2025 Question 20 A patient recovering from shingles presents with tenderness and sensitivity to the upper back He states it is

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nurs 6630 2025

Question 20 A patient recovering from shingles presents with tenderness and sensitivity to the upper back. He states it is bothersome to put a shirt on most days. This patient has end stage renal disease (ESRD) and is scheduled to have hemodialysis tomorrow but states that he does not know how he can lie in a recliner for 3 hours feeling this uncomfortable. What will be the PMHNP’s priority? a) order herpes simplex virus (HSV) antibody testing b) Order a blood urea nitrogen (BUN) and creatinine STAT c) Prescribe lidocaine 5% d) Prescribe hydromorphone (dilaudid) 2mg Question 21 The PMHNP prescribed a patient lamotrigine (Lamictal), 25 mg by mouth daily, for nerve pain 6 months ago. The patient suddenly presents to the office with the complaint that the medication is no longer working and complains of increased pain. What action will the PMHNP most likely take? a) Increase the dose of lamotrigine (Lamictal) to 25mg twice daily b) Ask if the pt has been taking the medication as prescribed c) Order gabapentin, 100mg TID because lamotrigine is no longer working for this patient d) Order a CBC to assess for an infection Question 22 An elderly woman with a hx of alzheimer’s disease, coronary artery disease, and myocardial infarction had a fall at home 3 months ago that resulted in her receiving an open reduction internal fixation. While assessing this patient, the pmhnp is made aware that the patient continues to experience mild to moderate pain. What is the pmhnp most likely to do? a) order an X-ray because it is possible that she dislocated her hip b) order ibuprofen because she mayneed long term treatment and chronic pain is not uncommon c) Order naproxen because she may havarthritis and chronic pain is not uncommon d) Order morphine and physical therapy Question 23 The PMHNP is assessing a 49-year-old male with a history of depression, post-traumatic stress disorder (PTSD), alcoholism with malnutrition, diabetes mellitus type 2, and hypertension. His physical assessment is unremarkable with the exception of peripheral edema bilaterally to his lower extremities and a chief complaint of pain with numbness and tingling to each leg 5/10. The PMHNP starts this patient on a low dose of doxepin (Sinequan). What is the next action that must be taken by the PMHNP? a) Orders liver function tests b) Educate the patient on avoiding grapefruits when taking this medication c) Encourage this patient to keep fluids to 1500ml/day until the swelling subside d) Order BUN/Creatinine test Question 24 The PMHNP is evaluating a 30-year-old female patient who states that she notices pain and a drastic change in mood before the start of her menstrual cycle. The patient states that she has tried diet and lifestyle changes but nothing has worked. What will the PMHNP most likely do ? a) Prescribe estrin FE 24 birth control b) Prescribe Ibuprofen 800mg every 8 hours as needed for pain c) Prescribe desvenlafaxine (Pristiq) 50mg daily d) Prescribe Risperdal 2mg TID Question 25 A patient with chronic back pain has been prescribed a serotonin-norepinephrine reuptake inhibitor (SNRI). How does the PMHNP describe the action of SNRIs on the inhibition of pain to the patient? a) “the SNRI can increase noradrenergic neurotransmission in the descending spinal pathway to the dorsal horn” b) “the SNRI can decrease noradrenergic neurotransmission in the descending spinal pathway to the dorsal horn” c) “the SNRI can reduce brain atrophy by slowing the gray matter loss in the dorsolateral prefrontal cortex” d) “the SNRI can increase neurotransmission to descending neurons” Question 26 A patient with fibromyalgia and major depression needs to be treated for symptoms of pain. Which is the PMHNP most likely to prescribe for this patient? a) Venlafaxine (Effexor) b) Duloxetine (Cymbalta) c) Clozapine (Clozaril) d) Phenytoin (Dilantin) Question 27 The PMHNP prescribes gabapentin (Neurontin) for a patient’s chronic pain. How does the PMHNP anticipate the drug to work? a) It will bind to the alpha-2-delta ligand subunit of voltage-sensitive calcium channels b) It will induce synaptic changes, including sprouting c) It will act on the presynaptic neuron to trigger sodium influx d) It will Inhibit activity of dorsal horn neurons to suppress body input from reaching the brain Question 28 Mrs. Rosen is a 49-year-old patient who is experiencing fibro-fog. What does the PMHNP prescribe for Mrs. Rosen to improve this condition? a) Venlafaxine (Effexor) b) Armodafinil (Nuvigil) c) Bupropion (Wellbutrin) d) All of the above Question 29 The PMHNP is caring for a patient with fibromyalgia. Which second-line treatment does the PMHNP select that may be effective for managing this patient’s pain ? a) Methylphenidate (Ritalin) b) Viloxazine (Vivalan) c) Imipramine (Tofranil) d) Bupropion (Wellbutrin) Question 30 The PMHNP is attempting to treat a patient’s chronic pain by having the agent bind the open channel conformation of VSCCs to block those channels with a “use-dependent” form of inhibition. Which agent will the PMHNP most likely select ? a) Pregabalin (Lyrica) b) Duloxetine (Cymbalta) c) Modafinil (Provigil) d) Atomoxetine (Strattera) Question 31 A patient with irritable bowel syndrome reports chronic stomach pain. The PMHNP wants to prescribe the patient an agent that will cause irrelevant nociceptive inputs from the pain to be ignored and no longer perceived as painful. Which drug will the PMHNP prescribe? a) Pregabalin (Lyrica) b) Gabapentin (Neurontin) c) Duloxetine (Cymbalta) d) B and C Question 32 The PMHNP wants to use a symptom-based approach to treating a patient with fibromyalgia. How does the PMHNP go about treating this patient? a) Prescribing the patient an agent that ignores the painful symptoms by initiating a reaction known as “fibro-fog” b) Targeting the patient’s symptoms with anticonvulsants that inhibits gray matter loss in the dorsolateral prefrontal cortex c) Mzatching the patient’s symptoms with the malfunctioning brain circuits and neurotransimitters that might mediate those symptoms d) None of the above Question 33 The PMHNP is working with the student to care for a patient with diabetic peripheral neuropathic pain. The student asks the PMHNP why SSRIs are not consistently useful in treating this particular patient’s pain. What is the best response by the PMHNP? a) “SSRIs only increase norepinephrine levels” b) “SSRIs only increase serotonin levels” c) “SSRIs only increase serotonin and norepinephrine levels” d) “SSRIs do not increase serotonin or norepinephrine levels” Question 34 A patient with gambling disorder and no other psychiatric comorbidities is being treated with pharmacological agents. Which drug is the PMHNP most likely to prescribe? a) Antipsychotics b) Lithium c) SSRI d) Naltrexone Question 35 Kevin is an adolescent who has been diagnosed with kleptomania. His parents are interested in seeking pharmacological treatment. What does the PMHNP tell the parents regarding his treatment options ? a) “Naltrexone may be an appropriate option to discuss” b) “there are many medicine options that treat Kleptomania” c) “Kevin may need to be prescribed antipsychotics to treat this illness” d) “Lithium has proven effective for treating kleptomania” Question 36 Which statement best describes a pharmacological approach to treating patients for impulsive aggression? a) Anticonvulsant mood stabilizers can eradicate limbic irritability b) Atypical antipsychotics can increase subcortical dopaminergic stimulation c) Stimulants can be used to decrease frontal inhibition d) Opioid antagonists can be used to reduce drive Question 37 A patient with hypersexual disorder is being assessed for possible pharmacologic treatment. Why does the PMHNP prescribe an antiandrogen for this patient? a) It will prevent feelings of euphoria b) It will amplify impulse control c) It will block testosterone d) It will redirect the patient to think about other things Question 38 Mrs. Kenner is concerned that her teenage daughter spends too much time on the Internet. She inquires about possible treatments for her daughter’s addiction. Which response by the PMHNP demonstrates understanding of pharmacologic approaches for compulsive disorders? a) “Compulsive internet use can be treated similarly to how we treat people with substance use disorders” b) “internet addiction is treated with drugs that help block the tension/arousal state your daughter experiences” c) “When it comes to internet addiction, we prefer to treat patients with pharmaceuticals rather than psychosocial methods” d) “there are no evidence-based treatments for internet addiction, but there are behavioral therapies your daughter can try” Question 39 Mr. Peterson is meeting with the PMHNP to discuss healthier dietary habits. With a BMI of 33, Mr. Peterson is obese and needs to modify his food intake. “Sometimes I think I’m addicted to food the way some people are addicted to drugs”, he says. Which statement best describes the neurobiological parallels between food and drug addiction? a) There is decreased activation of the prefrontal cortex b) There is increased sensation of the reactive reward system c) There is reduced activation of regions that process palatability d) There are amplified reward circuits that activate upon consumption Question 40 The PMHNP is caring for a patient who reports excessive arousal at nighttime. What could the PMHNP use for a time-limited duration to shift the patient’s brain from a hyperactive state to a sleep state? a) Histamine 2 receptor antagonist b) Benzodiazepines c) Stimulants d) Caffeine Question 41 The PMHNP is caring for a patient who experiences too much overstimulation and anxiety during daytime hours. The patient agrees to a pharmacological treatment but states, “I don’t want to feel sedated or drowsy from the medicine.” Which decision made by the PMHNP demonstrates proper knowledge of this patient’s symptoms and appropriate treatment options? a) Avoiding prescribing the patient a drug that blocks H1 receptors b) Prescribing the patient a drug that acts on H2 receptors c) Stopping the patient from taking medicine that unblocks H1 receptors d) None of the above

