2023 This homework consists of 3 separate homework each focused on a specific

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Nursing 2023 Three Different Case Study

This homework consists of 3 separate homework each focused on a specific 2023 Assignment

This homework consists of 3 separate homework each focused on a specific case study.  Each case and subsequent homework question are taken from the Olden text. 

In order to fully answer each homework question, your response should typically range between 1 ½ -2 pages per question or 4-5 pages for the entire homework, double spaced using 12-point typeface.  Each homework is worth a maximum of 33 points. 

Please submit your homework by Wednesday October 27, 11:59 pm. 
 

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2023 comment1 Prior to the passing of the Patient Protection and Affordable Care

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Nursing 2023 Comment

comment1 Prior to the passing of the Patient Protection and Affordable Care 2023 Assignment

comment1

Prior to the passing of the Patient Protection and Affordable Care Act (PPACA) of 2010, the health care system was fragmented.  There was no one single entity responsible for the overall coordination and quality of a patient’s care.  The PPACA provides many provisions that seek to connect the quality of care with the cost of care.  It creates incentives for integrated care delivery models and pays for coordination and quality of care. One innovative care delivery model addressed in the PPACA is the accountable care organization (American Nurses Association [ANA], 2010).

                An Accountable Care Organization (ACO) is a collaboration of primary care providers, a hospital, specialists, and other health care professionals that accept joint responsibility for the quality and cost of patient care.  While ACOs are not new, the PPACA brought them to the forefront of new delivery models and provides the ACO with more leeway regarding who can lead them.  This permits greater nursing leadership and participation.  In fact, a key term in the PPACA is “ACO professional.” The law defines the ACO professional as a physician “and” a nurse practitioner, clinical nurse specialist, or a physician assistant (ANA, 2010).

  

comment2

In the PCMH, the team would know and care for the patient in their home. This would require a consistent and timely team work between team members. The use of electronic medical records increase the teams timely response and care. Also included with electronic care systems is the ability to request a consult from another team member. The progress, charting, labs and other pertinent information would be made available to each team member at all times. It is also imperative that nurses and physicians be able to contact a specialty physician. Getting to know who is on your team and being able to contact the specialty is important. Relationships need to be built or reinforced in order to provide quality care. In the PCMH, the care is focused on medical care given in the home (Haas, S., 2010). Patient-Centered Primary Care Collaborative (PCPCC) published an Annual Review of Evidence 2014-2015, in which it examined the cost measures and utilization of services. It was reported that PCMH care costs were lower and the health care quality had improved (Gross, A., 2016). The report continued to state that “The evidence continues to build that a high performing, patient-centered medical home – especially when supported by multiple, committed and aligned payers – is the foundation for a better performing health care system”. “…it [PCMH] can control costs and promote the right care” (Gross, A., 2016). The report continued to show evidence of improved health care, improved health for the client, decreased hospital admissions and emergency room visits. Overall, the quality of care was increased and costs decreased (Gross, A., 2016). Using  a telehealth with the RN as the point of contact increases the clients confidence at being heard. Some places call this form as a telehealth buddy, where the RN can triage, educate and counsel the patient (Haas, S., 2010). Telehealth systems are in place to compliment the home visits by the RN and helps the client to feel as though the health care team is always available to them without the traveling or long waits for doctor’s appointments.

              

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2023 Peer reply pharmacy DB5 1 triana DERMATOLOGY CASE STUDY Chief complaint My right great

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Nursing 2023 Peer Reply DB 5

Peer reply pharmacy DB5 1 triana DERMATOLOGY CASE STUDY Chief complaint My right great 2023 Assignment

Peer reply pharmacy DB5

1 -triana

DERMATOLOGY CASE STUDY

 Chief complaint: “ My right great toe has been hurting for about 2 months and now it’s itchy, swollen and yellow. I can’t wear closed shoes and I was fine until I started going to the gym”.

HPI: E.D a 38 -year-old Caucasian female presents to the clinic with complaint of pain, itching, inflammation, and “yellow” right great toe. She noticed that the toe was moderately itching after she took a shower at the gym. She did not pay much attention. About two weeks after the itching became intense and she applied Benadryl cream with only some relief.  She continued going to the gym and noticed that the itching got worse and her toe nail started to change color. She also indicated that the toe got swollen, painful and turned completely yellow 2 weeks ago. She applied lotrimin  AF cream and it did not help relief her symptoms. She has not tried other remedies.

Denies associated symptoms of fever and chills. 

 1.According to the AAFP/CDC Guidelines, what antifungal medication(s) should this patient be prescribed, and for how long? Write her complete prescriptions using the prescription writing format in your textbook.

