Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders 2025

Gastrointestinal (GI) and hepatobiliary disorders affect the structure and function of the GI tract. Many of these disorders often have similar symptoms such as abdominal pain, cramping, constipation, nausea, bloating, and fatigue. Since multiple disorders can be tied to the same symptoms, it is important for advanced practice nurses to carefully evaluate patients and prescribe treatment that targets the cause rather than the symptom. Once the underlying cause is identified, an appropriate drug therapy plan can be recommended based on medical history and individual patient factors. In this Discussion, you examine a case study of a patient who presents with symptoms of a possible GI/hepatobiliary disorder, and you design an appropriate drug therapy plan. Consider the following case study: Patient HL comes into the clinic with the following symptoms: nausea, vomiting, and diarrhea. The patient has a history of drug abuse and possible Hepatitis C. HL is currently taking the following prescription drugs: · Synthroid 100 mcg daily · Nifedipine 30 mg daily · Prednisone 10 mg daily To prepare: · Review this week’s media presentation on pharmacology for the gastrointestinal system. · Review the provided case study. Reflect on the patient’s symptoms, medical history, and drugs currently prescribed. · Think about a possible diagnosis for the patient. Consider whether the patient has a disorder related to the gastrointestinal and hepatobiliary system or whether the symptoms are the result of a disorder from another system or other factors such as pregnancy, drugs, or a psychological disorder. · Consider an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed. With these thoughts in mind: Post an explanation of your diagnosis for the patient including your rationale for the diagnosis. Then, describe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed

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Discussion: Searching Databases 2025

Searching Databases (APA 7 format and at least 3-4 references) When you decide to purchase a new car, you first decide what is important to you. If mileage and dependability are the important factors, you will search for data focused more on these factors and less on color options and sound systems. The same holds true when searching for research evidence to guide your clinical inquiry and professional decisions. Developing a formula for an answerable, researchable question that addresses your need will make the search process much more effective. One such formula is the PICO(T) format. In this Discussion, you will transform a clinical inquiry into a searchable question in PICO(T) format, so you can search the electronic databases more effectively and efficiently. You will share this PICO(T) question and examine strategies you might use to increase the rigor and effectiveness of a database search on your PICO(T) question. To Prepare: Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry. Review the materials offering guidance on using databases, performing keyword searches, and developing PICO(T) questions provided in the Resources. Based on the clinical issue of interest and using keywords related to the clinical issue of interest, search at least two different databases in the Walden Library to identify at least four relevant peer-reviewed articles related to your clinical issue of interest. You should not be using systematic reviews for this assignment, select original research articles. Review the Resources for guidance and develop a PICO(T) question of interest to you for further study. It is suggested that an Intervention-type PICOT question be developed as these seem to work best for this course. By Day 3 of Week 4 Post a brief description of your clinical issue of interest. This clinical issue will remain the same for the entire course and will be the basis for the development of your PICOT question. Then, post your PICO(T) question, the search terms used, and the names of at least two databases used for your PICO(T) question. Describe your search results in terms of the number of articles returned on original research and how this changed as you added search terms using your Boolean operators. Finally, explain strategies you might make to increase the rigor and effectiveness of a database search on your PICO(T) question. Be specific and provide examples. By Day 6 of Week 4 Respond to at least two of your colleagues on two different days and provide further suggestions on how their database search might be improved. Mike RE: Discussion – Week 4/Initial (at least 2-3 references and APA 7 format) Given the diverse nature of the health care industry, the ubiquitous array of multi faceted axillary services, the sector we service the most sometimes becomes the focus of our interest given the opportunity and longevity in such an institution. For the purpose of this discussion post I will be posing a question on post operative pain management since this sector happens to be a critical pivotal point in patient recovery following either inpatient or outpatient surgical interventions. Using the PICOT question format; Does the management of pain using pharmacological and non pharmacological interventions