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2025 Week 6 Antipsychotic Therapy According to the National Alliance on Mental Illness approximately

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Examine Case Study: Pakistani Woman with Delusional Thought Processes. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmaco 2025

Week 6: Antipsychotic Therapy According to the National Alliance on Mental Illness, approximately 100,000 people experience psychosis in the United States each year (NAMI, 2016). In practice, clients may present with delusions, hallucinations, disorganized thinking, disorganized or abnormal motor behavior, as well as other negative symptoms that can be disabling for these individuals. Not only are these symptoms one of the most challenging symptom clusters you will encounter, many are associated with other disorders such as depression, bipolar disorder, and disorders on the schizophrenia spectrum. As a psychiatric mental health nurse practitioner, you must understand the underlying neurobiology of these symptoms to select appropriate therapies and improve outcomes for clients. This week, as you examine antipsychotic therapies, you explore the assessment and treatment of clients with psychosis and schizophrenia. You also consider ethical and legal implications of these therapies. Photo Credit: Ingram Publishing/Getty Images Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia Psychosis and schizophrenia greatly impact the brain’s normal processes, which interferes with the ability to think clearly. When symptoms of these disorders are uncontrolled, clients may struggle to function in daily life. However, clients often thrive when properly diagnosed and treated under the close supervision of a psychiatric mental health practitioner. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with psychosis and schizophrenia. Learning Objectives Students will: · Assess client factors and history to develop personalized plans of antipsychotic therapy for clients · Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring antipsychotic therapy · Evaluate efficacy of treatment plans · Analyze ethical and legal implications related to prescribing antipsychotic therapy to clients across the lifespan Learning Resources 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. Required Readings Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear. Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press. To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter. · Chapter 4, “Psychosis and Schizophrenia” · Chapter 5, “Antipsychotic Agents” Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press. To access information on the following medications, click on The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication. Review the following medications: amisulpride aripiprazole asenapine chlorpromazine clozapine flupenthixol fluphenazine haloperidol iloperidone loxapine lurasidone olanzapine paliperidone perphenazine quetiapine risperidone sulpiride thioridazine thiothixene trifluoperazine ziprasidone Naber, D., & Lambert, M. (2009). The CATIE and CUtLASS studies in schizophrenia: Results and implications for clinicians. CNS Drugs, 23 (8), 649-659. doi:10.2165/00023210-200923080-00002 Note: Retrieved from Walden Library databases. Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261-276. Note: Retrieved from Walden Library databases. Clozapine REMS. (2015). Clozapine REMS: The single shared system for clozapine. Retrieved from https://www.clozapinerems.com/CpmgClozapineUI/rems/pdf/resources/Clozapine_REMS_A_Guide_for_Healthcare_Providers.pdf Walden University. (2016). ASC success strategies: Studying for and taking a test. Retrieved from http://academicguides.waldenu.edu/ASCsuccess/ASCtesting Required Media Laureate Education. (2016j). Case study: Pakistani woman with delusional thought processes [Interactive media file]. Baltimore, MD: Author Note: This case study will serve as the foundation for this week’s Assignment. Optional Resources Chakos, M., Patel, J. K., Rosenheck, R., Glick, I. D., Hammer, M. B., Tapp, A., & … Miller, D. (2011). Concomitant psychotropic medication use during treatment of schizophrenia patients: Longitudinal results from the CATIE study. Clinical Schizophrenia & Related Psychoses, 5 (3), 124-134. doi:10.3371/CSRP.5.3.2 Fangfang, S., Stock, E. M., Copeland, L. A., Zeber, J. E., Ahmedani, B. K., & Morissette, S. B. (2014). Polypharmacy with antipsychotic drugs in patients with schizophrenia: Trends in multiple health care systems. American Journal of Health-System Pharmacy, 71 (9), 728-738. doi:10.2146/ajhp130471 Lin, L. A., Rosenheck, R., Sugar, C., & Zbrozek, A. (2015). Comparing antipsychotic treatments for schizophrenia: A health state approach. The Psychiatric Quarterly, 86 (1), 107-121. doi:10.1007/s11126-014-9326-2 To prepare for this Assignment: · Review this week’s Learning Resources. Consider how to assess and treat clients requiring anxiolytic therapy. The Assignment Examine Case Study: Pakistani Woman with Delusional Thought Processes. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes. At each decision point stop to complete the following: · Decision #1 o Which decision did you select? o Why did you select this decision? Support your response with evidence and references to the Learning Resources. o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. o Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different? · Decision #2 o Why did you select this decision? Support your response with evidence and references to the Learning Resources. o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. o Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different? · Decision #3 o Why did you select this decision? Support your response with evidence and references to the Learning Resources. o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. o Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different? Also include how ethical considerations might impact your treatment plan and communication with clients. Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.

