approximately 6 hours ago as a dull ache and gradually has worsened such that he can no longer stand without doubling over. He is afebrile and in marked pain. Physical exam results are negative except for elevation of the left testicle, diffuse scrotal edema, and the presence of a blue dot sign.

    Case Study 3: Maya is a 16-year-old female who presents to the ER for urinary pain. She is a healthy adolescent with complaints of lower abdominal pain, low back pain, and burning with urination. She had a fever of 102°F at home. Physical examination results are normal. Routine urinalysis indicates 2+ proteinuria; specific gravity 1.020; negative for glucose, blood. Leukocytes are moderate and nitrites, moderate. Her blood pressure is normal, and she is at the 60th percentile for height and weight. Vitals are: temp 103.1°F, HR 116, RR 18, BP 100/58. P Ox is 98% (Johns Hopkins Children’s Center, 2010).

    To prepare:

    Review and select 1 of the 3 provided case studies. Analyze the patient information.

    Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.

    Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or nonpharmacologic treatments.

    Consider strategies for educating patients and families on the treatment and management of the genitourinary disorder.

    Post on or before Day 3 an explanation of the differential diagnosis for the patient in the case study you selected. Explain which is the most likely diagnosis for the patient and why. Include an explanation of unique characteristics of the disorder you identified as the primary diagnosis. Then, explain a treatment and management plan for the patient, including appropriate dosages for any recommended treatments. Finally, explain strategies for educating patients and families on the treatment and management of the genitourinary disorder.

    Read a selection of your colleagues’ responses.

    Respond on or before Day 6 to at least two of your colleagues on 2 different days in both of the ways listed below. Respond to colleagues who selected different case studies from yours.

    Describe how culture might affect the diagnosis, management, and follow-up care of patients with the genitourinary disorders your colleagues discussed.

    Based on your personal and/or professional experiences, expand on your colleagues’ postings by providing additional insights or different perspectives.?

    Discussion Part II: Pharmacology

    Read the following articles to enhance your knowledge of commonly prescribed medications:

    Daley, B. (2015, February 23). Peritonitis and abdominal sepsis. Retrieved from http://emedicine.medscape.com/article/180234-overview

    Shahedi, K., Chudasama, Y. N., Dea, S. K., & Cooperman, A. (2015, January 14). Diverticulitis treatment and management. Retrieved from http://emedicine.medscape.com/article/173388-treatment

    Tobias, J. D., & Leder, M. (2011). Procedural sedation: A review of sedative agents, monitoring, and management of complications. Saudi Journal of Anasthesia, 5(4), 395–410. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3227310/

    All of the following groups of medications are commonly prescribed in the acute care setting. Choose one of the topics below to discuss. If it is a medication group, select a specific drug within that group. (This is a good way for you to prepare for clinical practice, because you will get to know the drugs you will prescribe for patients.). Focus your discussion on the hospital or ICU setting and IV usage.

    Sedation

    Diazepam

    Fentanyl

    Ketamine

    Lorazepam

    Midazolam

    Propofol

    Nonsedation

    Chlorpromazine

    Peritonitis—what antibiotics are chosen for peritonitis?

    Nerve blocks—what drugs are used with nerve blocks?

    Diverticulitis—what drugs are used with diverticulitis?

    Note: When sharing your initial post, select a topic that has not yet been discussed. If all topics have been discussed, then you may select that topic again, but select a different drug within the medication group.

    For this Discussion, address 1 of the following options. Post by Day 3:

    Option 1: Post a description of a patient you have taken care of (inpatient as an RN, or as an NP student) who has been prescribed the medication you selected. Include the scenario, indication, dosing, complications, and outcome. Then explain whether or not you would have ordered the same drug and same dose.

    Option 2: Conduct an evidence-based drug search on the drug you selected and post an explanation of any possible issues. Are there any drug interactions? Any black box warnings? To what type of patient would you prescribe this medication?

    Option 3: Post an explanation of the properties of the drug you selected, including usages and dosing in the hospital or ICU. Describe a patient to whom you would prescribe this medication.

    Week 10 discussion

    Discussion Part I: Neurologic and Orthopedic Conditions and Plastic/Reconstructive Surgery

    This week, you study neurologic and orthopedic conditions with plastic surgery considerations. Both neurologic and orthopedic conditions are seen in the trauma areas of the hospital. These conditions encompass cardiovascular, pulmonary, and metabolic aspects of care in the ICU. For this Discussion, focus on adolescent patients, and consider potential diagnoses, treatment, and/or referral options for the patients in the following 3 case studies.

