Instructions:

 Follow the 3 x 3 rule: minimum three paragraphs per DQ, with a minimum of three sentences each paragraph.

·      All answers or discussions comments submitted must be in APA format according to Publication Manual American Psychological Association (APA) (7th ed.)

·      Minimum of two (2) references, not older than 2015.

Nursing Research:

QD1.  

Discuss the topic you are planning to use for the clinical practice experience. Create a PICOT research question that will guide the practice experience.

*See the attachment for a PICOT selection guidelines

 QD2. Discuss the purpose of the literature review and which topics are you going to search for your topic? Discuss also what are the challenges that nurses are facing today when they have to do a literature review?

Pathophysiology:

 QD1. Fifty-four–year-old Fred is complaining of a headache that started about 2 weeks ago. For the past 2 days, the headache has increased in severity, and he is photophobic and has uncial rigidity and projectile vomiting. CT scan results show an arteriovenous malformation in the basal artery and a small hemorrhagic bleed in the middle meningeal artery

1.How is the concept “disorders of brain function” related to Fred’s presenting symptoms?

2.What aspects of cerebral circulation would come into play in Fred’s case?

QD2. A 32-year-old mother is driving her 10-year-old daughter home from the store when their van is stuck by a drunk driver, causing their vehicle to careen over a bridge into the water below. The daughter’s arm is caught underneath a crumpled seat. Acting quickly, the mother is able to move the entire 400-lb seat to free her daughter’s arm and take her to safety. They are taken to a local emergency room and treated for minor injuries.

1. When the mother arrives to the ER, she is perplexed at how she was able to move the seat. She tells you she can barely lift 50 lb at home. She asks you how it was possible for her to move such a tremendous amount. How would you respond?
2. The woman asks you how to further explain to her “how all levels of the brain work together to perform such a complex movement”?

Shock and Multiple Organ Dysfunction Syndrome

1. Adam Smith, 77 years of age, is a male patient who was admitted from a nursing home to the intensive care unit with septic shock secondary to urosepsis. The patient has a Foley catheter in place from the nursing home with cloudy greenish, yellow-colored urine with sediments. The nurse removes the catheter after obtaining a urine culture and replaces it with a condom catheter attached to a drainage bag since the patient has a history of urinary and bowel incontinence. The patient is confused, afebrile, and hypotensive with a blood pressure of 82/44 mm Hg. His respiratory rate is 28 breaths/min and the pulse oximeter reading is at 88% room air, so the physician ordered 2 to 4 L of oxygen per nasal cannula titrated to keep SaO2 greater than 90%. The patient responded to 2 L of oxygen per nasal cannula with a SaO2 of 92%. The patient has diarrhea. His blood glucose level is elevated at 160 mg/dL. The white blood count is 15,000 and the C-reactive protein, a marker for inflammation, is elevated. The patient is being treated with broad-spectrum antibiotics and norepinephrine (Levophed) beginning at 2 mcg/min and titrated to keep systolic blood pressure greater than 100 mm Hg. A subclavian triple lumen catheter was inserted and verified by chest x-ray for correct placement. An arterial line was placed in the right radial artery to closely monitor the patient’s blood pressure during the usage of the vasopressor therapy. (Learning Objectives 6 and 7)

1. What predisposed the patient to develop septic shock?
2. What potential findings would suggest that the patient’s septic shock is worsening from the point of admission?
3. The norepinephrine concentration is 16 mg in 250 mL of normal saline (NS). Explain how the nurse should administer the medication. What nursing implications are related to the usage of a vasoactive medication?
4. Explain why the effectiveness of a vasoactive medication decreases as the septic shock worsens. What treatment should the nurse anticipate to be obtained to help the patient?
5. Explain the importance for nutritional support for this patient and which type of nutritional support should be provided?

2. Carlos Adams was involved in a motor vehicle accident and suffered blunt trauma to his abdomen. Upon presentation to the emergency department, his vital signs are as follows: temperature, 100.9°F; heart rate, 120 bpm; respiratory rate, 20 breaths/min; and blood pressure, 90/54 mm Hg. His abdomen is firm, with bruising around the umbilicus. He is alert and oriented, but complains of dizziness when changing positions. The patient is admitted for management of suspected hypovolemic shock.

The following orders are written for the patient:

Place two large-bore IVs and infuse 0.9% NS at 125 mL/hr/line

Obtain complete blood count, serum electrolytes

Oxygen at 2 L/min via nasal cannula

Type and cross for 4 units of blood

Flat plate of the abdomen STAT 

(Learning Objectives 1, 4, and5)

1. Describe the pathophysiologic sequence of events seen with hypovolemic shock.
2. What are the major goals of medical management in this patient?
3. What is the rationale for placing two large-bore IVs?
4. What are advantages of using 0.9% NS in this patient?
5. What is the rationale for placing the patient in a modified Trendelenburg position?