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2025 HOMEWORK SLP 2 ASSIGNMENT OPERATING REVENUE REIMBURSEMENT COST VOLUME PROFIT AND BREAK EVEN After completing the required background

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SLP Assignment 2 Homework 2025

HOMEWORK SLP 2 ASSIGNMENT OPERATING REVENUE, REIMBURSEMENT, COST-VOLUME-PROFIT, AND BREAK-EVEN After completing the required background readings, please complete the following: **Please see attachment Imagine you are the Practice Manager of a multi-physician primary care center in Pennsylvania. The four physician-owners have asked you to make a presentation to them on how their group’s profitability could be improved, without having to raise their charges/rates for services. Using Exhibit 8.5 and 8.6 in Dr. Nowicki’s textbook (see required background reading), as well as some research in peer-reviewed sources of your own, create a professional-looking PowerPoint presentation of 6-8 slides which clearly summarizes the information the physicians are requesting. Include thorough speaker’s notes to further expand upon and explain your points. SLP Assignment Expectations Conduct additional research to gather sufficient information to support your presentation. Provide 6-8 quality powerpoint slides of bulleted-point information content (with speaker’s notes), not including title page and reference slides. Don’t forget to use in-text citations. Support your presentation with peer-reviewed articles and reliable sources. Use at least two peer-reviewed sources. For additional information on how to recognize peer-reviewed journals, see http://www.angelo.edu/services/library/handouts/peerrev.php and for evaluating internet sources: https://www.library.georgetown.edu/tutorials/research-guides/evaluating-internet-content You may use the following source to assist in your formatting your references and in-text citations for your slides: https://owl.english.purdue.edu/owl/resource/560/01/. Paraphrase all source information into your own words carefully and use in-text citations.

