As an advanced practice nurse, you will examine patients presenting with a variety of disorders. You must, therefore, understand how the body normally functions so that you can identify when it is reacting to changes. Often, when changes occur in body systems, the body reacts with compensatory mechanisms. These compensatory mechanisms, such as adaptive responses, might be signs and symptoms of alterations or underlying disorders. In the clinical setting, you use these responses, along with other patient factors, to lead you to a diagnosis.

Consider the following scenarios:

Scenario 1:

Jennifer is a 2-year-old female who presents with her mother. Mom is concerned because Jennifer has been “running a temperature” for the last 3 days. Mom says that Jennifer is usually healthy and has no significant medical history. She was in her usual state of good health until 3 days ago when she started to get fussy, would not eat her breakfast, and would not sit still for her favorite television cartoon. Since then she has had a fever off and on, anywhere between 101oF and today’s high of 103.2oF. Mom has been giving her ibuprofen, but when the fever went up to 103.2oF today, she felt that she should come in for evaluation. A physical examination reveals a height and weight appropriate 2-year-old female who appears acutely unwell.  Her skin is hot and dry. The tympanic membranes are slightly reddened on the periphery, but otherwise normal in appearance. The throat is erythematous with 4+ tonsils and diffuse exudates. Anterior cervical nodes are readily palpable and clearly tender to touch on the left side. The child indicates that her throat hurts “a lot” and it is painful to swallow. Vital signs reveal a temperature of 102.8oF, a pulse of 128 beats per minute, and a respiratory rate of 24 beats per minute.

Scenario 2:

Jack is a 27-year-old male who presents with redness and irritation of his hands. He reports that he has never had a problem like this before, but about 2 weeks ago he noticed that both his hands seemed to be really red and flaky. He denies any discomfort, stating that sometimes they feel “a little bit hot,” but otherwise they feel fine. He does not understand why they are so red. His wife told him that he might have an allergy and he should get some steroid cream. Jack has no known allergies and no significant medical history except for recurrent ear infections as a child. He denies any traumatic injury or known exposure to irritants. He is a maintenance engineer in a newspaper building and admits that he often works with abrasive solvents and chemicals. Normally he wears protective gloves, but lately they seem to be in short supply so sometimes he does not use them. He has exposed his hands to some of these cleaning fluids, but says that it never hurt and he always washed his hands when he was finished.

Scenario 3:

Martha is a 65-year-old woman who recently retired from her job as an administrative assistant at a local hospital. Her medical history is significant for hypertension, which has been controlled for years with hydrochlorothiazide. She reports that lately she is having a lot of trouble sleeping, she occasionally feels like she has a “racing heartbeat,” and she is losing her appetite. She emphasizes that she is not hungry like she used to be. The only significant change that has occurred lately in her life is that her 87-year-old mother moved into her home a few years ago. Mom had always been healthy, but she fell down a flight of stairs and broke her hip. Her recovery was a difficult one, as she has lost a lot of mobility and independence and needs to rely on her daughter for assistance with activities of daily living. Martha says it is not the retirement she dreamed about, but she is an only child and is happy to care for her mother. Mom wakes up early in the morning, likes to bathe every day, and has always eaten 5 small meals daily. Martha has to put a lot of time into caring for her mother, so it is almost a “blessing” that Martha is sleeping and eating less. She is worried about her own health though and wants to know why, at her age, she suddenly needs less sleep.

To Prepare

• Review the three scenarios, as well as Chapter 6 in the Huether and McCance text.
• Identify the pathophysiology of the disorders presented in each of the three scenarios, including their associated alterations. Consider the adaptive responses to the alterations.
• Review the examples of “Mind Maps—Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease (GERD)” media in this week’s Learning Resources. Then select one of the disorders you identified from the scenarios. Use the examples in the media as a guide to construct a mind map for the disorder you selected. Consider the epidemiology, pathophysiology, risk factors, clinical presentation, and diagnosis of the disorder, as well as any adaptive responses to alterations.
• Review the Application Assignment Rubric found under Course Information 

To Complete

Write a 2- to 3-page paper excluding the title page, reference page and Mind Map that addresses the following:

• For each of the three scenarios explain the pathophysiology, associated alterations and the patients’ adaptive responses to the alterations caused by the disease processes.  You are required to discuss all three scenarios within the paper component of this assignment.
• Construct one mind map on a selected disorder presented in one of the scenarios. Your Mind Map must include the epidemiology, pathophysiology, risk factors, clinical presentation, and diagnosis of the disorder, as well as any adaptive responses to alterations.

 How did the ideology of Manifest Destiny contribute to the Mexican War of 1846? Why did the Mexican War of 1846 take place? Was the war necessary? Was it beneficial to the United States? What does this war tell us about this period of American history? Was it God’s plan that the United States extend from the Atlantic to the Pacific, or were imperialists looking for a way to defend what they planned to do anyway? 

respond

EBP is integral to the profession of nursing as it has the ability to increase successful outcomes in patient treatment. Expanded demand for provision of quality and safe care furnished by providers who believe in accountability is a main reason for the emphasis on EBP in nursing practice (Melnyk, Gallagher-Ford, Long, & Fineout-Overholt, 2014). To model evidence-based practice in my future advanced practice setting I must use my growing knowledge of the research process. One way in which I can do this is by keeping current with research studies and continuing to learn from and critique them as needed. I can share my knowledge with co-workers and encourage them to use the latest evidence-based research in their clinical practice. By doing so myself I can be a model of how use of EBR translates in to EBP and improves patient outcomes.

In order to promote such an environment it is crucial to have the support of the organization. It is my duty to advise others, including those in charge, of the importance of maintaining a finger on the pulse of the latest in nursing research. I can ask specifically for the tools related to research, such as online and print journal subscriptions focusing on the type of care provided in the practice. I can also offer to spearhead educational opportunities to impart my knowledge of EBP and the research process to my co-workers.

FNPs have direct access to patients and have firsthand knowledge regarding what is working in regards to patient care versus practices that may no longer be valuable. FNPs can then facilitate problem-solving in cases of the latter, contributing to evidence-based research and therefore changing evidence-based practice in the process. I would emphasize the important role we as FNPs have in the EBP process and urge the practice to see the benefits of fostering a workplace supportive of EBP (Black, Balneaves, Garossino, Puyat, & Qian, 2015).

As for the detractor, I would relay the message that evidence-based practice is responsible for generating comprehensive and useful healthcare guidelines and practice which affects patient outcomes. Positive patient outcomes equals happier patients, and, as a result, a happier practice. EBP is also tasked with improving overall healthcare systems, as well as advancing the practice of practitioners. I would remind this person that using EBP will improve the workplace atmosphere and even his personal practice (Correa-de-Araujo, 2016).

www.nbcnews.com/id/43529641/ns/health-health_care/t/nurses-suicide-highlights-twin-tragedies-medical-errors#.XWVfRUxFzIU

Your written assignment this week is to reflect on a video and an article. In each tragic case discuss what lead to error in the system. In a paragraph or two reflect on how you might practice differently based on what you have learned in this module.

Video Example

Article Example

Submit your completed assignment by following the directions linked below. Please check the Course Calendar for specific due dates.

Save your assignment as a Microsoft Word document. (Mac users, please remember to append the “.docx” extension to the filename.) The name of the file should be your first initial and last name, followed by an underscore and the name of the assignment, and an underscore and the date. An example is shown below:

Jstudent_exampleproblem_101504