Part one

For the theory that you have selected  to do your theory paper on, you will be using it for this discussion board. You will be analyzing a few components of the theory. 

The theory is Toward a Praxis of Suffering. Janice Morse.

Find a research article that uses the theory AND ANSWER THE FOLLOWING QUESTIONS.You can use this for your paper.

It must be a research article. See Module two for an overview of  research articles. 

POST A PDF OF YOUR ARTICLE: WE NEED THE ACTUAL ARTICLE NOT THE LINK

INCLUDE A VERY BRIEF DESCRIPTION OF THE STUDY

1. What is the purpose of the theory? 
2.   What are the main concepts in the theory?  3. Are they operationally defined? Theoretically defined? 4. Does the theory contribute to the discipline of nursing? 

Theoretical and operational definitions. For that chosen concept, write theoretical and operational definitions. You can find it in the article. If it is not explicitly written , then you have to surmise what  it  is based on article.

If  the study is qualitative you have to determine  how the researcher used the theory to generate the interview questions and based on the results how you would ope rationalize the concept (since there is no operational definition in a qualitative study).

 

Shool requirements:

Turn it in Score must be less than 50%, must be your own work and in your own words,APA format, 

 Copy paste from websites or textbooks will not be accepted or tolerated. 

Please see College Handbook with reference to Academic Misconduct Statement.

Pick any Chronic Disease from Weeks 6-10: you can pick any of this condition,but have to be chonic not acute, cistic fibrosis,influenza,pleural effsuin,pulmonary embolism,tubercolosis,celiac disease,cirrhosis,divertiulitis,hepatitis encephalopathy,,hepatitis,pancreatic cancer,bladder cancer,prostate cancer,bph,prostatitis,cushing disease,addison disease,myasthemia gravis,priapis.ANY OF THAT CONDITIONS,JUST ONE,BUT CHONIC.

Sample:

SOAP NOTE SAMPLE FORMAT FOR MRC 

Name:  LP Date: Time: 1315   Age: 30 Sex: F SUBJECTIVE CC:   “I am having vaginal itching and pain in my lower abdomen.”  HPI:   Pt is a 30y/o AA female, who is a new patient that has recently moved to Miami.  She seeks treatment today after unsuccessful self-treatment of vaginal itching, burning upon urination, and lower abdominal pain.  She is concerned for the presence of a vaginal or bladder infection, or an STD.  Pt denies fever.  She reports the itching and burning with urination has been present for 3 weeks, and the abdominal pain has been intermittent since months ago.  Pt has tried OTC products for the itching, including Monistat and Vagisil.  She denies any other urinary symptoms, including urgency or frequency.  She describes the abdominal pain as either sharp or dull.  The pain level goes as high as 8 out of 10 at times.  200mg of PO Advil PRN reduces the pain to a 7/10.  Pt denies any aggravating factors for the pain.  Pt reports that she did start her menstrual cycle this morning, but denies any other discharge other that light bleeding beginning today.  Pt denies douching or the use of any vaginal irritants.  She reports that she is in a stable sexual relationship, and denies any new sexual partners in the last 90 days.  She denies any recent or historic known exposure to STDs.  She reports the use of condoms with every coital experience, as well as this being her only form of contraceptive.  She reports normal monthly menstrual cycles that last 3-4 days.  She reports dysmenorrhea, which she also takes Advil for.  She reports her last PAP smear was in 7/2016, was normal, and reports never having an abnormal PAP smear result.  Pt denies any hx of pregnancies.  Other medical hx includes GERD.  She reports that she has an Rx for Protonix, but she does not take it every day.  Her family hx includes the presence of DM and HTN.                 

Current Medications:  Protonix 40mg PO Daily for GERD MTV OTC PO Daily Advil 200mg OTC PO PRN for pain   

PMHx: Allergies:    NKA & NKDA 

Medication Intolerances:   Denies Chronic Illnesses/Major traumas  GERD Hospitalizations/Surgeries : Denies   

Family History :Father- DM & HTN; Mother- HTN; Older sister- DM & HTN; Maternal and paternal grandparents without known medical issues; 1 brother and 3 other sisters without known medical issues; No children.   

Social History:Lives alone.  Currently in a stable sexual relationship with one man.  Works for DEFACS.  Reports occasional alcohol use, but denies tobacco or illicit drug use.   

ROS General:  Denies weight change, fatigue, fever, night sweats Cardiovascular Denies chest pain and edema. Reports rare palpitations that are relieved by drinking water   

Skin:Denies any wounds, rashes, bruising, bleeding or skin discolorations, any changes in lesions  

Respiratory Denies cough. Reports dyspnea that accompanies the rare palpitations and is also relieved by drinking water   

Eyes Denies corrective lenses, blurring, visual changes of any kind  Gastrointestinal Abdominal pain (see HPI) and Hx of GERD.  Denies N/V/D, constipation, appetite changes   

Ears Denies Ear pain, hearing loss, ringing in ears  

Genitourinary/Gynecological Reports burning with urination, but denies frequency or urgency.  Contraceptive and STD prevention includes condoms with every coital event.  Current stable sexual relationship with one man.  Denies known historic or recent STD exposure. Last PAP was 7/2016 and normal. Regular monthly menstrual cycle lasting 3-4 days.    Nose/Mouth/Throat Denies sinus problems, dysphagia, nose bleeds or discharge  

