2023 Max Points 150 Details Interview a patient with a chronic pulmonary health condition who is on at least two medications

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Nursing 2023 NUR-641E Week 4 Assignment Patient Interview Paper

Max Points 150 Details Interview a patient with a chronic pulmonary health condition who is on at least two medications 2023 Assignment

Max Points: 150

Details:

 

Interview a patient with a chronic pulmonary health condition who is on at least two medications.

In a 1,350-1,600-word paper, discuss the following:

  1. Obtain a complete health history.
  2. Obtain a complete medication history, including prescription and over-the-counter drugs or supplements.
  3. Analyze the client’s current knowledge level of medications and compliance with the prescribed dosing and administration.
  4. For each medication, identify the pharmacokinetics, pharmacodynamics, dose, route of administration, side effects, adverse reactions, any drug interactions, potential safety issues, and the impact on the client’s health status.
  5. Formulate possible interventions related to lack of drug efficacy, lack of client knowledge, or client compliance issues as identified during the interview.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.

 

 

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2023 For this Assignment you are creating a PowerPoint presentation Your presentation audience is the community The topic is immunization

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Nursing 2023 Immunization Presentation

For this Assignment you are creating a PowerPoint presentation Your presentation audience is the community The topic is immunization 2023 Assignment

 

For this Assignment you are creating a PowerPoint® presentation. Your presentation audience is the community. The topic is immunization/ vaccination. Information should include herd immunity, types of immunity related to vaccination, immunization effects on the individual, and community as well as worldwide effects of immunization. Additionally content should include vaccination trends, myths, disease statistics for those conditions prevented with vaccination, and pediatric vaccination schedule/s. Legal, ethical, and cultural considerations should be addressed.

Master’s-prepared nurse educators, leaders, nurse practitioners and all specialty nursing fields are contributors to health promotion in populations across the life span. This Assignment is focused on the child and adolescent immunization, health information, epidemiology and surrounding influences. You should apply the topic towards your area of specialty focus as it relates to health promotion and epidemiology.

The presentation must have speaker notes per slide; 1–3 paragraphs. The PowerPoint should be developed in a professional design and style; succinct, not overly wordy, with a tasteful amount of elegant text and visual appeal, as well as accurate and complete content. Number of content slides are 12, not to exceed 14. Title slide and reference slide required and not included in the total. This presentation should adhere to appropriate 6th edition APA format.

Number of content slides are 12, not to exceed 14. Title slide and reference slide required and not included in the total. This presentation should adhere to appropriate 6th edition APA format.

This link provides Microsoft tutorials in PPTX:

PowerPoint 2013 videos and tutorials. (n.d.). Retrieved from https://support.office.com/en-us/article/PowerPoint-2013-videos-and-tutorials-bd93efc0-3582-49d1-b952-3871cde07d8a

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2023 Use attachment senerio to assist with assignment Write a 700 1250 word paper in

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Nursing 2023 Needed With 5 Hours! Needed ASAP Please Don’t Offer If You Can’t Get It Done ASAP…. Urgent Care Facility Business Plan. Business Recommendation

Use attachment senerio to assist with assignment Write a 700 1250 word paper in 2023 Assignment

Use attachment senerio to assist with assignment.

Write a 700- 1250 word paper in which you identify and recommend technology needs, hours of operation, and services offered for the health care organization. The facility will be an Urgent care facility in Augusta Ga.

Include the following in your paper:

  • Recommend which services should be provided at the center and describe why they are appropriate at this site.
  • Describe the hours of operation and why you recommend those hours.
  • Describe the major equipment and technology needed to provide the recommended service. Include a projected cost for that equipment.
  • Discuss the type of corporation you think the center should consider (e.g., a department of the hospital or an LLC) and why.

Cite at least 2 peer-reviewed, scholarly, or similar references.

Format your paper according to APA guidelines.

