In clinical settings, some of the most common questions that patients ask are Why do I have this? What caused this disorder? Will it ever go away? These emotional questions can be difficult to ask and to answer. However, for patients to come to terms with their diagnoses and adhere to treatment plans, they must have an understanding of factors that might have caused, or continue to impact, their disorders. As an advanced practice nurse, it is important that you are able to explain disorders, associated alterations and symptoms, and changes that might occur within your patients’ bodies.

To Prepare

• Review this week’s media presentation with Dr. Terry Buttaro. Reflect on the importance of developing an in-depth understanding of pathophysiology.
• Select a disorder from the following list:
  • Adrenal insufficiency (Addison’s disease)
  • Atherosclerosis
  • Cholelithiasis (gallstones)
  • Colon cancer
  • Cystic fibrosis
  • Hemophilia
  • Nephrolithiasis (kidney stones)
  • Osteoporosis
  • Parkinson’s disease
  • Tuberculosis
• Select one of the following patient factors: genetics, gender, ethnicity, age, or behavior. Reflect on how that factor might impact your selected disorder, as well as potential associated alterations and symptoms.
• Identify the pathophysiology of the associated alterations, including the normal and altered cellular function. Consider both intra- and extra-cellular changes that occur.

By Day 3

Post a brief description of a patient scenario involving the disorder and the factor you selected. Explain how the factor might impact your selected disorder, as well as potential associated alterations and symptoms. Finally, explain the pathophysiology of the associated alterations, including changes in cellular function.

Jamie is a 3-month-old female who presents with her mother for evaluation of “throwing up.” Mom reports that Jamie has been throwing up pretty much all the time since she was born. Jamie does not seem to be sick. In fact, she drinks her formula vigorously and often acts hungry. Jamie has normal soft brown bowel movements every day and, overall, seems like a happy and contented baby. She smiles readily and does not cry often. Other than the fact that she often throws up after drinking a bottle, she seems to be a very healthy, happy infant. A more precise history suggests that Jamie does not exactly throw up—she does not heave or act unwell—but rather it just seems that almost every time she drinks a bottle she regurgitates a milky substance. Mom thought that she might be allergic to her formula and switched her to a hypoallergenic formula. It didn’t appear to help at all, and now Mom is very concerned.

Cases like these are not uncommon. The mother was concerned and thinking her daughter may have an allergy; she changed to a different formula. However, sometimes babies have immature GI tracts that can lead to physiology reflux as they adapt to normal life outside the uterus. Parents often do not consider this possibility, prompting them to change formulas rather than seeking medical care. As in the case study above, GI alterations can often be difficult to identify because many cause similar symptoms. This same issue also arises with adults—adults may present with symptoms that have various potential causes. When evaluating patients, it is important for the advanced practice nurse to know the types of questions he or she needs to ask to obtain the appropriate information for diagnosis. For this reason, you must have an understanding of common GI disorders such as gastroesophageal reflux disease (GERD), peptic ulcer disease (PUD), and gastritis.

To Prepare

• Review this week’s media presentation on the gastrointestinal system.
• Review Chapter 35 in the Huether and McCance text. Identify the normal pathophysiology of gastric acid stimulation and production.
• Review Chapter 37 in the Huether and McCance text. Consider the pathophysiology of gastroesophageal reflux disease (GERD), peptic ulcer disease (PUD), and gastritis. Think about how these disorders are similar and different.
• Select a patient factor different from the one you selected in this week’s Discussion: genetics, gender, ethnicity, age, or behavior. Consider how the factor you selected might impact the pathophysiology of GERD, PUD, and gastritis. Reflect on how you would diagnose and prescribe treatment of these disorders for a patient based on this factor.
• Review the “Mind Maps—Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease (GERD)” media in the Week 2 Learning Resources. Use the examples in the media as a guide to construct a mind map for gastritis. Consider the epidemiology and clinical presentation of gastritis.

To Complete

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

• Describe the normal pathophysiology of gastric acid stimulation and production. Explain the changes that occur to gastric acid stimulation and production with GERD, PUD, and gastritis disorders.
• Explain how the factor you selected might impact the pathophysiology of GERD, PUD, and gastritis. Describe how you would diagnose and prescribe treatment of these disorders for a patient based on the factor you selected.
• Construct a mind map for gastritis. Include the epidemiology, pathophysiology, and clinical presentation, as well as the diagnosis and treatment you explained in your paper.

