It is necessary for an RN-BSN-prepared nurse to demonstrate an enhanced understanding of the pathophysiological processes of disease, the clinical manifestations and treatment protocols, and how they affect clients across the life span.

Evaluate the Health History and Medical Information for Mr. C., presented below.

Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below.

Health History and Medical Information

Health History

Mr. C., a 32-year-old single male, is seeking information at the outpatient center regarding possible bariatric surgery for his obesity. He currently works at a catalog telephone center. He reports that he has always been heavy, even as a small child, gaining approximately 100 pounds in the last 2-3 years. Previous medical evaluations have not indicated any metabolic diseases, but he says he has sleep apnea and high blood pressure, which he tries to control by restricting dietary sodium. Mr. C. reports increasing shortness of breath with activity, swollen ankles, and pruritus over the last 6 months.

Objective Data:

1. Height: 68 inches; weight 134.5 kg
2. BP: 172/98, HR 88, RR 26
3. 3+ pitting edema bilateral feet and ankles
4. Fasting blood glucose: 146 mg/dL
5. Total cholesterol: 250 mg/dL
6. Triglycerides: 312 mg/dL
7. HDL: 30 mg/dL
8. Serum creatinine 1.8 mg/dL
9. BUN 32 mg/dl

Critical Thinking Essay 

In 750-1,000 words, critically evaluate Mr. C.’s potential diagnosis and intervention(s). Include the following:

1. Describe the clinical manifestations present in Mr. C.
2. Describe the potential health risks for obesity that are of concern for Mr. C. Discuss whether bariatric surgery is an appropriate intervention.
3. Assess each of Mr. C.’s functional health patterns using the information given. Discuss at least five actual or potential problems can you identify from the functional health patterns and provide the rationale for each. (Functional health patterns include health-perception, health-management, nutritional, metabolic, elimination, activity-exercise, sleep-rest, cognitive-perceptual, self-perception/self-concept, role-relationship, sexuality/reproductive, coping-stress tolerance.)
4. Explain the staging of end-stage renal disease (ESRD) and contributing factors to consider.
5. Consider ESRD prevention and health promotion opportunities. Describe what type of patient education should be provided to Mr. C. for prevention of future events, health restoration, and avoidance of deterioration of renal status.
6. Explain the type of resources available for ESRD patients for nonacute care and the type of multidisciplinary approach that would be beneficial for these patients. Consider aspects such as devices, transportation, living conditions, return-to-employment issues.

You are required to cite to a minimum of two sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.

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

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. 

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

In a complex and fast-paced healthcare environment, change is inevitable and constant. The advanced practice nurse is required to lead and adapt to the constant changing environment while working with multidisciplinary teams. Imagine you are assigned by your director to work with a multidisciplinary team that is assisting with transition from the current paper record-based system to an electronic health record (EHR).

Create a PowerPoint presentation (10-15 slides) in which you will assess the situation and the steps that should be taken to successfully implement the change. Be sure to include 100-250 word presenter’s notes per slide. Your presentation should address the following:

1. Describe the driving forces that relate to the need for implementing electronic health records.
2. Identify the key interprofessional stakeholders (both internal and external) that should be involved in change efforts.
3. Outline how you would initiate the change and be a change advocate. Utilizing change theory and innovative models of care, explain how you would provide a structure for the planned change to achieve successful implementation of the EHR.
4. Demonstrate how the change will affect current workflows. What revised workflow would you implement?
5. Identify resources (human, time, material, etc.) required for implementation.
6. Identify risks within the implementation plan. What are the impacts of the poor planning on cost, quality, and safety?
7. Identify potential barriers when implementing the change and discuss how you will handle resistance.

Integrate 3-5 scholarly sources into your presentation.

Comment 1

Extraneous variables are undesirable variables that influence the relationship between the variables that an experimenter is examining. These variables are undesirable because they add error to an experiment. A major goal in research design is to decrease or control the influence of extraneous variables as much as possible (Psychology World, 2017).

The extraneous variables can be held constant by creating a standardized environment and procedure so that all variables are the same in each condition and cannot be confused. These variables exist in all studies and can interfere with obtaining a clear understanding of the relationships among the study variables.

For example, if a study focused on the effect of relaxation therapy on the perception of incisional pain, the researchers would have to control the extraneous variables, such as type of surgical incision and time, amount, and type of pain medication administered after surgery, to prevent their influence on the patient’s pain perception. Selecting only patients with abdominal incisions who are hospitalized and receiving only one type of pain medication intravenously after surgery would control some of these extraneous variables. Controlling extraneous variables enables researchers to determine the effects of an intervention or treatment on study outcomes more accurately (Grove, Gray & Burns, 2015).

To control an extraneous variable the research needs to identify those variables that are most likely to influence the dependent variable. This is done based on the researcher’s common sense, logical reasoning, and past experiences. For example, being in a loud room can cause distraction to people taking a test than that of a quieter room. So, using a quiet room, you are inhibiting the extraneous variable of noise. Furthermore, once identifying an extraneous variable they can be controlled by either holding a variable constant or matching value across treatment conditions (Psychology World, 2017).

Comment 2

Extraneous independent variables can be very hard, or even impossible  in some situations, to control and can have an influence on the result  or dependent variable. One example of this is when the subjects are  people. Inclusion criteria help to eliminate some inconsistencies in  subjects; however exclusion criteria must be relatively broad simply  out of necessity. Every person is different and finding a sample of  individuals with all of the same demographic, personal history, and  family history is usually not possible.

There are many methods to reduce the effect that extraneous  variables have on the dependent variable. Grove, Gray, & Burns  (2015, p. 38) state “Laboratories, research or experimental  centers, and test units in hospitals or other healthcare agencies are  highly controlled settings in which experimental studies are often  conducted. This type of setting reduces the influence  of extraneous variables, which enables the researcher to  examine the effect of one variable on another  accurately.” In these types of facilities attempts are made to  control the environmental factors such as lighting, temperature, noise  level, etc. Regardless of the cause and the method to control  extraneous variables, researchers should be aware that these variables  can influence or skew results. “Researchers need to consider  the extraneous variables identified during data collection, data  analysis, and interpretation. They should also note these variables in  the research report so that future researchers can be aware of and  attempt to control them (Grove, Gray, & Burns, 2015, p. 311).

System Admin   Max Points: 5.0    Child abuse and maltreatment is not limited to a particular age and can occur in the infant, toddler, preschool, and school-age years. Choose one of the four age groups (infant, toddler, preschool, or school age) and discuss the types of abuse that are most often seen in this age. Discuss warning signs and physical and emotional assessment findings the nurse may see that could indicate child abuse. Discuss cultural variations of health practices that can be misidentified as child abuse. Describe the reporting mechanism in your state and nurse responsibilities related to the reporting of suspected child abuse.

Healthcare reform is a term that is ever present in our practice settings and will not disappear any time soon.

Review the article below and answer the following questions.

Buerhaus, P. I., Skinner, L. E., Auerbach, D. I., & Staiger, D. O. (2017). Four challenges facing the nursing workforce in the United States. Journal of Nursing Regulation, 8(2), 40-46. . doi:10.1016/S2155-8256(17)30097

1. Select one of the four challenges and expand on how your workforce has responded to the change.
2. How have these challenges affected the access to care for your patients?
3. What can you do to decrease the effect on your patients? Provide a specific example.

2 references with in text citation.