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2023 What are the risk factors among the Hispanics How is HIV impacting

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Nursing 2023 HIV among Hispanics: An overview

What are the risk factors among the Hispanics How is HIV impacting 2023 Assignment

What are the risk factors among the Hispanics?

How is HIV impacting the Hispanic US populations in US?

Discuss the health, economic and family influence?

Paper must be 3 to 4 pages in body, font of 12, with at least 4 peer review articles.

No Plagiarism!!!!!! Paper run through TURNITINN app.

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2023 The wife of C W a 70 year old man brought him to the emergency department ED at 4 30

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Nursing 2023 The Wife Of C.W., A 70-year-old Man, Brought Him To The Emergency Department (ED) At 4:30 This Morning. She Told The ED Triage Nurse That He Had Had Dysentery For The Past 3 Days, And, Last Night, He Had A Lot Of “dark Red” Diarrhea. When He Became Very D

The wife of C W a 70 year old man brought him to the emergency department ED at 4 30 2023 Assignment

The wife of C.W., a 70-year-old man, brought him to the emergency department (ED) at 4:30 this morning. She told the ED triage nurse that he had had dysentery for the past 3 days, and, last night, he had a lot of “dark red” diarrhea. When he became very dizzy, disoriented, and weak this morning, she decided to bring him to the hospital. C.W.'s vital signs (VS) were 70/- (systolic blood pressure [BP] 70 mm Hg, diastolic BP inaudible), 110, 20, 99.1° F (37.3° C). A 16-gauge IV catheter was inserted, and a lactated Ringer's (LR) infusion was started. The triage nurse obtained the following history from the patient and his wife. C.W. has had idiopathic dilated cardiomyopathy for several years. The onset was insidious, but the cardiomyopathy is now severe, as evidenced by an ejection fraction (EF) of 13% found during a recent cardiac catheterization. He experiences frequent problems with heart failure (HF) because of the cardiomyopathy. Two years ago, he had a cardiac arrest that was attributed to hypokalemia. He also has a long history of hypertension (HTN) and arthritis. He has also had atrial fibrillation in the past but it has been under control recently. Fifteen years ago he had a peptic ulcer. An endoscopy showed a 25 × 15 mm duodenal ulcer with adherent clot. The ulcer was cauterized, and C.W. was admitted to the medical intensive care unit (MICU) for treatment of his volume deficit. You are his admitting nurse. As you are making him comfortable, Mrs. W. gives you a paper sack filled with the bottles of medications he has been taking: enalapril (Vasotec) 5 mg PO bid, warfarin (Coumadin) 5 mg/day PO, digoxin (Lanoxin) 0.125 mg/day, PO, potassium chloride 20 mEq PO bid, and diclofenac sodium (Voltaren) 50 mg PO tid. As you connect him to the cardiac monitor, you note that he is in sinus tachycardia. Doing a quick assessment, you find a pale man who is sleepy but arousable and oriented. He is still dizzy, hypotensive, and tachycardic. You hear S3 and S4 heart sounds and a grade II/VI systolic murmur. Peripheral pulses are all 2+, and trace pedal edema is present. Lungs are clear. Bowel sounds are present, midepigastric tenderness is noted, and the liver margin is 4 cm below the costal margin. A Swan-Ganz catheter and an arterial line are inserted.

  

1. What may have precipitated C.W.'s gastrointestinal (GI) bleeding?

2. From his history and assessment, identify five signs and symptoms (S/S) of GI

bleeding and loss of blood volume.

3. What is the most serious potential complication of C.W.'s bleeding?

4. What is the effect of C.W.'s blood pressure on his kidneys?

Case study progress:

C.W. receives a total of 4 units of packed red blood cells (PRBCs), 5 units of fresh

frozen plasma (FFP), and several liters of crystalloids to keep his mean BP above 60 mm Hg.