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2025 1 Assign CPT code s and appropriate modifiers to each statement The physician performed a complex repair during

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Medical Coding 2025

1) Assign CPT code(s) and appropriate modifiers to each statement. The physician performed a complex repair during resection of the diaphragm and closed the residual defect with synthetic graft material. 2) Mediastinotomy to remove foreign body using transthoracic approach, including median sternotomy. 3) Patient underwent repair, laceration of diaphragm. 4) Physician inserted a mediastinoscope through an incision in the sternal notch and performed a mediastinal lymph node biopsy. 5) Physician repaired an acute traumatic diaphragmatic hernia. Patient underwent alveoloplasty to remove sharp areas or undercuts of alveolar bone, one quadrant. Surgeon used a scalpel to slice off a cancerous portion of the vermillion border of the patient’s lip: mucosal advancement was performed after excision. Surgeon made an incision through submucosal tissue and removed a lesion in the vestibule of the mouth. Wound repair was not required. Patient underwent simple incision of the lingual frenum to free the tongue. Patient underwent incision in the parotid gland to remove calcified stone. Surgeon repaired a tear at the pharyngeal esophageal junction. Physician drained and abscess near the tonsil. Surgeon removed an 8 year old patient’s tonsils and adenoids. Physician controlled secondary oropharyngeal hemorrhaging, status post tonsillectomy, by using cellulose sponges that expanded when placed in the tonsillar cavity. Physician performed a tonsillectomy on a 12 year old male patient. Physician inserted a flexible esophagoscope into the esophagus and destroyed a lesion, using snare technique. Surgeon made an incision in the left posterior chest wall into the esophagus to remove a foreign body from the esophagus. Physician inserted a balloon endoscopically for tamponade of bleeding esophageal varices. Dr. Smith performed a partial cervical esophagectomy while Dr. Jones performed a jejunum transfer with microvascular anastomosis. The physyician passed an endoscope through the patient’s mouth and visualized the entire esophagus, stomach, duodenum, and jejunum. One lesion was removed using biopsy forceps. Another was remove using snare. Patient underwent incision of the pyloric muscle. The physician performed an open revision of a previously performed gastric restrictive procedure and reversed the previously partitioned stomach to restore normal gastrointestinal continuity. Using fluoroscopic guidance, the physician repositioned a gastric feeding tube through the duodenum. The physician performed a laparoscopic surgical gastric restrictive procedure with gastric bypass and roux-en-Y gastroenterostomy. The physician percutaneously place a gastrostomy tube into the stomach under fluoroscopic guidance including contrast injection(s), image documentation.

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2025 Benchmark Capstone Project Change Proposal In this assignment students will pull together the change

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Benchmark – Capstone Project Change Proposal 2025

Benchmark – Capstone Project Change Proposal In this assignment, students will pull together the change proposal  project components they have been working on throughout the course to  create a proposal inclusive of sections for each content focus area in  the course. At the conclusion of this project, the student will be  able to apply evidence-based research steps and processes required as  the foundation to address a clinically oriented problem or issue in  future practice. Students will develop a 1,250-1,500 word paper that includes the  following information as it applies to the problem, issue, suggestion,  initiative, or educational need profiled in the capstone change proposal: Background Problem statement Purpose of the  change proposal PICOT Literature search strategy  employed Evaluation of the literature Applicable  change or nursing theory utilized Proposed implementation  plan with outcome measures Identification of potential  barriers to plan implementation, and a discussion of how these could  be overcome Appendix section, if tables, graphs, surveys,  educational materials, etc. are created Review the feedback from your instructor on the Topic 3 assignment,  PICOT Statement Paper, and Topic 6 assignment, Literature Review. Use  the feedback to make appropriate revisions to the portfolio components  before submitting. 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. Please refer  to the directions in the Student Success Center.