ANNOTATED BIBLIOGRAPHY:Implementing research in your proposal is key to convincing your audience to adopt your new ideas or procedures. However, before implementing research into your assignment, you need to be able to find relevant, credible sources to support your points. Completing an annotated bibliography is a practical way to both practice writing correct APA citations and evaluate the sources you are planning to use in your proposal.   An annotated bibliography consists of two parts: a citation (in APA style) and an annotation, which you will use to analyze the source and evaluate how it will be used in your proposal.  For your annotated bibliography, you will write at least seven entries that include a citation and an annotation.Specifics: 

• Five of the seven entries must be scholarly, peer-reviewed journal articles 
  • Two must be academic articles. Here is the difference.
• Entries must have been published in the last 5 years. 
• Use a variety of academic journals.  Overly-depending on one or two journals suggests bias, even when academic journals are used. 

Each entry in your annotated bibliography will consist of your citation, followed by your annotation, which includes three parts. First, you will briefly summarize the source in your own words. Title this section Summary. Next, you will write a paragraph where you assess the source by determining whether it is useful and reliable. Title this section Assessment. Finally, you will reflect on your source to determine how you will use it within the proposal. Title this section Reflection.  Thus, each of your seven sources will have the following: 

1. An APA-formatted bibliographic entry.
2. A Summary section. 

a.  The summary is about the content of the article.

1. An Assessment section. 

.  The assessment is about the veracity of, quality of, credibility of, and usefulness of the article. For example, how does this article compare to the other articles you have found?  Is the author known to publish often in this area? Author credentials?  Will this article truly help your argument?  For this section, you’ll essentially need to do research on your research.

1. A Reflection section. 

.  In this section, you will explain how you will use this source in your proposal. Specifically, how will this source support the points you are making about your argument?  Which points will this source support?  In which section of the proposal will you use this source?Tips:

• Avoid writing “I feel” or “I believe.”  Your assessment of the source should use concrete evidence from the article that proves your source is reliable, credible, scholarly, and supports your argument.
• Simply stating that an article is reliable, credible, scholarly, and supports the argument for your proposal isn’t quite what you need to do.  Prove it with evidence from the article and analysis of the author/publisher. 
• Clearly explain how the source will support specific aspects of your proposal. For example, if the source supports your claim that your solution is cost-effective, say so. If the source supports your claim that a current protocol is inefficient, say so.
• Do not include pictures or other visuals in the annotated bibliography. 

A 4 page (does not include graphics or references), single-spaced internal unsolicited proposal targeted specifically toward your organizationYour proposal will have the following sections:

• The Purpose is a brief statement that informs the reader of the purpose of your proposal–why you are writing and what you hope to achieve.
• The Problem section is more detailed and describes for the reader what the current problem is that your proposal hopes to solve. Since a proposal is essentially a solution to a problem, you cannot convince readers you have a viable solution unless you first convince them there is a problem.
• The Solution or Plan section is the heart of your assignment; this is where you will detail your proposal. What information you include in this section will depend upon the topic of your proposal. Some common items to include are: description of the plan; materials needed; costs; etc.  
•  The Timeline section will include the dates and necessary time for rollout of your  solution.  Include actual dates.
• The Conclusion section restates the problem, solution, and benefits and recommends the next course of action.

Includes at least two graphics.Need 5 scholarly sources published within the last 5 years******Please use this topic to complete the proposal and annotated bibliography:  My proposal will be to my director of nursing at the long-term care facility I work at. The problem is new graduate nurses tend to always quit. My plan is to create a safe place where a new graduate nurse can come to seek mentorship and advice from experienced nurses. This will create a positive work environment and the new graduate nurses will not give up so easily at working at this facility.*****Purpose: create a safe place where new graduate nurses can come to seek mentorship from experienced nurses. This will create a positive work environment and the new graduate nurses will not give up so easily at working at this facility. Problem: New graduate nurses that begin to work here have the tendency to quit before they reach their three months of working at this facility. These nurses feel overwhelmed and need guidance. Solution/Plan: Accepting volunteers that are experienced nurses. They will then be assigned to new graduate nurses that they agree to mentor. These nurses can work at this facility or perhaps nurses the Director of nursing know. The experienced nurses will be volunteering their time so they will not be getting paid. Therefore the facility can offer incentives. Perhaps future gatherings for them to thank them for all their hard work. Also, the director of nursing can offer incentives such as time off and employee recognition. I believe that most of the mentors will be happy to mentor these new grads because offering mentorship to brand new nurses is rewarding in itself. Conclusion: remind my audience of the problem at hand and what can be done to decrease the amount of new graduate nurses that quit. PLEASE MAKE SURE PROPOSAL IS SINGLE SPACED! 

NR 505 Advance Research Method: Evidence-based Practice

(Chamberlain College – Spring 2016)

Week 1, TD 1 – Qualitative Research

View each of the two short videos in the lesson. You will be conducting a participant observation study for this TD. The research question is: What are the health and safety issues in Ironridge compared to Summerville?

Record the health and safety issues you find in Ironridge and Summerville. Describe one health issue and one safety issue in each city (Ironridge and Summerville). Try to avoid repeating an issue identified by another student if possible.

Why is this participant observation an example of qualitative research? What are other ways, both qualitative and quantitative, that you could research this question? Finally, how are theory, research, and practice advanced by the combination of qualitative and quantitative approaches?

Week 1, TD 2 Ask a PICO(T) Question 

Conduct a search of the literature on one of the problems you have identified, using the PICO(T) format. How many “randomized, controlled trials (RCTs)” have you found in comparison to other types of studies? What are the advantages and disadvantages of RCTs in comparison to other types of studies? Generally, how would you summarize your articles?