Rubric:

Quality of Work Submitted:
The extent of which work meets the assigned criteria and work reflects graduate level critical and analytic thinking.–Levels of Achievement:Excellent 27 (27%) – 30 (30%)
Assignment exceeds expectations. All topics are addressed with a minimum of 75% containing exceptional breadth and depth about each of the assignment topics.
Good 24 (24%) – 26 (26%)
Assignment meets expectations. All topics are addressed with a minimum of 50% containing good breadth and depth about each of the assignment topics.
Fair 21 (21%) – 23 (23%)
Assignment meets most of the expectations. One required topic is either not addressed or inadequately addressed.
Poor 0 (0%) – 20 (20%)
Assignment superficially meets some of the expectations. Two or more required topics are either not addressed or inadequately addressed.Feedback:

Quality of Work Submitted:
The purpose of the paper is clear.–Levels of Achievement:Excellent 5 (5%) – 5 (5%)
A clear and comprehensive purpose statement is provided which delineates all required criteria.
Good 4 (4%) – 4 (4%)
Purpose of the assignment is stated, yet is brief and not descriptive.
Fair 3.5 (3.5%) – 3.5 (3.5%)
Purpose of the assignment is vague or off topic.
Poor 0 (0%) – 3 (3%)
No purpose statement was provided.Feedback:

Assimilation and Synthesis of Ideas:
The extend to which the work reflects the student’s ability to:

Understand and interpret the assignment’s key concepts.–Levels of Achievement:Excellent 9 (9%) – 10 (10%)
Demonstrates the ability to critically appraise and intellectually explore key concepts.
Good 8 (8%) – 8 (8%)
Demonstrates a clear understanding of key concepts.
Fair 7 (7%) – 7 (7%)
Shows some degree of understanding of key concepts.
Poor 0 (0%) – 6 (6%)
Shows a lack of understanding of key concepts, deviates from topics.Feedback:

Assimilation and Synthesis of Ideas:
The extend to which the work reflects the student’s ability to:

Apply and integrate material in course resources (i.e. video, required readings, and textbook) and credible outside resources.–Levels of Achievement:Excellent 18 (18%) – 20 (20%)
Demonstrates and applies exceptional support of major points and integrates 2 or more credible outside sources, in addition to 2-3 course resources to suppport point of view.
Good 16 (16%) – 17 (17%)
Integrates specific information from 1 credible outside resource and 2-3 course resources to support major points and point of view.
Fair 14 (14%) – 15 (15%)
Minimally includes and integrates specific information from 2-3 resources to support major points and point of view.
Poor 0 (0%) – 13 (13%)
Includes and integrates specific information from 0 to 1 resoruce to support major points and point of view.Feedback:

Assimilation and Synthesis of Ideas:
The extend to which the work reflects the student’s ability to:

Synthesize (combines various components or different ideas into a new whole) material in course resources (i.e. video, required readings,  textbook) and outside, credible resources by comparing different points of view and highlighting similarities, differences, and connections.–Levels of Achievement:Excellent 18 (18%) – 20 (20%)
Synthesizes and justifies (defends, explains, validates, confirms) information gleaned from sources to support major points presented. Applies meaning to the field of advanced nursing practice.
Good 16 (16%) – 17 (17%)
Summarizes information gleaned from sources to support major points, but does not synthesize.
Fair 14 (14%) – 15 (15%)
Identifies but does not interpret or apply concepts, and/or strategies correctly; ideas unclear and/or underdeveloped.
Poor 0 (0%) – 13 (13%)
Rarely or does not interpret, apply, and synthesize concepts, and/or strategies.Feedback:

Written Expression and Formatting

Paragraph and Sentence Structure: Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are clearly structured and carefully focused–neither long and rambling nor short and lacking substance.–Levels of Achievement:Excellent 5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for structure, flow, continuity and clarity
Good 4 (4%) – 4 (4%)
Paragraphs and sentences follow writing standards for structure, flow, continuity and clarity 80% of the time.
Fair 3.5 (3.5%) – 3.5 (3.5%)
Paragraphs and sentences follow writing standards for structure, flow, continuity and clarity 60%- 79% of the time.
Poor 0 (0%) – 3 (3%)
Paragraphs and sentences follow writing standards for structure, flow, continuity and clarity < 60% of the time.Feedback:

Written Expression and Formatting

English writing standards: Correct grammar, mechanics, and proper punctuation–Levels of Achievement:Excellent 5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors.
Good 4 (4%) – 4 (4%)
Contains a few (1-2) grammar, spelling, and punctuation errors.
Fair 3.5 (3.5%) – 3.5 (3.5%)
Contains several (3-4) grammar, spelling, and punctuation errors.
Poor 0 (0%) – 3 (3%)
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.Feedback:

Written Expression and Formatting

The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.–Levels of Achievement:Excellent 5 (5%) – 5 (5%)
Uses correct APA format with no errors.
Good 4 (4%) – 4 (4%)
Contains a few (1-2) APA format errors.
Fair 3.5 (3.5%) – 3.5 (3.5%)
Contains several (3-4) APA format errors.
Poor 0 (0%) – 3 (3%)

  

DQ 1: Case Study, Chapter 1, Entry Into Practice: The Debate Rages On

The entry-into-practice debate in the United States continues to be one of the oldest and hottest professional issues nurses face as we enter the second decade of the 21st century. It appears that little progress has been made since 1965 in creating a consensus to raise the entry level into professional nursing practice, although experts do not agree even on that issue. Your neighbors ask you for information about considerations for selection of an appropriate nursing education program for their child.

1. Your neighbor is confused because both ADN and BSN schools preparing graduates for RN licensure meet similar criteria for state board approval and have roughly the same number of nursing coursework units. How would you summarize the arguments for changing or not changing the nursing entry level?

2. There is current evidence-based research that explores the impact of registered nurse educational level on patient outcomes. What does the current evidence-based research conclude about the impact of RN educational level on patient outcomes?

3. Achieving the BSN as the entry degree for professional nursing practice will take the best thinking of our nursing leaders. What will it require in order to successfully achieve the BSN as the entry degree for professional nursing practice?

Assignment: Evidence-Based Project, Part 4: Critical Appraisal of RRealtors rely on detailed property appraisals—conducted using appraisal tools—to assign market values to houses and other properties. These values are then presented to buyers and sellers to set prices and initiate offers.Research appraisal is not that different. The critical appraisal process utilizes formal appraisal tools to assess the results of research to determine value to the context at hand. Evidence-based practitioners often present these findings to make the case for specific courses of action.

In this Assignment, you will use appraisal tools to conduct a critical appraisal of published research. You will then present the results of your efforts.

To Prepare:

• Review the Resources and consider the importance of critically appraising research evidence.
• Reflect on the four peer-reviewed articles you selected in Module 2 and analyzed in Module 3.
• Review and download the Critical Appraisal Tools document provided in the Resources.

The Assignment (Evidence-Based Project)

Part 4A: Critical Appraisal of Research

Conduct a critical appraisal of the four peer-reviewed articles you selected and analyzed by completing the Critical Appraisal Tools document. Be sure to include:

• An evaluation table
• A levels of evidence table
• An outcomes synthesis table

Part 4B: Critical Appraisal of Research

Based on your appraisal, in a 1-2-page critical appraisal, suggest a best practice that emerges from the research you reviewed. Briefly explain the best practice, justifying your proposal with APA citations of the research.

   

Medicaid and the Middle Class

Description

Part I: Medicaid is not just for low-income people. The American middle class benefits significantly from the Medicaid program. In a 4 page synopsis, analyze a specific Medicaid program that seeks to benefit the middle class in the state in which you reside (Illinois). Please keep in mind the position and facility you selected. Make sure to include the following:

a. Discuss the purpose of the program.

b. Describe whether the program is effective and offer evidence to support your rationale.

c. Discuss other viewpoints or opposing viewpoints to the program.

d. This portion of your assignment will require you to research and examine information from various sources. Use a minimum of five credible sources for your paper, with three being an academic source from the Rasmussen College Online Library (don’t forget to include in-text citations throughout your paper with paraphrasing or quoting)

e. Make sure to include your APA formatted reference page. 

Part II: It’s tough for healthcare professionals to keep up with all the programs offered through the government. Based on the position and facility you selected, create a one-page information sheet for our staff that they can use to answer questions. SkillSurfer in the online tutoring platform offers beginner, intermediate, and advanced tutorials on Microsoft Office products. 

a. The information sheet should give your staff enough information to have an educated conversation with a patient about their healthcare coverage options through Medicaid.

b. Make sure to use audience specific language and tone in your information sheet. Remember, you are writing this information sheet for your staff.

c. Be creative and make your information sheet fun and organized.