on a post operative surgical adult patient improve pain control in four days post surgery? Following from the PICOT abbreviation, the P represents the population which refers to our surgical patients, I represents the intervention; pain management, C represents comparison; the comparison of pharmacological and alternate pain management strategies, O represents the outcome which is pain management while T speaks to our time frame for achieving this goal which is four days post surgery. According to Melnyk, (2018, p34) “the desire to gather the right information in the right way at the right time is not sufficient. Mastering practical, lifelong learning skills (e.g., asking focused questions, learning to systematically search) is required to negotiate the information rich environment that clinicians encounter.” For the purpose of this post, the search engines I utilized were ProQuest and CINAHL Plus database. My key word search was pain management, which returned 20,494 results and 21,460 respectively. After the utilization of limiters for full text, peer review, date range of 2016 to 2020 the streamlined search result was 13,601 and 15,787 respectfully. The inclusion of Boolean search parameter for surgical patients further helped narrow down the search as follows; 3,070 and 5,179 respectfully, my inclusion of a final modifier for the most recent year of publication “2020” further help streamline my search results as follows ProQuest 232, while CINAHL Plus with full text returned 203 searches. “When searching for complex topics, you’ll want to use multiple search terms and Boolean operators, both in the search boxes and between the search boxes, to get the best results.” (Retrieved September 6th, 2019) With the desire to increase the rigor and effectiveness on my data base search results, some of the strategies I will employ will be the refining of my search limiters which will help streamline my research to the most current year, using year of publication limiters, I will also include key words from my PICOT question like surgical, post surgical, pharmacological and or non pharmacological to help narrow in on the much desired research article that mirrors my PICOT question. “Keyword searching is the process of choosing search terms and entering them into the database search boxes to locate information on your topic.” (Retrieved September 19th, 2018) References Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer. Walden University Library. (n.d.-c). Evidence-based practice research: CINAHL search help. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/library/healthevidence/cinahlsearchhelp Walden University Library. (n.d.-g). Keyword searching: Finding articles on your topic: Introduction to keyword searching. Retrieved September 19, 2018, from http://academicguides.waldenu.edu/library/keyword/searching-basics Lau RE: Discussion – Week 4 I work on an IMCU, and it is hectic. Patient care is often interrupted for transferring improved patients to lower levels of care units to make room for admissions. About 1/3 of the unit will be newly admitted on my shift. The admission process includes asking patients about suicide and depression. I don’t feel awkward asking patients directly about the subject, but I see that patients are surprised that I ask even when I tell them in advance that I will be doing so. I have queried the significance of asking about suicidal ideation when patients are being admitted for a physical illness unrelated to psychiatric disorders. P- patients admitted for physical illness unrelated to psychiatric disorders I- hospital staff asking about suicidal ideation on admission to acute care settings C- not asking about suicidal ideation on admission to acute care settings O- value; decrease in the number of suicide attempts, an increase in patients seeking assistance in mental health care T- one year PICO question: Is there value in asking patients admitted to an acute care setting for physical illness unrelated to psychiatric disorder, about suicidal ideation, compared to not asking over one year. Search phrases could include ask suicide, medical admission, suicide screening, and asq suicide. I used Sage journals and queried “ask suicide” and received 39,212 results (Sage Journals, 2020). Using the same search terms on Taylor & Francis Online there were 75,136 results (Taylor & Francis Online, 2020). Using Boolean operators changed the results returned. Using “and” narrowed my search and “or” broadened my results. Adding more search terms linked together further narrowed the results by approximately 75% by using “and.” Both databases have the ability for the user to narrow searches by searching for terms in specific article type, journal type as well as the publication date. Strategies to increase the rigor and effectiveness of a database search might include using more than one database (UTHealth, 2019). One study on search strategies found a higher number of systematic reviews were obtained using a 2 PICO element search rather than a 4 element search. Additionally, it was found that it was essential to combine at least three databases together to achieve a 90% retrieval of relevant literature (Ho, Liew, Ng, Shunmugam, & Glasziou, 2016). This could provide me with the