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2025 opic 3 DQ 2 Adolescence is a period of growth and development that occurs between childhood

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Describe two external stressors that are unique to adolescents 2025

opic 3 DQ 2 Adolescence is a period of growth and development that occurs between childhood and adulthood. As they continue to form an identity, they face many difficulties in integrating themselves into society; they do not belong to either the childhood or adult groups. Any transition that upsets the balance of our lives and forces us to adapt is referred to as a stressor. Stress may be described as physical or mental tension experienced as a result of life events. They don’t stress factors affecting adolescents are here or social stressor and self-esteem and sexual stressor. Rejections when they begin to form intimate relationships, teasing or being teased, as this is the moment that teenage bodies are undergoing physical changes such as weight gain, awkwardness, acne growth, and so on, are all possible peer or social stressors. Other sources of tension during this time include education and the need to excel, dealing with a family crisis, and online social lives. Self-esteem and sexual stressors are normal in puberty as their bodies shift, they continue to develop sexual identities, and self-esteem may be low. An adolescent’s life revolves around fitting in, and identifying sexually outside of what is considered normal (i.e., bisexual, homosexual, transgender/gender neutral) can be stressful. Society does not often tolerate these kinds of sexual identities, and their bullying, teasing, gossip, and family rejection of their decisions contribute to a poor sense of self-esteem. As a result, when puberty is confronted by stressors like these, they feel depressed and resort to action to cope. Social avoidance, behaving violently against others, or self-abuse, as well as consuming alcohol or using drugs, are examples of those behaviors. When these fails to properly relive the stress experienced by the teenager, they may consider or attempt suicide. Any of the reinforcement or coping mechanisms that may be used are mentioned below. Since nurses’ assessments are critical for understanding stressor signs and symptoms, this would help nurses to understand how the teenager is feeling and speak about it when their adult is not present. As a result, they would feel more at ease debating those topics. We will teach them to talk about their feelings by giving them things to talk about that they are comfortable with. When it comes to suicidal thoughts or acts, ask them simple questions. To ease tension, encourage healthy coping skills such as sports or exercise, listening to music, or praying. If they don’t feel comfortable talking about their emotions, they can write them down in a diary as a stress reliever. Giving them information about support groups where they can go on their own and get assistance is another informative opportunity. Some of the support groups- self-esteem: Teens Health.org, gender identity question or stress associated with the subject: gay, lesbian and straight education Network (www.gisen.org), Bullying: www.bullying.org or kidshealth.org. Depression and suicide are complex issues and get torn on the flesh for adolescents. It is important for nurses to use communication and sensitivity in education for this group. Respond using 200-300 words APA format with references supporting the discussion. Describe two external stressors that are unique to adolescents. Discuss what risk-taking behaviors may result from the external stressors and what support or coping mechanism can be introduced.

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2025 I NEED A POSITIVE COMMENT BASED IN THIS ARGUMENT BETWEEN 100 120 WORDS Compare and contrast two change

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COMMENT THOMAS DQ2 2025

I NEED A POSITIVE COMMENT BASED IN THIS ARGUMENT..BETWEEN 100-120 WORDS Compare and contrast two change theories, and determine which theory makes the most sense for implementing your specific EBP project. Why? Has your mentor used either theory, and to what result? The first change theory is Lewin’s Change Theory. This theory is very widely used in nursing. This theory has three stages the unfreezing stage, moving stage, and refreezing stage. The theory has driving and resistant forces and for the theory to be successful the driving forces have to overcome the resistant forces. The other change theory is Rogers’ Change Theory. This theory has 5 stages and they are awareness, interest, evaluation, implementation and adoption.(Oguejiofo,2017) It is successful when nurses who ignored the proposed change earlier adopt it because of what they hear from nurses who adopted it initially. Both of these theory’s are widely used in nursing and both require nurses that want the change or who are willing to make the change. My mentor has used the Lewin’s change theory recently. The hospital already has hourly rounding but she just introduced new paperwork that has to be signed every hour. The unfreezing period she just explained how the new way will be better and she showed the nurses how it will be easier because the techs can also sign the sheet. The moving stage she let the nurses tell her how they feel about the whole situation and letting them express what they think will work. The final stage is refreezing and during this stage she went around for the first week making sure the nurses get this in their daily habit. I believe this theory makes more sense to my EBP because there are a lot of nurses that will be the driving force to make this happen and less people being the resistant force. So, it will be more likely to succeed. References: Oguejiofo,N. September 26, 2017. Change Theories in Nursing. https://bizfluent.com/about-5544426-change-theories-nursing.html

