All your posting should be three paragraphs with three sentences.  

Submit your first posting to plagiarism (acceptable similarity rate 20%)

 After reading Chapter 9 and reviewing the lecture power point (located in lectures tab),  please answer the following questions.  Each question must have at least 3 paragraphs and you must use at 3 least references (APA) included in your post. 

Discussion questions:

1.  Describe the link between quality and safety in the healthcare setting.

2.  Discuss the role of the nurse in quality improvement.

3.  Describe nursing-sensitive measurements and why they are important in Nursing care delivery.

CASE STUDY 3 – Reflecting on week 4’s lessons in the syllabus, select a patient population (pediatric, young adult, adult or geriatric), and briefly analyze a chronic cardiovascular disease (HTN, Heart failure, Dyslipidemia, Heart murmur etc.…), that may affect this population. Briefly tell how it impacts the patient’s quality of life and analyze the current research evidence on this topic and gold standard of care if any for your chosen population. (You may use an example from your clinical rotation (past or present) that you have encountered). Describe how you, the FNP, can/or have made a difference in the care of patients with this specific disease and tell of one specific patient care teaching that he/she may do to help minimize disease symptoms.

Assignment 2 meets the following course objectives:

• Apply a sociological perspective to the social world.
• Analyze contemporary social issues using the sociological imagination and use sociological theories and concepts to analyze everyday life.
• Demonstrate the ability to identify, locate, and retrieve information related to the topics in the course.

Purpose

The primary goal of this exercise is to apply your developing sociological knowledge and skills to the analysis of a current event.

Writing Expectations

This should be 4-6 pages long, double-spaced, 12pt font (arial or times new roman), with 1″ margins. You must include a cover page, running header, major heading and subheadings to identify each section; all according to APA requirements.  

Instructions:

Choosing a Current Event. A current event refers to something that is happening in the world at present and they are usually described on the news and in mass media. You must choose a report (written, from the radio, or televised) of an event that has been reported on within 3 months of the assignment deadline. Remember, the event you choose must have some relevance to the study of society, and you must properly cite the source from which you got your report. DO NOT include more than two articles or reports. 

Describe the Current Event. Second, you will need to provide a brief summary of the current event. This should include details such as location, timing (i.e is this an ongoing event, does it appear to be a one time event, is this an example of an event that happens frequently), people involved, and any analysis offered by the report(er).

Analyzing the Current Event. The final step in the process is conducting an analysis of the current event using knowledge you have gained from the course to-date. The most important thing here is that the analysis should not just be your opinion about the current event, but grounded in sociological theory and prior research. You will need to use at least 4 sociological concepts covered in this course to analyze the current event (i.e. social construction, stratification, social control, crime, deviance). (hint: sociological concepts should be clearly identified, defined and then applied; any paraphrasing or direct quotes used from another source should include APA formatted in-text citations and a full citation at the end of the essay).  

• The purpose of the signature assignment is for students to apply the research and EBP concepts they have learned in this course and develop a framework for the initial steps of the student’s capstone project. The assignment allows the student to initiate the steps for planning, researching and developing an evidence-based practice intervention project proposal. 
  On or before Day 7, of week eight each student will submit his or her final proposal paper to the week eight assignment link in D2L. This formal paper will include and expand upon work completed thus far in prior assignments.
  Essential Components of the Final Project Proposal will include:
  This formal paper will include and expand upon work completed thus far in prior assignments.
  Be sure to use the headings as  listed below. Essential Components of the Final Project Proposal will include:   
• Introduction– Provide an introduction to your topic or project. The introduction gives the reader an accurate, concrete understanding what the project will cover and what can be gained from implementation of this project.
• Overview of the Problem – Discuss the problem,  why the problem is worth exploring and the potential contribution of the proposed project to the discipline of nursing.
• Project Purpose Statement – Provide a declarative sentence or two which summarizes the specific topic and goals of the project.
• Background and Significance – State the importance of the problem and emphasize what is innovative about your proposed project. Discuss the potential impact of your project on your anticipated results to the betterment of health and/or health outcomes.
• PICOt formatted Clinical Project Question(s)– Provide the Population, Intervention, Comparison, Expected Outcomes and Timeframe for the proposed project.
• Literature Review – Provide the search engines used and the key terms used to guide a search for evidence and discuss at least five (5) summaries (this can be the copy and paste lit reviews you did in the last paper) of relevant, credible, recent, evidence-based research studies to support the project proposal.
• Critical Appraisal of Literature – Discuss the strengths and weaknesses of the evidence, what is known from the evidence and what gaps in evidence were found from the appraisal of evidence-based research studies.
  • Add this information at the conclusion of each of the articles you discussed above
• Develop an EBP Standard – Describe  two to three interventions (or a bundle of care) from the evidence and discuss how individual patient preferences or the preferences of others will be considered.
• Implications – Summarize the potential contributions of the proposed project for nursing research, education and practice.

