J.R. is a 36-year-old white, middle class woman who has been sexually active with one partner for the past 2 years. She and her partner have no history of STIs, but her partner has a history of fever blisters. She reports genital pain, genital vesicles and ulcers, and fever and malaise for the last 3 days. Examination reveals adenopathy and vaginal and cervical lesions.

DX: Genital herpes

1. List specific goals for treatment for J.R.

2. What drug therapy would you prescribe? Why?

3. Write prescription for drug therapy prescribed.

4. What are the parameters for monitoring success of the therapy?

5. Discuss specific patient education based on the prescribed therapy.

6. List one or two adverse reactions for the selected agent that would cause you to change therapy.

7. What would be the choice for second-line therapy?

8. What over the counter and/or alternative medications would be appropriate for J.R.?

9. What lifestyle changes would you recommend for J.R.?

10. Describe one or two drug-drug or drug-food interactions for the selected agent

IN-TEXT CITATIONS AND REFERENCES MUST MATCH. NURSING JOURNALS ONLY WITHIN 5 YEARS.

This case will focus specifically on endocrine and neural drug treatment.

Prompt: Consider the following scenario: Bill, age 70, came to the examination accompanied by his wife. Bill was tall and cheerful, greeted the doctor warmly, and then started walking around the room a bit until he realized he was supposed to sit down.

 As the physician asked Bill questions for the history, he answered some, and smiled at all of the questions. Bill’s wife, Cecilia, filled in the answers that Bill was not sure of. Both Bill and Cecilia seemed to be used to her supportive role in helping Bill remember things.

Bill had retired as an accountant two years earlier. In the period since retirement, Bill had reached the point that he could not balance his checkbook. Cecilia handled that task, as well as handling money and change while shopping. This change in Bill’s use of numbers was so sudden, she said, that she wondered if something could be done to help Bill.

Bill smiled at both Cecilia and the doctor, and shrugged his shoulders.

After doing a thorough physical exam, a psychometric evaluation, and a cranial MRI, the final diagnosis was Alzheimer’s disease.

The doctor ordered some medications specifically for this disease. An anticholinergic was prescribed to cure the disease. The physician also ordered vitamins B1, B6, B12, and E. Nutritional support, physical exercises, cognitive activities, safety precautions, and other suggestions were recommended.

 In a short paper, the following critical elements must be addressed:

● Identify the incorrect medication/drug classification/treatment and explain why it is incorrect.

● What drug classification would you use instead? Why?

● Provide an example of a generic medication from each drug classification. How would each of the medications/treatments in the scenario act on the patient’s body?

 

Support your answer with relevant resources

 

 

One of the most challenging aspects of EBP is to actually identify the answerable question.
—Karen Sue Davies

 

Formulating a question that targets the goal of your research is a challenging but essential task. The question plays a crucial role in all other aspects of the research, including the determination of the research design and theoretical perspective to be applied, which data will be collected, and which tools will be used for analysis. It is therefore essential to take the time to ensure that the research question addresses what you actually want to study. Doing so will increase your likelihood of obtaining meaningful results.

 

In this first component of the Course Project, you formulate questions to address a particular nursing issue or problem. You use the PICOT model—patient/population, intervention/issue, comparison, and outcome—outlined in the Learning Resources to design your questions.

 

To prepare:

 

• Review the article, “Formulating the Evidence Based Practice Question: A Review of the Frameworks,” found in the Learning Resources for this week. Focus on the PICOT model for guiding the development of research questions.

• Review the section beginning on page 75 of the course text, titled, “Developing and Refining Research Problems” in the course text,( Marquis & Huston) which focuses on analyzing the feasibility of a research problem.

• Reflect on an issue or problem that you have noticed in your nursing practice. Consider the significance of this issue or problem. (Refer to the PICOT question you earlier formulated for me on handwashing)

• Generate at least five questions that relate to the issue which you have identified. Use the criteria in your course text to select one question that would be most appropriate in terms of significance, feasibility, and interest. Be prepared to explain your rationale.

• Formulate a preliminary PICO question—one that is answerable—based on your analysis. What are the PICO variables (patient/population, intervention/issue, comparison, and outcome) for this question? (once again refer to the PICO question you earlier formulated for me on: Does hand washing and appropriate staff dressing among the surgical ward nurses reduce cross infection during patient management)

 

Note: Not all of these variables may be appropriate to every question. Be sure to analyze which are and are not relevant to your specific question.

 

• Using the PICOT variables that you determined for your question, develop a list of at least 10 keywords that could be used when conducting a literature search to investigate current research pertaining to the question.

  To complete:

  Write a  4-page paper that includes the following:

 

• (1) A summary of your area of interest, an identification of the problem that you have selected, and an explanation of the significance of this problem for nursing practice

• (2) The 5 questions you have generated and a description of how you analyzed them for feasibility

• (3) Your preliminary PICOT question and a description of each PICOT variable relevant to your question

• (4) At least 10 possible keywords that could be used when conducting a literature search for your PICOT question and a rationale for your selections

   

  Reference:
  Davies, K. S. (2011). Formulating the evidence based practice question: A review of the frameworks. Evidence Based Library and Information Practice, 6(2), 75–80. Retrieved from https://ejournals.library.ualberta.ca/index.php/EBLIP/article/viewFile/9741/8144

   

  Readings

  • Polit, D. F., & Beck, C. T. (2012).  Nursing research: Generating and assessing evidence for nursing practice (Laureate Education, Inc., custom ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
    • Chapter 2, “Evidence-Based Nursing: Translating Research Evidence into Practice” (Review pages 27–34)
    • Chapter 5, “Literature Reviews: Finding and Critiquing Evidence”

      In this chapter, you focus on conducting a literature review. Topics include how to identify the relevant literature on a given topic and then how to critique the strengths and weaknesses of the literature that you have found. Finally, the chapter examines how to synthesize the research findings into a written literature review.