 Onychomycosis is a fungal infection of the nail, either fingernail or toenail. The common dermatophyte that is found in onychomycosis is tinea unguium , with candida infections also a cause . Effective treatment usually involves months of systemic antifungal medication, commonly griseofulvin, ketoconazole ,itraconazole or terbinafine. Topical treatment is usually not effective except for ciclopirox nail lacquer (Woo & Robinson, 2016).

 

Terbinafine 250mg 1 tab PO daily x 12 weeks 

 Terbinafine 250mg take one tablet by mouth daily for 12 weeks 

 2.  What labs for baseline and follow up of therapy would you order for this patient?

Liver enzymes and complete blood count should be monitor every 6 weeks if treatment last longer than 6 weeks. 

 Terbinafine is an orally and topically active allylamine fungicidal agent which is used to treat superficial fungal infections of the skin and nails.  Terbinafine has been clearly linked to rare instances of acute liver injury that can be severe and sometimes fatal.

Drug induced liver injury due to terbinafine was identified shortly after its introduction into medical use.  Oral therapy with terbinafine is associated with elevations in serum aminotransferases in less than 1% of patients and the elevations are generally asymptomatic and resolve without stopping therapy.  The estimated probability of developing elevated serum aminotransferase levels requiring stopping treatment is about 0.31% for 2 to 6 weeks’ treatment and 0.44% for treatment longer than 8 weeks (“Terbinafine”, 2019).

 

Reference 

Woo, T. M., & Robinson, M. V. (2016). Pharmacotherapeutics for advance practice nurse prescribers. Philadelphia: F.A. Davis Company.

 Terbinafine. (2019, July 1). Retrieved September 30, 2019, from https://livertox.nlm.nih.gov/terbinafine.htm.

—————————————————————————————————————————————

2- Rivera

 

 

 

Part 2: Labs 

            Because Terbinafine is metabolized by the liver, will be important to perform hepatic function testing for the patient due to the risk of liver enzyme elevation, and establish a baseline. Liver enzymes and complete blood count should be done every 6 weeks, during treatment (Woo and Robinson, 2016).  

 

References

Woo, T. & Robinson, M., V. (2015). Pharmacotherapeutics for advanced practice nurse prescribers. Philadelphia, PA: F. A. Davis company.

 

Follow up 

Specify when to refer the patient after therapy and why? Provide rationale.

According to the recommended guidelines, what are the non-pharmacological approaches to Onychomycosis? Provide patient education. Keep in mind the past medical history of this patient.

Patient should be referring to Podiatrist for follow up. Foot care is essential for the diabetic patient, and should definitely follow up with podiatrist for further treatment.  

Patient will also be referred to endocrinologist for follow up due to her history of diabetes mellitus type 2. There is no documentation that diabetes is being treated. Patient is obese which may indicate she is not following an appropriate diet.  A referral will also be given to a dietician due to obesity (BMI: 31). 

According to Woo and Robinson Vicks VapoRub is commonly used for onychomycosis. A pilot study was conducted by Derby, Rohal, Jackson, Beutler, and Olsen (2011), to test Vicks VapoRub as a non-pharmacological approach to treat onychomycosis. The study included 18 participants and 83% had a positive response to this treatment after a course of 48 weeks. This study was done with a small sample; however Vicks VapoRub still showed to be a safe and cost-effective non-pharmacological treatment of onychomycosis (Derby, Rohal, Jackson, Beutler, and Olsen, 2011). 

Patient was educated on importance of an adequate diet that includes appropriate daily servings of fruits and vegetables, food low in saturated fat and low cholesterol. Patient was encouraged to continue being active, getting at least 30 minutes of regular physical activity.  Also encouraged to start taking Omega 3 fatty acids to help increase her HDL which is low (38mg/dl) and this is considered a risk factor for heart disease. 

References

Derby, R., Rohal, P., Jackson, C., Beutler, A. & Olsen, C. (2011). Novel treatment of 

onychomycosis using over the counter mentholated ointment: A clinical case series. 

Journal of the american board of family medicine (24)1 69-74. 

doi: 10.3122/jabfm.2011.01.100124

Woo, T. & Robinson, M., V. (2015). Pharmacotherapeutics for advanced practice nurse prescribers. Philadelphia, PA: F. A. Davis company.

 

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2023 Instructions Research Proposal Draft By the due date assigned write a 2 page paper addressing the sections

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Nursing 2023 Week 3 Project

Instructions Research Proposal Draft By the due date assigned write a 2 page paper addressing the sections 2023 Assignment

Instructions    

Research Proposal Draft  

By the due date assigned write a 2 page paper addressing the sections below of the research proposal.  