    Case Study 1: A 17-year-old male was celebrating his birthday with friends and alcohol. At one point he jumped into the hotel pool three stories below, hitting the side of the pool with his chest. EMS arrived and packaged him with spinal support. He arrives in the ER with breathing difficulty, chest pain, GCS 10, and O2 sat of 94%. You do initial assessment in the first 10 minutes and find that his chest is asymmetric for breathing and contusions are noted all over his chest. His CXR shows multiple rib fractures on both sides and pulmonary contusions. His cervical spine is stable in a collar. His thoracic and lumbar films are negative for fractures. In the next hours, what are your priorities, and what plan would you have for this patient as he moves to the ICU? At what stage of development is he, and how does that affect his care?

    Case Study 2: A 13-year-old female restrained passenger of a vehicle was involved in an MVA at 60 mph on the highway. The vehicle experienced a frontal impact. The patient arrived in the ER with closed fractures of the left tibia and fibula with angulation, dislocation of the right ankle, multiple pelvic fractures, and femur fracture on the left side. Her BP is 92/54 with pulse of 130. What is your plan for this patient, and what are the considerations to prevent further morbidity? At what stage of development is she, and how does that impact her care?

    Case Study 3: A 19-year-old male private in the U.S. Air Force was driving with friends when they dared him to “surf the car.” He fell off the roof of the car while it was moving at a speed of approximately 40 mph. He landed face first. He is now in the ICU with a closed head injury. His intracranial pressure is elevated, and his pupillary response is slowing. At this time, what medications do you recommend, and what other medical treatments do you recommend? In addition, after the acute situation is controlled and the patient awakens, what medication do you use for his agitation?

    To prepare:

    Review and select 1 of the 3 provided case studies. Analyze the patient information.

    Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.

    Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or nonpharmacologic treatments.

    Consider strategies for educating patients and families on the treatment and management of the trauma care.

    Post on or before Day 3 an explanation of the differential diagnosis for the patient in the case study you selected. Explain which is the most likely diagnosis for the patient and why. Include an explanation of unique characteristics of the disorder you identified as the primary diagnosis. Then, explain a treatment and management plan for the patient, including appropriate dosages for any recommended treatments. Finally, explain strategies for educating patients and families on the treatment and management of neurologic and orthopedic conditions.

    Read a selection of your colleagues’ responses.

    Respond on or before Day 6 to at least two of your colleagues on 2 different days in both of the ways listed below. Respond to colleagues who selected different case studies from yours.

    Describe how culture might affect the diagnosis, management, and follow-up care of patients with the neurological, orthopedic, or plastics disorders your colleagues discussed.

    Based on your personal and/or professional experiences, expand on your colleagues’ postings by providing additional insights or different perspectives.?

    Discussion Part II: Pharmacology

    To prepare:

    Read the following articles to enhance your knowledge of commonly prescribed medications:

    Family Practice Notebook. (2015). Nonsteroidal anti-inflammatory. Retrieved from http://www.fpnotebook.com/Pharm/Analgesic/NnstrdlAntInflmtry.htm

    Press, C. D. (2013, September 10). Infiltrative administration of local anesthetic agents. Retrieved from http://emedicine.medscape.com/article/149178-overview

    All of the following groups of medications are commonly prescribed in the acute care setting. Choose one of the topics below to discuss. If it is a medication group, select a specific drug within that group. (This is a good way for you to prepare for clinical practice, because you will get to know the drugs you will prescribe for patients.). Focus your discussion on the hospital or ICU setting and IV usage.

    Glycopeptides

    Oxazolidinones (Bs)

    Monobactams

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    Ansamycins

    Metronidazole

    Lincosamides (Bs)

    Tinidazole

    Lidocaine

    Marcaine

    NSAIDs

    Note: When sharing your initial post, select a topic that has not yet been discussed. If all topics have been discussed, then you may select that topic again, but select a different drug within the medication group.

    For this Discussion, address 1 of the following options. Post by Day 3:

    Option 1: Post a description of a patient you have taken care of (inpatient as an RN, or as an NP student) who has been prescribed the medication you selected. Include the scenario, indication, dosing, complications, and outcome. Then explain whether or not you would have ordered the same drug and same dose.

