(A)  Class discussion

Assigned to examine the nursing philosophy of Florence Nightingale. In this discussion, you must accomplish the following:

• Use Nightingale’s philosophy of nursing to consider the interventions you would use for the patient described in the following scenario:
  • A  35-year-old woman presents to the emergency room by herself complaining of acute onset right lower quadrant abdominal pain and nausea: She has vomited 3 times. Her color is ashen, her oral temperature is 99.2, her pulse is 118 beats per minutes, her respirations are 24 breaths/minute, and her blood pressure is 90/50- mm/Hg. She is diagnosed with a ruptured       right ovarian cyst.

In considering this scenario, be sure to provide a rationale for your actions/interventions recommended based specifically on Nightingale’s philosophy. See discussion board rubric attached.

See attached document for discussion rubric. 

(B)  Assignment Instructions.

The purpose of this assignment is to stimulate thinking about how specific care might be approached using the Roy Adaptation Model as a framework for practice.

Instructions: All instructions must be follow.

1. After reading the assigned scenario, identify 2 more problems or potential problems along with interventions to the plan of care for Mrs. M. based on those typical for a patient with her medical problems or symptoms and demographics (in other words, you can assume that she may have other problems such as anxiety or pain or may be at risk for other problems).

2. Develop a plan for one additional nursing problem using Roy’s theory as the basis for practice, while considering at least one of the four adaptive modes (physiological-Physical, Self-Concept-Group Identity, Role Function, or Independence Mode).

3. Put your plan of care into a PowerPoint presentation 

4. Be sure that you include a title page and reference page, as appropriate. The PowerPoint should not be more than 10 slides in addition to the title and reference page.

See below attached document for the assigned scenario and rubric.

The Assignment: 5 pages

Examine Case Study: Pharmacologic Approaches to the Treatment of Insomnia in a Younger Adult. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.

At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature. 

Introduction to the case (1 page)

• Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.

Decision #1 (1 page)

• Which decision did you select?
• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #2 (1 page)

• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #3 (1 page)

• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Conclusion (1 page)

• Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.

BACKGROUND

This week, we examine a 31-year-old male who presents to the office with a chief complaint of insomnia. 

SUBJECTIVE

Patient is a 31-year-old male. He states that his insomnia has gotten progressively worse over the past 6 months. Per the patient, he has never been a “great sleeper” but is now having difficulty both falling asleep and staying asleep at night. The problem began approximately 6 months ago after the sudden loss of his fiancé. The patient states this is affecting his ability to perform his job, which is a forklift operator at a local chemical company. The patient states he has used diphenhydramine in the past to sleep but does not like the way it makes him feel the morning after. He states he has fallen asleep on the job due to lack of sleep from the night before. The patient’s medical record from his previous physician states that he has a history of opiate abuse, which began after he broke his ankle in a skiing accident and was prescribed hydrocodone/apap (acetaminophen) for acute pain management. The patient has not received a prescription for an opiate analgesic in 4 years. The patient states recently he has been using alcohol to help him fall asleep, approximately four beers prior to bed.

MENTAL STATUS EXAM

The patient is alert and oriented to person, place, time, event. He makes good eye contact and is dressed appropriately for time of year. He denies auditory/visual hallucinations. Judgement, insight, and reality contact are all intact. Patient denies suicidal/homicidal ideation, and is future oriented.

Decision Point One

Trazodone: 50–100 mg daily at bedtime 

RESULTS OF DECISION POINT ONE

• Patient returns to clinic in 2 weeks
• Patient states medication works well but gives him an unpleasant side effect of a prolonged erection of the penis, approximately 15 minutes after waking 
• Patient states this makes it difficult to get ready for work or go downstairs and have coffee with his girlfriend and daughter in the morning
• Patient denies auditory/visual hallucinations and is future oriented

Decision Point Two

Explain that priapism is a side effect of trazodone that should diminish over time. Continue dose 

RESULTS OF DECISION POINT TWO

• Patient returns to clinic in 2 weeks
• Patient states priapism has diminished over time
• Patient denies auditory/visual hallucinations and is future oriented 
• Patient states trazodone is effective at 50 mg dose but sometimes wakes up following day with next-day drowsiness
• Patient denies auditory/visual hallucinations and is future oriented

Decision Point Three

Continue dose. Explain to patient he may split the 50 mg tablet in half. The decreased dose should minimize next-day drowsiness. Follow up in 4 weeks 

Guidance to Student
Trazodone is a selective serotonin reuptake inhibitor that has a low side effect profile. It would not be prudent to prescribe sonata as it carries with it the risk of complex sleep behaviors. Hydroxyzine is an antihistamine with strong sedative properties. However, many patients complain of anticholinergic adverse effects the following morning, such as Xerostomia and Xerophthalmia.
The patient is presenting with excessive somnolence. It would be prudent to reduce the dose of trazodone by 50% and reassess in 4 weeks. 

  

1. Portfolio part II 

a) APRN protocol also known as collaborative agreement with supervising physician(s).

b.) business proposal (refer to portfolio explanation/examples found on your BB lecture section. 

There is an example of a business proposal. Use the example to create a brief business proposal with no more than two pages word or power point as your choice;

c.) Create a LinkedIn page and send me a proof of you creating the link.