Introduction 

•Background and Significance of the Problem 

•Statement of the Problem and Purpose of the Study  

Research Questions, Hypothesis, and Variables with Operational Definitions 

•Research Question 

•Hypothesis: Research and Null 

•Identifying and Defining Study Variables 

•Operationalize Variables

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2023 Diagnosis and Management of Respiratory Cardiovascular and Genetic Disorders Respiratory disorders such as pneumonia and asthma are

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Nursing 2023 6512 WK 7 DISCUSSION

Diagnosis and Management of Respiratory Cardiovascular and Genetic Disorders Respiratory disorders such as pneumonia and asthma are 2023 Assignment

 

Diagnosis and Management of Respiratory, Cardiovascular, and Genetic Disorders:

 

Respiratory  disorders such as pneumonia and asthma are among the leading causes of hospitalization in pediatric patients (U.S. Department of Health and Human Services, 2011). With such severe implications associated with many respiratory disorders, advanced practice nurses (FAMILY NURSE PRACTITIONER) must be able to quickly identify symptoms, diagnose patients, and recommend appropriate treatment. For this Discussion, consider potential diagnoses and treatments for the patients in the following three case studies.

 

 

 

Case Study 1:

 

 A 14-month-old female presents with a 4-day history of nasal congestion and congested cough. This morning, the mother noted that her daughter was breathing quickly and “it sounds like she has rice cereal popping in her throat.” Oral intake is decreased. Physical examination reveals the following: respiratory rate is 58, lung sounds are diminished in the bases, she has pronounced intercostal and subcostal retractions, expiratory wheezes are heard in all lung fields, and her tympanic membranes are normal. There is moderate, thick, clear rhinorrhea and postnasal drip. Her capillary refill is less than 3 seconds, and she is alert and smiling. Her RSV rapid antigen test is positive

 

 

 

POST I TO 2 PAGES DISCUSSION PAPER ON:  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 respiratory, cardiovascular, and/or genetic disorder.

 

 

 

Reference

 

Readings

 

•Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., & Blosser, C. G. (2013). Pediatric primary care (5th ed.). Philadelphia, PA: Elsevier.

 

◦Chapter 31, “Respiratory Disorders” (pp. 708–738)

 

•Chapter 40, “Genetic Disorders” (pp. 1032–1054)

 

National Heart, Lung, and Blood Institute. (2007). Expert panel report 3 (EPR3): Guidelines for the diagnosis and management of asthma. Retrieved from http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm

 

.

 

•Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis by  Ralston, S.L., Lieberthal ,A.S., Meissner, H.C., Alverson, B.K., Baley, J.E., Gadomski ,A.M., Johnson, D.W., Light, M.J., Maraqa, N.F., Mendonca ,E.A., Phelan, K.J., Zorc ,J.J., Stanko-Lopp, D., Brown, M.A., Nathanson ,I., Rosenblum, E., Sayles, S. 3rd, & Hernandez-Cancio, S. in Pediatrics, 134(5), 1474-1502.

 

Dexamethasone for Acute Asthma Exacerbations in Children: A Meta-analysis by Keeney, G.E., Gray, M.P., Morrison, A.K., Levas, M.N., Kessler, E.A., Hill, G.D., Gorelick, M.H., & Jackson J.L. in Pediatrics, 133(3): 493–499.

 

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2023 Write a brief Introduction why you chose these decisions Decision 1 The PMHNP will

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Nursing 2023 Assignmen””@@@6

Write a brief Introduction why you chose these decisions Decision 1 The PMHNP will 2023 Assignment

 Write a brief Introduction why you chose these decisions .

  

Decision 1

The PMHNP will administer 10 mg of zyprexa orally at bed time and initiate 230mg of invega sustenna through intramuscular, in addition to 156 mg via the same route on day four. A similar dose will be administered within one months’ time. In addition the PMHNP will administer 10mg of Abfility orally at bed time. Expected outcome for this decision is a 25% decrease in the PANSS score (Stahl, 2013). This decision is also expected to alleviate the patient’s psychotic symptoms and achieve normalcy within one month. A slight weight gain is also expected as the drugs are known to increase weight in patients. Because I don’t select the other decisions, the patient is expected to have faster and noticeable changes in psychotic behavior within two weeks of treatment commencement. 

Decision 2

At this point the PMHNP will decide to continue with use of medications selected in decision 1 (Stahl, 2013). However the PMHNP will instruct the administering nurse to begin intramuscular injections of 300mg of Abfility and continue with 10 mg of the same drug in the morning. At this point, PANSS is expected to decrease by 50 % although the patient will also have noticeable weight gain due to use of invega sustenna (Stahl 2014). Because I don’t select other decisions, the patient is expected to have less cardiovascular drug toxicities and experience reduced risks for adverse drug reactions between Invega sustenna and Haldol Deaconoate. 