opportunity to find more significant studies to review. Another strategy would be to combine search terms and phrases with Boolean operators to refine my search. UTHealth libguides also points out that all databases are not created the same (UTHealth, 2019). They each have different rules and quirks. I must familiarize myself with the tool I choose to use, or it will not be effective. References Ho, G. J., Liew, S. M., Ng, C. J., Shunmugam, R. H., & Glasziou, P. (2016, 12). Development of a Search Strategy for an Evidence Based Retrieval Service. PLoS One, 11 (2), e0167170. doi:10.1371/journal.pone.0167170 Sage Journals. (2020). Search Results . Retrieved 12 22, 2020, from Sage Journals: https://journals-sagepub-com.ezp.waldenulibrary.org/action/doSearch?AllField=Ask+Suicide Taylor & Francis Online. (2020). Your search for All: ask suicide . Retrieved 12 22, 2020, from Taylor & Francis Online: https://www-tandfonline-com.ezp.waldenulibrary.org/action/doSearch?AllField=ask+suicide UTHealth. (2019). Best Practices for Developing Search Strategies: Home . Retrieved 12 22, 2020, from UTHealth: https://libguides.sph.uth.tmc.edu/c.php?g=543359

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Assessment 1: Evidence-Based Patient-Centered Concept Map 2025

Overview Create an evidence-based, patient-centered concept map that illustrates an individualized approach to patient care, based on a patient case file of your choice. Evidence-based practice is a key skill in the toolkit of the master’s-prepared nurse. Its goal is to ensure that health care practitioners are using the best available evidence to ensure that patients are receiving the best care possible (Godshall, M., 2015.). In essence, evidence-based practice is all about ensuring quality care. SHOW LESS In this assessment, you have an opportunity to apply evidence-based practice and personalized care concepts to ensure quality care and improve the health of a single patient. By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria: Competency 1: Apply evidence-based practice to plan patient-centered care. Analyze the needs of a patient, and those of their family, with regard to how they will influence a patient-centered concept map. Design an individualized, patient-centered concept map, based upon the best available evidence for treating a patient’s specific health, economic, and cultural needs. Competency 3: Evaluate outcomes of evidence-based interventions. Propose relevant and measurable criteria for evaluating the outcomes of a patient-centered concept map. Competency 4: Evaluate the value and relative weight of available evidence upon which to make a clinical decision. Justify the value and relevance of evidence used as the basis of a patient-centered concept map. Competency 5: Synthesize evidence-based practice and academic research to communicate effective solutions. Develop a strategy for communicating with patients and their families in an ethical, culturally sensitive, and inclusive way. Integrate relevant and credible sources of evidence to support assertions, correctly formatting citations and references using APA style. Reference Godshall, M. (2015). Fast facts for evidence-based practice in nursing: Implementing EBP in a nutshell (2nd ed.). New York, NY: Springer Publishing Company. Competency Map CHECK YOUR PROGRESS Use this online tool to track your performance and progress through your course. Questions to Consider: As you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. You are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as part of your assessment. Recall an experience you have had—or one that you might have observed in your care setting—in which you individualized care for a patient. In your approach to individualized care, did you: Address any health concerns other than those for which the patient was seeking care? Consider the patient’s economic and daily environmental circumstances? Consider any ethical issues inherent in working with the patient? What might you have done differently, if you could revisit that patient’s case? What evidence supported your original course of action? What evidence would you present to support an alternative course of action, if you could revisit that patient’s case? S uggested Resources The resources provided here are optional. You may use other resources of your choice to prepare for this assessment; however, you will need to ensure that they are appropriate, credible, and valid. The MSN-FP6011 – Evidence-Based Practice for Patient-Centered Care and Population Health Library Guide can help direct your research, and the Supplemental Resources and Research Resources, both linked from the left navigation menu in your courseroom, provide additional resources to help support you. Evidence-Based Practice Godshall, M. (2015). Fast facts for evidence-based practice in nursing: Implementing EBP in a nutshell (2nd ed.). New York, NY: Springer Publishing Company. Read Chapter 7. Blix, A. (2014). Personalized medicine, genomics, and pharmacogenomics: A primer for nurses . Clinical Journal of Oncology Nursing , 18 (4), 437–441. Baker, J. D. (2017). Nursing Research, Quality Improvement, And Evidence-Based Practice: The Key To Perioperative Nursing Practice: Editorial . Association of Operating