CS/SB 614 authorizes  an ARNP to prescribe, dispense, administer, or order any drug, which would include controlled substances.

ARNP disciplinary sanctions are added to the bill in s. 456.072, F.S., (Section 5) to mirror a physician’s sanctions for prescribing or dispensing a controlled substance other in the course of professional practice or failing to meet practice standards. Additional acts for which discipline may be taken against an ARNP relating to practicing with controlled substances that are added to the Nurse Practice Act (Section 10) include:

 Presigning blank prescription forms.

 Prescribing a Schedule II for office use.

 Prescribing, dispensing, or administering an amphetamine or sympathomimetic amine drug, except for specified conditions.

 Prescribing, dispensing, or administering certain hormones for muscle-building or athletic performance.

 Promoting or advertising a pharmacy on a prescription form unless the form also states that the prescription may be filled at the pharmacy of your choice.

 Prescribing, dispensing, or administering drugs, including controlled substances, other than in the course of his or her professional practice.

 Prescribing, dispensing, or administering a controlled substance to himself or herself.

 Prescribing, dispensing, or administering laetrile.

 Dispensing a controlled substance listed in Schedule II or Schedule III in violation of the requirements for dispensing practitioners in the Pharmacy Practice Act.

 Promoting or advertising controlled substances.

After reading the following news article http://c-hit.org/2015/04/06/high-prescribing-nurse-surrenders-drug-licenses/

Identify what issues may arise with prescriptive authority of controlled substances and how you may avoid these situations? 

Effective communication is vital to constructing an accurate and detailed patient history. A patient’s health or illness is influenced by many factors, including age, gender, ethnicity, and environmental setting. As an advanced practice nurse, you must be aware of these factors and tailor your communication techniques accordingly. Doing so will not only help you establish rapport with your patients, but it will also enable you to more effectively gather the information needed to assess your patients’ health risks

For this Discussion, you will take on the role of a clinician who is building a health history for a particular new patient assigned by your Instructor.

To prepare:

With the information presented in Chapter 1 of Ball et al. in mind, consider the following:

This is your case:

38-year-old  Native American pregnant female living on a reservation

• How would your communication and interview techniques for building a health history differ with each patient?
• How might you target your questions for building a health history based on the patient’s social determinants of health?
• What risk assessment instruments would be appropriate to use with each patient, or what questions would you ask each patient to assess his or her health risks?
• Identify any potential health-related risks based upon the patient’s age, gender, ethnicity, or environmental setting that should be taken into consideration.
• Select one of the risk assessment instruments presented in Chapter 1 or Chapter 5 of the Seidel’s Guide to Physical Examination text, or another tool with which you are familiar, related to your selected patient.
   
• Develop at least five targeted questions you would ask your selected patient to assess his or her health risks and begin building a health history.

Post a summary of the interview and a description of the communication techniques you would use with your assigned patient. Explain why you would use these techniques. Identify the risk assessment instrument you selected, and justify why it would be applicable to the selected patient. Provide at least five targeted questions you would ask the patient.

Rubric:

Answers all parts of the Discussion question(s) with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.   Supported by at least three current, credible sources.  Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

References:

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Chapter 1, “The History and Interviewing Process”
This chapter explains the process of developing relationships with patients in order to build an effective health history. The authors offer suggestions for adapting the creation of a health history according to age, gender, and disability.
 
Chapter 5, “Recording Information”
This chapter provides rationale and methods for maintaining clear and accurate records. The authors also explore the legal aspects of patient records.
 

Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.
Chapter 2, “The Comprehensive History and Physical Exam” (pp. 19–29)

References has to be 3 or more

 

Project 2: Promoting Health Care Quality

Section 4: Quality Improvement Strategies

Throughout this course you have been considering the relationship between structure, process, and outcomes as it relates to health care quality. Looking at outcomes, alone, may not tell the “whole story.” For instance, if you are concerned with improving fall rates, evaluating the process—related activities or practices—can help you identify factors that contribute to outcomes and develop strategies for improving them.

For this section of your Course Project, you create a process map to examine a current process related to your quality improvement issue. You will use the results of the process mapping to redesign a process to help minimize or close the performance gap(s). As you proceed, keep in mind the importance of maintaining a patient-centered focus so the patient experience is not negatively affected by any changes in process.

To prepare:

• Review the instructions provided in the Learning Resources for creating a process map.
• With your quality improvement issue in mind, as well as the other work you have completed on your Course Project thus far, think about how creating a process map could help you to better understand your quality improvement issue and redesign an associated process.
• Create a process map using Microsoft Word or PowerPoint.
• Refine the strategies for promoting systems-level change to minimize or close the performance gap(s) that you began to think about in Week 7. As part of this, identify a way to redesign at least one process based on your analysis of the process map that you have created.

To complete:

• Write a 2- to 3-page paper in which you describe quality improvement strategies that you selected related to your quality improvement issue.
• Finalize your process map, which will be submitted along with the paper.

 

Required Readings

Cookson, D., Read, C., Mukherjee, P., & Cooke, M. (2011). Improving the quality of emergency department care by removing waste using Lean Value Stream mapping. International Journal of Clinical Leadership, 17(1), 25–30.
Retrieved from the Walden Library databases.

This article demonstrates how a process map can be used to identify waste and promote efficiency, particularly in large departments.

Ford, J. H., Wise, M., & Wisdom, J. P. (2010). A peek inside the box: How information flows through substance abuse treatment agencies. Journal of Technology in Human Services, 28(3), 121–143.
Retrieved from the Walden Library databases.

The authors of this article establish the importance of using process maps for improving productivity and information flow.