Musculoskeletal Denies back pain, joint swelling, stiffness or pain 

Breast Denies SBE

Neurological Denies syncope, seizures, paralysis, weakness Heme/Lymph/Endo Denies bruising, night sweats, swollen glands

Psychiatric Denies depression, anxiety, sleeping difficulties 

OBJECTIVE Weight   140lb      Temp -97.7 BP 123/82 Height  5’4” Pulse 74

Respiration: 18 General Appearance Healthy appearing adult female in no acute distress. Alert and oriented; 

answers questions appropriately.  

Skin Skin is normal color for ethnicity, warm, dry, clean and intact. No rashes or lesions noted. HEENT Head is norm cephalic, hair evenly distributed. Neck: Supple. Full ROM. Teeth are in good repair. Cardiovascular S1, S2 with regular rate and rhythm. No extra heart sounds.  Respiratory Symmetric chest walls. Respirations regular and easy; lungs clear to auscultation bilaterally. Gastrointestinal Abdomen flat; BS active in all 4 quadrants. Abdomen soft, suprapubic tender. No hepatosplenomegaly.    Genitourinary Suprapubic tenderness noted.  Skin color normal for ethnicity.  Irritation noted at labia majora, minora, and perineum. No ulcerated lesions noted. Lymph nodes not palpable.  Vagina pink and moist without lesions.  Discharge minimal, thick, dark red, no odor.  Cervix pink without lesions. No CMT. Uterus normal size, shape, and consistency.         Musculoskeletal Full ROM seen in all 4 extremities as patient moved about the exam room. Neurological  Speech clear. Good tone. Posture erect. Balance stable; gait normal. Psychiatric Alert and oriented. Dressed in clean clothes. Maintains eye contact. Answers questions appropriately. 

Lab Tests Urinalysis – blood noted (pt. on menstrual period), but results negative for infection Urine culture testing unavailable Wet prep – inconclusive  STD testing pending for gonorrhea, chlamydia, syphilis, HIV, HSV 1 & 2, Hep B & C    Special Tests- No ordered at this time.    

Diagnosis   Differential Diagnoses :

1-Bacterial Vaginosis (N76.0) o

2- Malignant neoplasm of female genital organ, unspecified. (C57.9) 

3-Gonococcal infection, unspecified. (A54.9) Diagnosis o Urinary tract infection, site not specified. (N39.0) Candidiasis of vulva and vagina. (B37.3) secondary to presenting symptoms (Colgan & Williams, 2011) & (Hainer & Gibson, 2011).   Plan/Therapeutics •

Plan:   o Medication : Terconazole cream 1 vaginal application QHS for 7 days for Vulvovaginal Candidiasis;   Sulfamethoxazole/TMP DS 1 tablet PO twice daily for 3 days for UTI (Woo & Wynne, 2012) o Education –  Medications prescribed:UTI and Candidiasis symptoms, causes, risks, treatment, prevention. Reasons to seek emergent care, including N/V, fever, or back pain.    STD risks and preventions.   Ulcer prevention, including taking Protonix as prescribed, not exceeding the recommended dose limit of NSAIDs, and not taking NSAIDs on an empty stomach.   o Follow-up –   Pt will be contacted with results of STD studies.    Return to clinic when finished the period for perform pap-smear or if symptoms do not resolve with prescribed TX.     

                         References 

Colgan, R. & Williams, M. (2011). Diagnosis and Treatment of Acute Uncomplicated Cystitis. American Family Physician, 84(7), 771-776. Hainer, B. & Gibson, M. (2011). Vaginitis: Diagnosis and Treatment. American Family Physician, 83(7), 807-815.  Woo, T. M., & Wynne, A. L. (2012). Pharmacotherapeutics for Nurse Practitioner Prescribers (3rd ed.). Philadelphia, PA: F.A. Davis Company.

• Discussion Prompt 1

Use the survey data you collected last week to answer the following discussion question. Make a basic hypothesis about your data. For example, I hypothesize that the average survey respondent spends at least two hours on social media each day. This hypothesis test should test a mean. Use the statistical techniques learned this week to test your hypothesis and explain your results. Were your results surprising?Why or why not? Make sure you show all 6 steps of the process.

• Discussion Prompt 2

Read “How Statistics Can Help Save Failing Hearts” on p. 410 in your book.  It mentions a very interesting website ,https://www.medicare.gov/hospitalcompare/search.html? , which allows people to compare the results seen at different hospitals across things such as patient experience and timely and effective care. Visit the website and compare the hospitals in your local area. What statistics stand out to you? Do you believe that these statistics should/could play a role in patient care?

 

Section D: Change Model

Roger’s Diffusion of Innovation theory is a particularly good theoretical framework to apply to an EBP project. However, students may also choose to use change models, such as Duck’s Change Curve Model or the Transtheoretical Model of Behavioral Change. Other conceptual models presented such as a utilization model (Stetler’s model) and EBP models (the Iowa Model and ARCC Model) can also be used as a framework for applying your evidence-based intervention in a health care setting.