Room Nurses , 105 (1), 3. Hain D. J., & Kear, T. M. (2015). Using evidence-based practice to move beyond doing things the way we have always done them . Nephrology Nursing Journal , 42 (1), 11–20. Evidence-Based Practice in Nursing & Health Sciences: Review Levels of Evidence . Evidence-Based Practice in Nursing & Health Sciences . Evidence-Based Practice: What It Is and What It Is Not | Transcript . Concept Mapping Concept Maps . This resource provides a general overview of concept maps. The guide is not specific to nursing, but may prove helpful to the initial conceptualization of your assessment. Taylor, L. A., Littleton-Kearney, M. (2011). Concept mapping: A distinctive educational approach to foster critical thinking . Nurse Educator , 36 (2), 84–88. This article will help you decide how you would like to structure and conceptualize your concept map. Concept Map Template [DOCX] . Concept Map Tutorial | Transcript . Information on working with the concept map and template to complete your assignment. Research Guides Nursing Masters (MSN) Research Guide . Database Guide: Ovid Nursing Full Text PLUS . Kaplan, L. (n.d.). Framework for how to read and critique a research study . Retrieved from https://www.nursingworld.org/~4afdfd/globalassets/practiceandpolicy/innovation–evidence/framework-for-how-to-read-and-critique-a-research-study.pdf APA Style APA Module . Capella provides a thorough selection of online resources to help you understand APA style and use it effectively. Assessment Instructions: Preparation You have been presented with a number of patient case files in the Evidence-Based Patient-Centered Care media piece. You reviewed each case, selected one case for further research, and created draft evidence-based concept map to illustrate an approach to individualized care for the patient. In this assessment, you will build upon and refine your draft concept map and develop a supporting narrative. Create your concept map and narrative as separate documents. Be sure to note the areas where you need to include your evidence-based support and where you need to make clear your strategies for communicating information to the patient and the patient’s family. Note: Many organizations use the spider style of concept maps (see the Taylor & Littleton-Kearney article for an example). Also, if a specific style of concept map is used in your current care setting, you may use it in this assessment. Create your concept map and narrative as separate documents. Be sure to note the areas where you need to include your evidence-based support and where you need to make clear your strategies for communicating information to the patient and the patient’s family. Requirements Note: The requirements outlined below correspond to the grading criteria in the scoring guide, so be sure to address each point. In addition, you may want to review the performance level descriptions for each criterion to see how your work will be assessed. Supporting Evidence and APA Style Integrate relevant evidence from 3–5 current scholarly or professional sources to support your assertions. Apply correct APA formatting to all in-text citations and references. Attach a reference list to your narrative. Concept Map Develop a concept map for the individual patient, based upon the best available evidence for treating your patient’s health, economic, and cultural needs. Narrative Develop a narrative (2–4 pages) for your concept map. Analyze the needs of your patient and their family, and determine how those needs will influence a patient-centered concept map. Consider how your patient’s economic situation and relevant environmental factors may have contributed to your patient’s current condition or affect their future health. Consider how your patient’s culture or family should influence your concept map. Justify the value and relevance of the evidence you used as the basis of your concept map. Explain why your evidence is valuable and relevant to your patient’s case. Explain why each piece of evidence is appropriate for both the health issue you are trying to correct and for the unique situation of your patient and their family. Propose relevant and measurable criteria for evaluating the degree to which the desired outcomes of your concept map were achieved. Explain why your proposed criteria are appropriate and useful measures of success. Explain how you will communicate specific aspects of the concept map to your patient and their family in an ethical, culturally sensitive, and inclusive way. Ensure that your strategies: Promote honest communications. Facilitate sharing only the information you are required and permitted to share. Are mindful of your patient’s culture. Enable you to make complex medical terms and concepts understandable to your patient and their family, regardless of language, disabilities, or level of education. Additional Requirements Be sure to include both documents when you submit your assessment. Note : Faculty may use the Writing Feedback Tool when grading this assessment. The Writing Feedback Tool is designed to provide you with guidance and resources to develop your writing based on five core skills. You will find writing feedback in the Scoring Guide for the assessment, once your work has been evaluated.