• Expectations

• Length: A minimum of 8 pages and a maximum of 10 pages (excluding the title and reference pages)
• Format: Formal scholarly paper in APA 6th ed format
• Reference Citations: A minimum of five, recent (past five years), peer-reviewed scholarly references cited in APA 6th ed format.
• File name: Save the file with Student First Name_Last Name_SigAssignment
• See USU NUR Research Paper Rubric for additional details and Proposal 
• Revised PICOT Question: On a medical-surgical hospital unit (P), how does implementing hourly nursing rounding (I), compared to no scheduled rounding (C), affect patient safety (O), within 6 months of implementing (T)? FYI please use the first attachment  below as sample paper and the guidelines them the other 3 papers need to be expanded and incorporated in 
  

WK #5 DQ:

Apply information from the Aquifer Case Study to answer the following discussion questions:

· Discuss the Mr. Payne’s history that would be pertinent to his genitourinary problem. Include chief complaint, HPI, Social, Family and Past medical history that would be important to know.

· Describe the physical exam and diagnostic tools to be used for Mr. Payne. Are there any additional you would have liked to be included that were not? 

· Please list 3 differential diagnoses for Mr. Payne and explain why you chose them.  What was your final diagnosis and how did you make the determination?

· What plan of care will Mr. Payne be given at this visit, include drug therapy and treatments; what is the patient education and follow-up?

Forty-five-year-old white male truck driver complaining of two weeks of sharp, stabbing back pain. The pain was better after a couple of days but then got worse after playing softball with his daughter. This morning his pain is so bad that he had trouble getting out of bed.

You and Dr. Lee take a few minutes to review Mr. Payne’s chart:

Vital signs:

· Temperature: 98.6° Fahrenheit

· Heart rate: 80 beats/minute

· Respiratory rate: 12 breaths/minute

· Blood pressure: 130/82 mmHg

· Weight: 170 pounds

· Body Mass Index: 24 kg/m2

Past Medical History: Diabetes, well controlled. Hypertension, fair control. Hyperlipidemia, fair control.

Past Surgical History: None

Social History: Works as a truck driver, which involves lifting 20-35 lbs 4 hours of the day, married with 2 daughters,

Habits: Quit smoking two years ago, drinks 1 to 2 beers occasionally on the weekends, no history of IV drug use.

Medication:

· metformin 500mg 2 twice daily

· glyburide 5mg 2 twice daily

· amlodipine 2.5 mg daily

· lisinopril 40 mg daily

· simavastin 40 mg daily

Allergies: No known drug allergies.

Can you tell me about your back pain?”

“As I told the nurse, the pain started two weeks ago after I lifted a box at work. Right away, I got this sharp pain on the left side of my back. The box wasn’t even that heavy.

“I talked to the nurse at work; she said to ice it and to take ibuprofen. It got better after three days. But, I was playing softball with my daughter last weekend, and the pain came back. This time it was worse than before. This week, the pain is so bad I can hardly get out of bed. I get a sharp pain in my back which goes down my left leg to my ankle.”

“On a scale of 0 to 10, 10 being the worst, how severe is the pain?”

“It’s probably a 7.”

“Have you found anything that improves the pain?”

“Ibuprofen and Naproxen worked at first, but they are not helping much anymore.”