See page 16 and 17 of attached document. Assignment labeled Genomics part 1

 Patient Genetic and Genomics Interview and Education Part 1

 To assess a patient’s genetic risk, you must understand the relationship of genetics and genomics to health, prevention, screening, treatment, and monitoring. E This is a two-part assignment whose purpose is to help you develop your abilities to apply genetics and genomic information while providing patient care. Purpose: Use a constructed genetic pedigree from collected family history information to identify a risk profile and develop a plan of care, including patient education and referral. Before you start this project go and register for the G3C (Global Genetics and Genomics Community) learning portal https://www.genomicscases.net/en/. The site is free and has interactive cases that demonstrate how genetic and genomics link to health and illness. Throughout each patient scenario, there are links to resources and supplemental educational activities to expand upon genetic/genomic learning concepts. At the end of each patient encounter, learners are prompted to make a recommendation to their “patient” and are assessed across multiple domains such as risk assessment, family history, and patient medical history. There are 17 cases, and you can get CEs for the activities. Part 1: a. Choose one case in the https://www.genomicscases.net/en/ and complete the activity, please submit the report given at the end of the activity. b. Select a patient that you can interview virtually. Set up a time and quiet time, go over with the patient about confidentiality, and explain that no identifiable information will be used in this assignment. c. Go to the Center for Disease Control “My Family Health Portrait: A tool from the Surgeon General at https://phgkb.cdc.gov/FHH/html/index.html d. Collect a client’s personal and three-generation family health history to assess for genomic factors that impact the client’s health ( Save the created Family Health History, please, use fictitious names, but keep the rest of the information accurate). e. Identify genetic and genomic factors within collected history and that contribute to illness and/or health risk. f. Identify issues in this patient-related to each of the following: Financial/Socioeconomics, Cultural, Religious, and Lifestyle. g. Identify ethical/legal concepts related to this patient. Include concepts Genetics/Genomics Nursing Practice. 17 h. Identify the major challenge with this patient and identified possible strategies to overcome this challenge i. Report your findings in a three-page report including the three-generation Map using APA guidelines 

Grading Rubric Rating Criteria Needs Improvement 10 points Proficient 15 points Exceptional 20 points Pedigree Construction Student included most data from family members but is missing data from some individuals. Trait of interest is clearly diagramed in the pedigree. Student included 3 or more generations using standardized symbols and terminology OR the U.S. Surgeon General’s My Family Health Portrait Tool. Student included 3 or more generations using standardized symbols and terminology OR the U.S. Surgeon General’s My Family Health Portrait Tool. Pedigree Analysis Analysis of the pedigree is incomplete, inaccurate, and/or does not address relevant genomic factors that impact the client’s health. Analysis of the pedigree is complete, accurate, AND addresses relevant genomic factors that impact the client’s health. Analysis of the pedigree is comprehensive, accurate, AND addresses relevant genomic factors that impact the client’s health. Pedigree identification of health risk Identifies some risk factors but fails to make connections. Identifies partially potential health risk factors for this patient. Identifies potentially significant health risk for this patient. Pedigree identification of environmental and cultural factor as risk fa tors. Completes a risk analysis of the environmental and cultural factors but misses two or more components. Completes a risk analysis of the environmental and cultural factors but misses one component. Completes a thorough risk analysis for the identified patient based on their pedigree, culture, environmental exposure and life style.

This is a re do assignment. If there is any questions about the assignment let me know. I have attached the incorrect one that I turned in.

Instructions

Week 2 Project

This week we will focus on Transformational Leadership.

For this assignment, you will research your advanced nursing practice role and summarize your findings in a 2-4 page paper (excluding the title page and references):

Define Transformational Leadership and as it relates to your identified leadership attributes that you possess or need to develop. The master’s prepared nurse demonstrates leadership in the four domains: the profession of nursing, clinical practice arena, health policy arena, and systems level. The impact could be found in health promotion, disease prevention/management, quality improvement and/or within management of a health system. In order to complete this assignment, you will first complete an assessment about your leadership style. Choose one of the topics below and respond to the question asked. Assure your leadership style is evident in your response.

These are:

Cherry, K. (2016). What’s Your Leadership Style? Learn more about your strengths and weaknesses as a leader.

How to Become a Better Leader

Topics:

Domains: health promotion, disease prevention, quality improvement and health systems

Health Promotion: Healthy People 2020 have identified Metabolic Syndrome as a major health concern. Sara, lives and works as an A/GNP in rural America. Several local faith organizations have asked if she can organize a Health Fair that will address health promotion, specifically DM. What AP roles, core competencies and support are needed to make this happen?

Disease Prevention: Obesity in school age children is a significant problem. Melissa, a former elementary school teacher, is a new CNL who has recently joined her state nursing association and is passionate about the 30% or more of the students being over-weight. The local nursing association is looking for a community project to address disease prevention. Melissa has approached the officers with her concern. What AP roles, core competencies and support are needed to make this happen?

Quality Improvement:Nancy, FNP, is the clinical director of a nurse managed health center that is connected to a School of Nursing. The center’s staff members includes of all advance practice nurse providers, a nurse educator, a nursing informaticists, 2 RNs, and paraprofessional staff. The team wants to determine patient satisfaction and capture data on patient experiences both for QI and as a learning experience for students studying nursing. What AP roles, core competencies and support are needed to make this happen?

Health Systems: Daniel, a DNP prepared ED NP identified that patients seen in the ED for various reasons had undiagnosed HTN. He observed that the patient’s chief compliant was well addressed but the HTN was not. He has approached the hospital system about the problem and suggested an outpatient clinic adjacent to the ED to address the HTN and other coincidentally found problems. What AP roles, core competencies and support are needed to make this happen?

Submission Details:

• Support your responses with examples.
• Cite any sources in APA format.