Decision 3

The decision at this point is to have the patient continue with Invega Sustenna and provide psychological counseling on the effects of the drugs associated with weight gain. It will be essential to explain to the patient that the weight gain from this drug is minimal in comparison with other drugs (Stahl, 2013). The PMHNP will set an appointment follow up date with the patient after one month duration and refer to the nutritionist and physical activity instructor. The difference between expected outcome in decision 3 and results of the decision is Abfility may not be efficacious for more than a period of 6 months given that it does not bind to D 2 receptors in a similar manner as Invega Sustenna. This will necessitate the PMHNP to change to Abfility Maintena because it is easily tolerated by patients on Abfility. 

Because I don’t select the other decisions, the patent will be able to utilize the same drug for the longest possible duration and optimize on their efficacy prior to switching to other types of medication (Stahl, 2013). Since the patient may not have the mental capacity to participate in the decision making process or make autonomous mental health decisions, it is essential to discuss treatment options with the spouse and explain the importance of adherence to treatment (Stein & Giordano, 2015). In addition, the mental health nurse is required to make those decisions which will benefit the patient and also outweigh the risk for adverse health outcomes. 

References

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2023 Mr David Jackson Gender male Age 19 years old T 98 8 P 89

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Nursing 2023 Anxiety Disorder, PTSD And OCD

Mr David Jackson Gender male Age 19 years old T 98 8 P 89 2023 Assignment

 

Mr. David Jackson Gender: male Age:19 years old T- 98.8 P- 89 R 18 110/62 Ht 5’7 Wt 133lbs Background: Lives in Minneapolis, MN with both of his parents, only child. Works part time at Starbucks. Not currently partnered. No previous psychiatric history. Symptoms began in the last 1.5 months when he discovered he is being activated with the Navy Reserves. His MOS is SK1 Storekeeper; no medical illnesses Allergies: NKDA; sleeps 6.5 hrs; appetite good

Training Title 15. Anonymous Symptom Media, 2017. https://video.alexanderstreet.com/watch/training-title-15.

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2023 3 power points needed 1 for elementary kids 1 for middle school kids

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Nursing 2023 Corona Virus PowerPoint

3 power points needed 1 for elementary kids 1 for middle school kids 2023 Assignment

3 power points needed= 1 for elementary kids/ 1 for middle school kids/ 1 for parents

Address: what is the virus?

how do you get it?

how can you stay protected?

how can you protect others?

why are we not in school?

Must be at least 10 slides minimum

Must include 1 youtube video

page 1 can be title

last page can be references

 

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2023 Explore the technology systems offered by Nanthealth a provider of telehealth and health management services via the following link http nanthealth com

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Nursing 2023 Connected Health and the Digital Age of Medicine

Explore the technology systems offered by Nanthealth a provider of telehealth and health management services via the following link http nanthealth com 2023 Assignment

 

Explore the technology systems offered by Nanthealth, a provider of “telehealth” and health management services via the following link:

http://nanthealth.com/

Prepare a brief (8-10 slides) PowerPoint presentation in which you do the following:

  1. Identify at least two technology innovations to connect patients, providers, and insurers across the care continuum.
  2. Describe how the technologies work to provide patients and providers with data necessary for health care decision making.
  3. Discuss how the real-time data encourages outcome-focused planning.
  4. Predict what impact the technology will have on future health care delivery. Provide rationale and examples.

Presentations must include speakers’ notes on each slide, as well as references for the presentation. A minimum of three academic references from credible sources are required for this assignment. The slide count (8-10 slides) does not include the introduction and References slide(s).

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

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2023 In collaboration with your approved course mentor you will identify a specific

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Nursing 2023 Nurse staffing is my topic

In collaboration with your approved course mentor you will identify a specific 2023 Assignment

In collaboration with your approved course mentor, you will identify a specific evidence-based practice proposal topic for the capstone project. Consider the clinical environment in which you are currently working or have recently worked. The capstone project topic can be a clinical practice problem, an organizational issue, a quality improvement suggestion, a leadership initiative, or an educational need appropriate to your area of interest as well as your practice immersion (practicum) setting. Examples of the integration of community health, leadership, and an EBP can be found on the “Educational and Community-Based Programs” page of the Healthy People 2020 website.

Write a 500-750 word description of your proposed capstone project topic. Make sure to include the following:

  1. The problem, issue, suggestion, initiative, or educational need that will be the focus of the project
  2. The setting or context in which the problem, issue, suggestion, initiative, or educational need can be observed.
  3. A description providing a high level of detail regarding the problem, issue, suggestion, initiative, or educational need.
  4. Impact of the problem, issue, suggestion, initiative, or educational need on the work environment, the quality of care provided by staff, and patient outcomes.
  5. Significance of the problem, issue, suggestion, initiative, or educational need and its implications to nursing.
  6. A proposed solution to the identified project topic

You are required to retrieve and assess a minimum of 8 peer-reviewed articles. Plan your time accordingly to complete this assignment.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

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