In 500-750 words (not including the title page and reference page), apply a change model to the implementation plan.

1. Apply one of the above models and carry your implementation through each of the stages, phases, or steps identified in the chosen model.
2. In addition, create a conceptual model of the project. The conceptual model should be placed in the appendices for the final paper.

Paper topic is Healthcare burnout and it’s affect on patient care and preventing/alleviating burnout.  See attached introduction to paper and literature support. Please build off of those.

The occurrence of cancer around the world is receiving increased attention by the medical establishment and the community. Numerous charities, universities, and non-profit organizations expend vast amounts of money and research to eliminate this disease in all of its forms. Unfortunately, not all types of cancer receive the same amount of attention in the media spotlight.  Whether it is due to embarrassment, ignorance, or fear, conversations about cancers involving the sexual reproduction systems are not as freely discussed in the United States or any other societies. 

While penile cancer is rare in the United States, it accounts for approximately 10% of cancers in African and South American men (Huether, McCance, Brashers, and Rote, 2017). A lack of social understanding, as well as the fear and ignorance that accompany diseases associated with sexual subjects, make delays a compounding problem. A specific diagnosis of penile cancer generally comes after a patient has noted a tumor or lesion. Further diagnosis, if it is not delayed, is done through an examination of the size, location, and fixation of the lesion. A biopsy is then performed along with imaging to determine if any metastasis has occurred in the surrounding lymph nodes. Treatment of this condition is usually completed with surgery although multimodal chemotherapy options are also being studied.  

Vaginal or cervical cancer is often discovered by females who experience vaginal bleeding or discomfort. These symptoms, again if not delayed, likely are followed by a physical including a bimanual pelvic examination and a Pap test. Additional testing for suspected cancerous growth includes an HPV test, colposcopy, and biopsy test to look for abnormal cellular growth or signs of cancer. Lastly, imaging, including MRI scans, computerized tomography, and positron emission tomography may be employed to identify and plan for the treatment of abnormal cellular growths. Treatment for cancer in the female reproductive organs is similar to that of men as surgery and chemotherapy, including radiation is often employed. 

Another similarity among men and women developing penile or cervical/vulvar cancer is the acquisition of the Human Papilloma Virus (HPV). Douglawi and Masterson (2019) note that nearly 40% of cases in France have been linked to this virus, which is most often acquired through unprotected sexual contact. Abramowitz et al. (2018) indicate an incidence of 7.5 per 100,000 women in the United States. Recent campaigns to vaccinate young adults, teens, and those in early adulthood has shown positive results in preventing transmission of this disease Joura, et al. (2019) agree that proper vaccination combined with screening can reduce recurrent or subsequent HPV disease transmission. 

A difference in the ability to recognize the presence of cancer includes visibility to the patient. Male sexual organs present an additional chance to catch the presence of a lesion by existing outside the body. Men that use good hygiene and self-examination practices are more likely to note a sore or lump on the penis than a female who must contend with pelvic pain or vaginal bleeding as a warning sign. 

Many of the same behavioral factors that cause cancer in other areas of the body are believed to be linked to the development of cancer within the reproductive organs. Factors such as smoking, poor personal hygiene, and HPV infection from unprotected sexual contact are associated with higher instances of penile or cervical/vulvar cancer (Emilio, Luigi, Riccardo, and Carlo, 2019). Additional factors such as diet and physical activity levels, remain a modifiable risk that can be adjusted with the appropriate education and effort. 

 Continued education of low-risk areas, as well as increased education of high-risk areas in Africa and South America, is the best way to reduce these debilitating illnesses. Information about the risk factors and best practices for maintaining a healthy lifestyle allow uneducated populations to realize access to treatment. The most effective avenue of treatment will include vaccines for males and females, to prevent acquiring HPV and information that stresses a healthier lifestyle, including physical activity and a low-fat diet.

References

Abramowitz, L., Lacau Saint Guily, J., Moyal-Barracco, M., Bergeron, C., Borne, H., Dahlab, A., Bresse, X., Uhart, M., Cancalon, C., Catella, L., and Bénard, S. (2018). Epidemiological and economic burden of potentially HPV-related cancers in France. Plos One, 13(9), e0202564. doi:10.1371/journal.pone.0202564

Emilio, S., Luigi, V., Riccardo, B., & Carlo, G. (2019). Lifestyle in urology: Cancer. Urologia, 86(3), 105–114. doi:10.1177/0391560319846012

Douglawi, A., & Masterson, T. A. (2019). Penile cancer epidemiology and risk factors: a contemporary review. Current Opinion In Urology, 29(2), 145–149. doi:10.1097/MOU.0000000000000581

Joura, E., Kyrgiou, M., Bosch, F., Kesic, V., Niemenen, P., Redman, C. W., & Gultekin, M. (2019). Human papillomavirus vaccination: The ESGO–EFC position paper of the European society of Gynaecologic Oncology and the European Federation for colposcopy. European Journal of Cancer, 116, 21–26. doi:10.1016/j.ejca.2019.04.032