    Option 2: Conduct an evidence-based drug search on the drug you selected and post an explanation of any possible issues. Are there any drug interactions? Any black box warnings? To what type of patient would you prescribe this medication?

    Option 3: Post an explanation of the properties of the drug you selected, including usages and dosing in the hospital or ICU. Describe a patient you would prescribe this medication to. Essay Assignments: NURS 6560 – Advanced Practice Care of Adults in Acute Care Settings

  • Heart Attack Essay

    Heart Attack Essay

    Scenario

    Marguerite M., an eighty-nine-year-old widow, was admitted into the cardiac intensive care unit in Chicago’s Memorial Hospital at 3:00 A.M. on a Sunday morning with a mas­sive heart attack (myocardial infarction). Her internist, Dr. K., who is also a close family friend, has ordered an angiogram to determine the status of Marguerite’s infarction (heart attack). Dr. K. has found that the angiogram needs to be done within the first six hours after an infarction to be effective. The procedure is going to be done as soon as the on-call surgical team can set up the angiography surgical room. The radiologist, who lives thirty minutes from the hospital, must also be in the hospi­tal before the procedure can begin. At 4:30 A.M. the team is ready to have Marguerite, who is barely conscious, transferred front the intensive care unit to the surgical suite.

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    Coincidentally, at 4:30 A.M. Sarah W., an unconscious forty-five-year-old woman, is brought in by ambulance with a massive heart attack. The emergency room physi­cians, after conferring with her physician by phone, conclude that she will need a balloon angiography to save her life. When they call the surgical department to have the on-call angiography team brought in, they are told that the room is already set up for Dr. K’s patient. They do not have another team or room for Sarah W. A de­cision is made that Sarah, who needs the balloon angiography to survive will receive the procedure.

    Dr. K. is called at home and told that his patient. Marguerite, will not he able to have the angiogram. The hospital is going to use the angiography team for Sarah since she is younger than Marguerite and has a greater chance for recovery. Unfortunately, it took longer than expected to stabilize Sarah both before and after the procedure, and the six-hour “window” when the procedure could he performed on Marguerite passed. Sarah survived, made a full recovery, and returned to her family. Marguerite expired the following morning.

    A. Should Dr. K. have had a voice in this decision ?

    B. Is it ethical to “bump” Marguerite in favor of the younger patient?

    C. Should this decision be discussed with Marguerite’s family?

    D. Does the fact that Sarah’s life has been saved due to the angiogram team being ready to operate on Marguerite make any difference? Heart Attack Essay.

  • Pros & Cons of Embryonic Stem Cell Research

    Pros & Cons of Embryonic Stem Cell Research

    Pros & Cons of Embryonic Stem Cell Research

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    1. What are the main arguments for and against embryonic stem cell research?

    2. What are President Bush’s views?

    3. Does the U.S. public support embryonic stem cell research or not? Include recent statistics and poll findings.

  • Medical Law and Ethics-Rights as a Healthcare Provider

    Medical Law and Ethics-Rights as a Healthcare Provider

    Medical Law and Ethics: Rights as a Healthcare Provider

    Given that rights have dominated several healthcare debates, how would you define rights as a healthcare provider and why?

    What are the consequences of your definition?

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    What type of patient-provider model would best accommodate your definition of rights?

    If rights also produce obligations – how can both patients and providers claim professional or personal rights over the same issue?

    Medical Law and Ethics-Rights as a Healthcare Provider

  • Healthcare Finance-Private and Government Sponsored

    Healthcare Finance-Private and Government Sponsored

    Healthcare Finance: Private and Government Sponsored

    1. With respect to financing, what are the main differences between private health care insurance and government sponsored health care for persons over age 65 (Medicare)?

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    2. Financially, what kind of balance must health care organizations strike in providing care among private pay patients, government program patients and charity patients?

    3. How would a health care organization’s inability to process patient billing correctly and/or in a timely manner be reflected in its financial statements?

    Healthcare Finance-Private and Government Sponsored

  • Ethical Principles in Hospital Budgeting

    Ethical Principles in Hospital Budgeting

    1. What are the ethical principles that should guide budget development?

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    2. If a department is consistently going over budget, yet the department’s management is sound, what are some of the things that could be causing the problem?