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Evaluation And Management And Anesthesia Coding 2025

Please answer all 20 questions correctly and get back to me within the next 3 hours 1. Modifier -P5 indicates that the patient A. experienced postoperative anemia. B. is not expected to survive without the operation. C. received a lower anesthesia dosage. D. is advanced in age. 2. Code 99217 is assigned for A. nursing home services. B. observation discharge services. C. established patient visits. D. new patient office visits. 3. Code range 99218–99220 denotes A. emergency room visits. B. initial hospital visits. C. initial observation care. D. follow-up hospital visits. 4. A physician performs an invasive surgical procedure. Prior to the start of the procedure, the anesthesiologist administers monitored anesthesia. Which modifier should be appended to the anesthesia code? A. -G10 B. -G8 C. -G1 D. -G9 5. When more than one surgery is performed during one anesthesia administration, the coder should A. report the anesthesia code with the highest base value unit. B. assign modifier -QS to the second surgery code. C. assign add-on code 01900 to indicate more than one surgery was performed during a single operative session. D. add modifier -QY to the first surgery code. 6. Modifier -P3 indicates that the patient A. received topical anesthesia. B. is in a coma. C. received local anesthesia. D. has severe systemic disease. 7. ___ modifiers indicate the number of anesthesia cases being directed at one time. A. Coordinated time B. Conversion C. Calculation D. Concurrent 8. A coder adds modifier -P2 to an anesthesia code. This modifier indicates the patient A. is allergic to lidocaine. B. received general anesthesia. C. is handicapped. D. has mild systemic disease. 9. The risk of morbidity or mortality would be considered as a part of A. review of systems. B. medical decision-making. C. history of present illness. D. chief complaint. 10. A patient who has not been seen by a physician or another physician in the same group within the last three years is a/an _______ patient. A. established B. new C. emergent D. existing 11. The dollar rate of each anesthesia unit is called the _______ factor. A. unit conversion B. conversion C. calculation D. base value unit rate 12. A patient who has been admitted to a hospital is a/an A. inpatient. B. established patient. C. new patient. D. ambulatory surgery patient. 13. A patient undergoes an esophagogastric tamponade with a balloon. How would this procedure be coded? A. 43460 B. 00500 C. 43460-P1 D. 00500-P1 14. Codes in the range of 99224–99226 represent services for A. critical care services. B. subsequent observations. C. consultations. D. initial observations. 15. Which of the following code ranges are add-on codes reported for prolonged physician services? A. 99458–99586, 99372 B. 99212–99252, 99344 C. 99673–99873, 99001 D. 99354–99357, 99359 16. A patient who has been treated by a physician or another physician in the same group within the last three years is a/an _______ patient. A. emergent B. new C. transmitted D. established 17. Modifier -QY indicates that A. anesthesia administration was abruptly terminated due to surgical complications. B. the surgeon is administering anesthesia. C. the physician is supplying topical anesthesia only. D. an anesthesiologist is directing the CRNA during anesthesia administration. 18. _______ circumstance codes are used in situations that increase the difficulty of administering anesthesia. A. UNIT administration modification B. Extenuating C. ASA relativity D. Qualifying 19. Other nursing facility services would be reported with code A. 99305. B. 99318. C. 99525. D. 99211. 20. A patient undergoes a pacemaker insertion. She is not expected to survive if she doesn’t have the operation. What code should be reported? A. 00530-P4 B. 33206-P4 C. 00530-P1 D. 33208-P2

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