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2025 Lat Week 3 discussion An anxious patient is having rapid and shallow breathing

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nursing assessment 2025

Lat…. Week 3 discussion An anxious patient is having rapid and shallow breathing. After a few moments, he complains of a tingling sensation. What could be the causes of this tingling sensation? What are the various patterns of respiration and their significance? Ethnicity and culture influence risk factors for heart disease. Do you agree? Why or why not? What is the technique of percussion and palpation of the chest wall for tenderness, symmetry, bulges, fremitus, and thoracic expansion? Explain. Would you anticipate hearing hyper-resonance on a patient with a history of tobacco use? Why or why not? What are the mechanics of breathing with reference to lung borders and the anatomical structure of the lungs and diaphragm? The patient is having rapid and shallow breathing because of a decrease in Co2 in the blood to the extremities. The patient is experiencing hyperventilation. This could be a result of a panic attack or cardiac related. Norml respirations between 12-20 breaths/min. The chest expands and falls with a normal and even rate and rhythm Tachypnea: Respiratory rate that is above 20 breath/min. Some things that can cause this change is fever, pain, anxiety, respiratory issues. Bradypnea: Respiratory rate below 12 breaths per/min. Some causes of this could be certain medications such as narcotics or sedatives. Cheyene Stokes: Deep shallow breathing with periods of apnea. This could be in relation to renal faluire or drug overdose. African Americans are at a higher risk for devoloping heart disease due to genetics. Yes, I do agree because African Americans consume alot of sodium in their diet, and are geneticly sensitive to salt consumption which causes an increase in blood volume and raises blood pressure. Palpitation: Stand behind the patient and place your thumbs at the 10 th rib. Your hands will be out with thumbs touching. You can ask your patient to take a deep breath and you would watch for symmetry movement on your thumbs. During this point in the examination you will ask the patient to say ninety-nine as you bring your hands down along the sides of chest. You should have the same type of vibration throughout as you make your way down. To feel for bulges you would assess both posteriorly and anteriorly. You would use the tips of your fingers and gently palpate the area below the breast tissue. Percussion: You can perform the anterior assessment this way with your patient lying down. Then, strike the finger placed on the patient’s skin with the end of the middle finger of your dominant hand. You are listening and feeling for differences. For someone that has a history of tobacco use, I would anticipate hyper resonance because tobacco use can cause emphysema or COPD. The action of breathing in and out is due to changes of pressure within the thorax, in comparison with the outside. This action is also known as external respiration . When we inhale the intercostal muscles (between the ribs) and diaphragm contract to expand the chest cavity. The diaphragm flattens and moves downwards and the intercostal muscles move the rib cage upwards and out. This increase in size decreases the internal air pressure and air from the outside (at a now higher pressure that inside the thorax) rushes into the lungs to equalise the pressures. When we exhale the diaphragm and intercostal muscles relax and return to their resting positions. This reduces the size of the thoracic cavity, thereby increasing the pressure and forcing air out of the lungs

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2025 Analysis and Evaluation of Frameworks and Theories Theory analysis is particularly helpful in research because it provides a

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Analysis and Evaluation of Frameworks and Theories 2025