  • Houde, S. C. (2009). The systematic review of literature: A tool for evidence-based policy. Journal of Gerontological Nursing, 35(9), 9–12.
    Retrieved from the Walden Library databases.  

    This article emphasizes the importance of systematic reviews of literature. The authors present an overview of resources that may assist in conducting systematic reviews.

  • Krainovich-Miller, B., Haber, J., Yost, J., & Jacobs, S. K. (2009). Evidence-based practice challenge: Teaching critical appraisal of systematic reviews and clinical practice guidelines to graduate students. Journal of Nursing Education, 48(4), 186–195.
    Retrieved from the Walden Library databases.

    This article reviews the features of the TREAD Evidence-Based Practice Model. In particular, the authors of this article stress how the model emphasizes the use of standardized critical appraisal tools and Level I evidence.

  • Robeson, P., Dobbins, M., DeCorby, K., & Tirilis, D. (2010). Facilitating access to pre-processed research evidence in public health. BMC Public Health, 10, 95.
    Retrieved from the Walden Library databases.

    This article describes a hierarchy of pre-processed evidence and how it is adapted to the public health setting. The authors identify a range of resources with relevant public health content.

  • Barker, J. (n.d.) Basic search tips and advanced Boolean explained. Retrieved August 3, 2012, from
    http://www.lib.berkeley.edu/TeachingLib/Guides/Internet/Boolean.pdf

    This resource provides a graphical representation of different approaches to research and gives examples of each.

  • Davies, K. S. (2011). Formulating the evidence based practice question: A review of the frameworks. Evidence Based Library and Information Practice, 6(2), 75–80. Retrieved from https://ejournals.library.ualberta.ca/index.php/EBLIP/article/viewFile/9741/8144

    This article reviews the frameworks commonly used to assist in generating answerable research questions. The author recommends considering the individual elements of the frameworks as interchangeable (depending upon the situation), rather than trying to fit a situation to a specific framework.

  • Walden University Library. (2012). Levels of evidence. Retrieved from http://libraryguides.waldenu.edu/evidencepyramid

    This guide provides a listing of evidence-based clinical resources, including systematic reviews and meta-analyses, critically appraised topics, background information and expert opinions, and unfiltered resources.

  • Indiana State University. (n.d.). Database search strategies. Retrieved July 6, 2012, from
    http://libguides.indstate.edu/content.php?pid=118904&sid=1065428

    In this resource, the most common types of database searches are highlighted. It includes topics such as nesting searches, phrase searches, and using synonyms of key words in the search.

  • Library of Congress Online Catalog. (2008). Boolean searching. Retrieved from
    http://catalog.loc.gov/help/boolean.htm

    This web page provides a basic overview of Boolean searches and provides simple examples of key search terms.

  • Walden University. (n.d.b.). Searching and retrieving materials in the research databases. Retrieved August 10, 2012, from http://libraryguides.waldenu.edu/content.php?pid=162865&sid=1375878

    This resource provides tips for searching in the Walden Library. It includes a guide to keyword searches, an explanation of Boolean searches, and tips on locating specific journals or articles.

  • Document: Course Project Overview (Word document)
  •  

  Media

  • Laureate Education, Inc. (Executive Producer). (2012e). Finding resources for EBP. Baltimore, MD: Author. 

    Note: The approximate length of this media piece is 6 minutes.

    In this video, Dr. Marianne Chulay identifies sources where nurses can find evidence to support their practices. She provides several examples of resources that provide specific information about best practices in health care.
  • Laureate Education, Inc. (Executive Producer). (2012f). Finding sources of evidence. Baltimore, MD: Author. 

    Note: The approximate length of this media piece is 9 minutes.

    Dr. Kristen Mauk explains the process of performing a literature review in this video. She provides advice for nursing students in browsing databases and analyzing sources of evidence.
  • Laureate Education, Inc. (Executive Producer). (2012g). Hierarchy of evidence pyramid. Baltimore, MD: Author. 

    This multimedia piece explains the hierarchy of evidence pyramid. The piece offers definitions and key information for each level of the pyramid.

   

   

 

 Personalised care as identified in the NHS Long Term Plan (2019) promotes the nurse to consider the ‘person’ as opposed to the ‘patient’ (NHS England, 2019; Nursing and  Midwifery Council [NMC], 2018). In doing so, you will need to use appropriate communication skills and interpersonal skills to support and enable the person to make informed choices within their episodes of care. This assessment will centre around a  person’s story of an episode of care (services provided to a patient within a specific period across a continuum of care in an integrated system). You will need to choose one story/experience and address the assessment criteria set out under ‘Assessment  Criteria’.