“What about positions that make things better or worse?”

“The pain is worse with any movement of my back or sitting for a long time. It is better when I lie down.”

“Have you had back pain before?”

“Yes, I have back pain from time to time. But I’m usually better after 2 to 3 days. This is the worst pain I have ever had.”

Review of Systems

Mr. Payne does not have numbness or weakness in his legs. The pain is better when he lies down. He denies urinary frequency, dysuria, problems with bowel or bladder control, fever or chills, nausea or vomiting, or weight loss. He denies any specific trauma, except for when he lifted a 10-pound box at work. He denies unrelenting night pain.

Based on your differential, you determine that it is highly likely that Mr. Payne is experiencing a mechanical cause of back pain with nerve involvement such as a disc herniation. It is possible that he has spinal fracture, but a lack of trauma history makes the latter unlikely. It is important to consider cauda equina syndrome, as it calls for immediate surgical investigation, but it is unlikely in the absence of neurological symptoms like loss of bowel or bladder control. Finally, infectious etiology, such as pyelonephritis, is unlikely without fever and chills, urinary frequency and dysuria.

Back Exam – Standing:

Mr. Payne has normal curvature, tenderness on palpation on the left lumbar paraspinous muscle with increase tone. Full range of motion, but has pain with movement. His gait is normal. He can walk on his heels and toes. He can do deep knee bends.

Back Exam – Seated:

Mr. Payne denies feeling pain when checked for CVA tenderness. He has no pain in his right leg with the modified version of SLR. While he does not exhibit a true tripod sign, he does complain of pain when his left leg is raised. Mr. Payne’s reflexes are 2+ and equal at the knees and 1+ at both ankles. The motor exam reveals no weakness of the muscles of the lower extremities. His sensory exam is normal.

Pulmonary Exam: His lungs are clear.

Cardiovascular Exam: His cardiac exam demonstrates a regular rhythm, no murmur or gallop.

Three weeks later, Mr. Payne returns for his follow-up appointment and you discover the following:

Pertinent History

Mr. Payne has had little relief with the treatment prescribed. He is frustrated that he has been in pain for more than a month. His pain has been progressively worse. It radiates down the lateral part of his left leg and side of his left foot. This pain is worse than the back pain. He does not have any problems with bowel or bladder control and there is no weakness of his leg.

Pertinent Exam Findings

Vital signs: stable

Neurologic: Normal gait, but moves slowly due to pain; range of motion is full, with pain on flexion; SLR is positive at 45 degree on the left; motor strength intact; reflexes 2+ bilaterally at the knees, absent at the left ankle, 1+ at the right ankle.

Dr. Lee agrees with your diagnosis of radiculopathy of S1 nerve root with progression. She orders an MRI and sets up an appointment to see Mr. Payne after the MRI.

You and Dr. Lee now return to Mr. Payne’s exam room to talk about treatment options with him. Dr. Lee tells Mr. Payne to avoid strenuous activities but to remain active. Dr. Lee increases the dosage of naproxen to 500 mg BID to take with food. Since his pain is intense (7/10), he is given a prescription for acetaminophen with codeine to take at night, when his pain is severe. Mr. Payne declines a muscle relaxant because they usually make him drowsy. He would like to be referred to physical therapy as it was helpful in the past.

FOLLOW-UP TREATMENT

MANAGEMENT

One week later, Mr. Payne returns for follow-up. You review the results of the MRI report.

MRI report:

1. Moderate-size, herniated disc at L5-S1 with associated marked impingement on the left S1 nerve root and mild to moderate impingement on the right S1 nerve root. There is mild central canal stenosis.

2. Annular tear with a small central disc herniation at L4-5 causing mild central canal stenosis.

You review the findings with Dr. Lee. She agrees with your diagnosis of radiculopathy of S1 nerve root due to a large herniated disc at L5-S1.

You call Mr. Payne two weeks later to see how he is doing. He reports that he is doing quite a bit better. He went to an osteopathic physician who did some manual therapy and started him on a strict walking program. He is very encouraged and plans on losing weight through exercise and diet.