Abubakker, H. T. (2010). Practical guide to creating better looking process maps. Retrieved from http://www.isixsigma.com/tools-templates/process-mapping/practical-guide-creating-better-looking-process-maps/

iSixSigma’s website offers a practical guide with many tips for creating an easy-to-follow process map.

NHS Institute for Innovation and Improvement. (2010). Quality and service improvement tools: Process mapping—an overview. Retrieved from http://www.miltonkeynesccg.nhs.uk/resources/uploads/files/NHS%20III%20Handbook%20serviceimprove.pdf

The NHS article outlines the importance of process maps and provides a detailed description of how to create a process map.

 

Chapter 41

A patient is admitted with renal calculi.

a.            What symptoms will the patient manifest if he is experiencing renal colic?

b.            How will the nurse best manage the renal colic?

c.             The nurse is straining the urine for presence of stones that the patient may have passed. What is the importance of this nursing action?

Parkinson’s disease (PD) is the second most common neurodegenerative disorder after Alzheimer’s disease (AD) (Moore, Shpiner, & Luca, 2019). PD has been traditionally considered as a pure movement disorder secondary to focal degeneration of dopaminergic neurons in the substantia nigra, but, in recent years, the clinical phenotype has been better illuminated, showing that PD is a multisystem neurodegenerative disorder with motor and non-motor features. Among motor symptoms and signs, the cardinal ones (bradykinesia, rest tremor, and rigidity) are mainly the loss of dopaminergic neurons, but those involving posture, balance, and gait are largely secondary to degeneration of nondopaminergic pathways and significantly contribute to impairment and disability in advanced PD patients (Moore, Shpiner, & Luca, 2019). Nonmotor features result from multiple neurotransmitter deficiencies in the central and peripheral nervous system and include psychiatric such as: depression, apathy, hallucinations, and delusions. Autonomic includes constipation, orthostatic hypotension, and urinary and genital disturbances. Cognitive impairment such as: involvement of executive functions, memory, sleep disorders, olfactory dysfunction, and pain that together contribute to worsening the quality of life and patient’s disability (Moore, Shpiner, & Luca, 2019).

  Cardinal motor features of Parkinson’s disease (PD) include bradykinesia, rest tremor, and rigidity, which appear in the early stages of the disease and largely depend on dopaminergic nigrostriatal denervation (Moore, Shpiner, & Luca, 2019). Intermediate and advanced PD stages are characterized by motor fluctuations and dyskinesia, which depend on complex mechanisms secondary to severe nigrostriatal loss and to the problems related to oral levodopa absorption, and motor and nonmotor symptoms and signs that are secondary to marked dopaminergic loss and multisystem neurodegeneration with damage to nondopaminergic pathways (Moore, Shpiner, & Luca, 2019). Nondopaminergic dysfunction results in motor problems, including posture, balance and gait disturbances, and fatigue, and nonmotor problems, encompassing depression, apathy, cognitive impairment, sleep disturbances, pain, and autonomic dysfunction. There are a number of symptomatic drugs for PD motor signs, but the pharmacological resources for nonmotor signs and symptoms are limited, and rehabilitation may contribute to their treatment (Moore, Shpiner, & Luca, 2019). 

  Pharmacological therapy is based on levodopa and dopamine agonists and is very successful in the early stages of the disease, when dopaminergic symptoms and signs are predominant and long term motor complications still have not developed, but other treatment strategies are necessary as time passes (Hajj, 2018). Long term levodopa-induced motor complications include motor fluctuations and dyskinesia and affect almost all PD patients at some point during the disease course, with relevant implications in global health status (Hajj, 2018). Despite various pharmacological approaches, as well as more invasive strategies including devices and functional neurosurgery, being available to manage such complications, many patients remain significantly disabled, and a fully satisfying management of motor complications is still an unmet need of PD therapy. Nonmotor symptoms and signs are integral to PD at onset and throughout the disease course, but to date their treatment is largely unsatisfactory (Hajj, 2018).

References

Hajj, R. (2018). Parkinson Disease Therapies and Drugs. Pathology, Prevention and Therapeutics of Neurodegenerative Disease, 151–158. doi: 10.1007/978-981-13-0944-1_13

Moore, H., Shpiner, D. S., & Luca, C. C. (2019). Management of Motor Features in Advanced Parkinson Disease. Clinics in Geriatric Medicine. doi: 10.1016/j.cger.2019.09.010

COLLAPSE

Heart Failure

Pathophysiology is a vital discipline in medicine and is generally useful for diagnosis and patient care. The disease-related to pathophysiology is heart failure. Wright and Thomas (2015) explain that pathophysiology in the management of heart failure ensures that patients are optimized on a maximum tolerated dose of medicine to treat heart failure with reduced ejection fraction. Heart failure is a complex clinical syndrome whereby the heart is not able to attain the metabolic demands of the body. The reasons underlying the mismatch can be multifactorial. However, the various pathological conditions make the treatments and management of the condition to be complex. Therefore, pathophysiology is essential in minimizing the burden on the condition. Heart failure is on the increase for the past decade leading to the heightening of the adult population to around 1% to 2%. The male population is the greatest affected gender, with an estimated 33% of men above 55 years old having the condition as compared to the 28% in women (Farmakis et al., 2015). Pathophysiology seeks to redress the balance through initiating contemporary measures. However, the measures have become damaging to the diseases and can lead to worsening cardiac output that can result in additional stress to a failing heart. 

 References

Farmakis, D., Parissis, J., & Filippatos, G. (2015). Acute heart failure: epidemiology, classification, and pathophysiology. Oxford Medicine Online, 2(1), 2-10. doi:10.1093/med/9780199687039.003.0051

Wright, P., & Thomas, M. (2018). Pathophysiology and management of heart failure. Clinical Pharmacist, 2(1), 1. doi:10.1211/cp.2018.20205742