Analysis and Evaluation of Frameworks and Theories Theory analysis is particularly helpful in research because it provides a clear idea of the form and structure of the theory in addition to the relevance of content, and inconsistencies and gaps present. The ‘missing links’ or inconsistencies are fruitful sources of new research ideas. They also point to the next hypotheses that need to be tested. —Walker and Avant, 2011, p. 206 Nurse scientists often find that examining the literature is a productive way to see how existing frameworks and theories have been applied in other research studies. By engaging in this process, they may gain insights about a particular framework or theory, be able to identify gaps in research, or uncover new questions they are eager to explore. In this Discussion, you analyze existing frameworks/theories using the procedure proposed by Walker and Avant. Your analysis should provide an objective understanding of the strengths and weaknesses of each framework or theory. This, in turn, should enable you to evaluate whether the framework/theory is useful for the purposes of your theoretical foundation for a program of research. To prepare Review the information that Dr. Hathaway presents in the Week 1 media program, “Theoretical Foundation for Research,” regarding the phases of theory development and the similarities and differences between frameworks and theories. Search the literature and identify two frameworks/theories that may be useful for investigating your phenomenon of interest. Review the procedure for theory analysis presented in Chapter 12 of Walker and Avant (2011). Apply these steps to each framework/theory you have selected and identify the strengths and weaknesses of each framework/theory. Determine whether additional development or refinement is needed (i.e., for each framework, identify which aspects would require further research in order for it to meet the requirements of a theory). Evaluate the value of each framework/theory for addressing your phenomenon. Determine which framework/theory has the most potential for use as part of your theoretical foundation of your research. Think about any questions you have related to theory analysis and evaluation. By Day 3 Post a description of the two frameworks/theories you analyzed and evaluated, and explain why each is considered either a framework or a theory. For framework(s) you have selected, explain which aspects would require further research to meet the requirements of a theory. Explain why one has the most potential for use in your theoretical foundation for research, noting its strengths and weaknesses. Also pose any questions that have arisen through your examination of frameworks/theories. Read a selection of your colleagues’ postings.

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2025 Soap Note 1 Acute Conditions 15 Points Due 06 15 2019 Pick any Acute Disease from Weeks

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Soap Note about Multiple Sclerosis 2025

Soap Note 1 Acute Conditions (15 Points) Due 06/15/2019 Pick any Acute Disease from Weeks 1-5 (see syllabus) Soap notes will be uploaded to Moodle and put through TURN-It-In (anti-Plagiarism program) Turn it in Score must be less than 50% or will not be accepted for credit, must be your own work and in your own words. You can resubmit, Final submission will be accepted if less than 50%. Copy paste from websites or textbooks will not be accepted or tolerated. Please see College Handbook with reference to Academic Misconduct Statement. Late Assignment Policy Assignments turned in late will have 1 point taken off for every day assignment is late, after 7 days assignment will get grade of 0. No exceptions Follow the MRU Soap Note Rubric as a guide: Grading Rubric Student______________________________________ This sheet is to help you understand what we are looking for, and what our margin remarks might be about on your write ups of patients. Since at all of the white-ups that you hand in are uniform, this represents what MUST be included in every write-up. 1) Identifying Data (___5pts): The opening list of the note. It contains age, sex, race, marital status, etc. The patient complaint should be given in quotes. If the patient has more than one complaint, each complaint should be listed separately (1, 2, etc.) and each addressed in the subjective and under the appropriate number. 2) Subjective Data (___30pts. ): This is the historical part of the note. It contains the following: a) Symptom analysis/HPI(Location, quality , quantity or severity, timing, setting, factors that make it better or worse, and associate manifestations.(10pts). b) Review of systems of associated systems, reporting all pertinent positives and negatives (10pts). c) Any PMH, family hx, social hx, allergies, medications related to the complaint/problem (10pts). If more than one chief complaint, each should be written u in this manner. 3) Objective Data(__25pt.): Vital signs need to be present. Height and Weight should be included where appropriate. a) Appropriate systems are examined, listed in the note and consistent with those identified in 2b.(10pts). b) Pertinent positives and negatives must be documented for each relevant system. c) Any abnormalities must be fully described. Measure and record sizes of things (likes moles, scars). Avoid using “ok”, “clear”, “within normal limits”, positive/ negative, and normal/abnormal to describe things. (5pts). 4) Assessment (___10pts.): Diagnoses should be clearly listed and worded appropriately. 5) Plan (___15pts.): Be sure to include any teaching, health maintenance and counseling along with the pharmacological and non-pharmacological measures. If you have more than one diagnosis, it is helpful to have this section divided into separate numbered sections. 6) Subjective/ Objective, Assessment and Management and Consistent (___10pts.): Does the note support the appropriate differential diagnosis process? Is there evidence that you know what systems and what symptoms go with which complaints? The assessment/diagnoses should be consistent with the subjective section and then the assessment and plan. The management should be consistent with the assessment/ diagnoses identified. 7) Clarity of the Write-up(___5pts.): Is it literate, organized and complete? Comments: Total Score: ____________ Instructor: __________________________________

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