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.

  

Details:

This assignment builds on the Risk Management Program Analysis Part One assignment you completed in Topic 1 of this course.

Assume that the example risk management program you analyzed in Topic 1 was developed by and is now currently implemented by your health care employer/organization. Further assume that your supervisor has asked you to present a high-level summary brief of this new risk management program to a group of administrative personnel from a newly created community health organization in your state who has enlisted your organization’s assistance in developing their own risk management policies and procedures.

Compose a 1,250-1,500 word summary brief that expands upon the elements you addressed in the Risk Management Program Analysis Part One assignment. In addition, analyze the following:

1. Explain the Joint Commission’s role in the evaluation of an organization’s quality management processes.

2. Describe the roles that different levels of administrative personnel play in establishing or sustaining operational policies that are focused on employer-employee organizational risk management policies.

3. Explain the relationship of risk management programs and compliance with ethical standards.

In addition to your textbook, you are required to support your analysis with a minimum of four peer-reviewed references

Book used by school. Risk Management in Health Care Institutions: Limiting Liability and Enhancing Care, 3rd Edition.

1. How is the text or material of phenomenological studies obtained by investigators? 2. What did you learn about how Ray (1991) created the methodological process to study the experience of caring or compassion in nursing research and the meaning of caring in the researcher’s experience? What are the sources used in this new method? 3. What affects you about the way Ray (1991) looked at caring inquiry?

Smith RN PhD AHN-BC FAAN, Marlaine C.. Caring in Nursing Classics: An Essential Resource (Kindle Locations 9846-9852). Springer Publishing Company. Kindle Edition. 

After reading the Kaiser Family Foundation summary on the Patient Protection and Affordable Care Act, state why or why not you believe the act should remain in law, or which pieces should be reversed. Then describe two pieces of the act that you were unaware was part of the act and how that may affect you as a citizen.

  

Assignment: Critiquing Quantitative, Qualitative, or Mixed Methods Studies

Critiquing the validity and robustness of research featured in journal articles provides a critical foundation for engaging in evidence-based practice. In Weeks 5 and 6, you explored quantitative research designs. In Week 7, you will examine qualitative and mixed methods research designs. For this Assignment, you will critique a quantitative and either a qualitative or a mixed methods research study and compare the types of information obtained in each.

To prepare:

· Select a health topic of interest to you that is relevant to your current area of practice- (Pediatric Nursing). The topic may be your Course Portfolio Project or a different topic of your choice.

· Using the Walden Library, locate two articles in scholarly journals that deal with your portfolio topic: 1) Select one article that utilizes a quantitative research design and 2) select a second article that utilizes either a qualitative OR a mixed methods design. These need to be single studies not systematic or integrative reviews (including meta-analysis and metasynthesis). You may use research articles from your reference list. If you cannot find these two types of research on your portfolio topic, you may choose another topic.

· Locate the following documents in this week’s Learning Resources to access the appropriate templates, which will guide your critique of each article:

• Critique Template for a      Qualitative Study
• Critique Template for a      Quantitative Study
• Critique Template for a      Mixed-Methods Study

· Consider the fields in the templates as you review the information in each article. Begin to draft a paper in which you analyze the two research approaches as indicated below. Reflect on the overall value of both quantitative and qualitative research. If someone were to say to you, “Qualitative research is not real science,” how would you respond?

To complete this Assignment:

· Complete the two critiques using the appropriate templates.

· Write a 2- to 3-page paper that addresses the following:

· Contrast the types of information that you gained from examining the two different research approaches in the articles that you selected.

• Describe the general advantages      and disadvantages of the two research approaches featured in the articles.      Use examples from the articles for support.
• Formulate a response to the      claim that qualitative research is not real science. Highlight the general      insights that both quantitative and qualitative studies can provide to      researchers. Support your response with references to the Learning      Resources and other credible sources.

· As you complete this Assignment, remember to:

· Submit your paper to Grammarly and SafeAssign through the Walden Writing Center. Based on the Grammarly and SafeAssign reports, revise your paper as necessary.

· Reminder: The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The School of Nursing Sample Paper provided at the Walden Writing Center provides an example of those required elements (available from the Walden University website found in this week’s Learning Resources). All papers submitted must use this formatting.

· Combine all three parts of this assignment into one Word document including both critique templates and the narrative with your references. Submit this combined document.

Required Readings

Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer.

• Chapter 10, “Rigor and      Validity in Quantitative Research”

This chapter introduces the concept of validity in research and describes the different types of validity that must be addressed. Key threats to validity are also explored.

• Chapter 11, “Specific Types      of Quantitative Research”

This chapter focuses on the specific types of quantitative research that can be selected. The focus is on the purpose of the research rather than the research design. These include such approaches as clinical trials, evaluation research, health services and outcomes research, needs assessments, or replication studies.

Cantrell, M. A. (2011). Demystifying the research process: Understanding a descriptive comparative research design. Pediatric Nursing, 37(4), 188–189.

Retrieved from the Walden Library databases.

The author of this article discusses the primary aspects of a prominent quantitative research design. The article examines the advantages and disadvantages of the design.

Schultz, L. E., Rivers, K. O., & Ratusnik, D. L. (2008). The role of external validity in evidence-based practice for rehabilitation. Rehabilitation Psychology, 53(3), 294–302.

Retrieved from the Walden Library databases.

This article details the results of a study that sought to balance concern for rigor with concern for relevance. The authors of the article derive and determine a rating format for relevance and apply it to cognitive rehabilitation.

Walden University. (n.d.a.). Paper templates. Retrieved July 23, 2012, from http://writingcenter.waldenu.edu/57.htm

This resource provides you access to the School of Nursing Sample Paper, which will serve as a template for formatting your papers.

Document: Critique Template for a Qualitative Study (Word document) ATTACHED

Note: You will use this document to complete this week’s Assignment.

Document: Critique Template for a Quantitative Study (Word document) ATTACHED

Note: You will use this document to complete this week’s Assignment.

Document: Critique Template for a Mixed-Methods Study (Word document) ATTACHED

Note: You will use this document to complete this week’s Assignment.