On the second day in the MICU, his total fluid intake is 8.498 L and output is 3.66 L for a

positive fluid balance of 4.838 L. His hemodynamic parameters after fluid resuscitation are

pulmonary capillary wedge pressure (PCWP) 30 mm Hg and cardiac output (CO) 4.5 L/min.

5. Why will you want to monitor his fluid status very carefully?

6. List at least six things you will monitor to assess C.W.'s fluid balance.

7. Explain the purpose of the FFP for C.W.

Case study progress:

As soon as you get a chance, you review C.W.'s admission laboratory results. These

were drawn before he received the PRBCs.

Chart view:

Lab work:

· Sodium – 138 mEq/L

· Potassium – 6.9 mEq/L

· BUN – 90 mg/dL

· Creatinine – 2.1 mg/dL

· WBC – 16,000/mm 3

· Hgb – 8.4 g/dL

· Hct – 25%

· PT – 23.4 seconds

· INR – 4.2

8. After examining the lab results, are there any concerns with C.W.'s electrolyte levels?

Explain your answer.

9. In view of the previous lab results, what diagnostic test will be performed and why?

10. Evaluate this ECG strip, and note the effect of any electrolyte imbalances.

11. Why do you think BUN and creatinine are elevated?

12. What do the low hemoglobin (Hgb) and hematocrit (Hct) levels indicate about the

rapidity of C.W.'s blood loss?

13. What is the explanation for the prolonged prothrombin time/international normalized

ratio (PT/INR)?

14. What will be your response to the prolonged PT/INR? (Select all that apply.)

a. Prepare to administer a STAT dose of protamine sulfate.

b. Hold the warfarin.

c. Monitor C.W. for signs and symptoms of bleeding.

d. Obtain an order for aspirin if needed for pain.

e. Avoid injections as much as possible.

15. What safety precautions should be considered in light of his prolonged PT/INR?

16. How do you account for the elevated white blood cell count?

Case study progress:

Mrs. W. has been with her husband since he arrived at the emergency department

and is worried about his condition and his care.

17. List four things you might do to make her more comfortable while her husband is in

the MICU.

Activity

1. Present the medical management of Peptic Ulcer Disease by highlighting:

a. Nutritional therapy

b. Surgical therapy

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2023 Discuss the changing landscape of the US health care system through the ACA and specific initiatives that

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Nursing 2023 changing landscape of the US health care system

Discuss the changing landscape of the US health care system through the ACA and specific initiatives that 2023 Assignment

 Discuss the changing landscape of the US health care system through the ACA and specific initiatives that have been funded, enacted and currently implemented to improve health care for all Americans 

References

 

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2023 1 What aspects of brain development underlie the tremendous gains in language thinking and motor control of

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Nursing 2023 What Aspects Of Brain Development Underlie The Tremendous Gains In Language, Thinking, And Motor Control Of Early Childhood?

1 What aspects of brain development underlie the tremendous gains in language thinking and motor control of 2023 Assignment

 

1. What aspects of brain development underlie the tremendous gains in language, thinking, and motor control of early childhood?

2.  Among children who spend much time playing alone, what factors distinguish those who are likely to have adjustment difficulties from those who are well-adjusted and socially skilled?

3. What experiences help children differentiate moral imperatives, social conventions, and matters of personal choice?

4. Explain how the social environment and young children’s cognitive limitations contribute to rigid gender stereotyping in early childhood.

5. Summarize findings on ethnic variations in child-rearing styles. Is the concept of authoritative parenting useful for understanding effective parenting across cultures? Explain.

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2023 Please post a short response to the following discussion Use a reference from scholarly literature Peer reviewed Nursing journal not

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Nursing 2023 Nursing

Please post a short response to the following discussion Use a reference from scholarly literature Peer reviewed Nursing journal not 2023 Assignment

Please, post a short response to the following discussion.

Use a reference from scholarly literature : Peer-reviewed Nursing journal not older than 5 years or your textbook:

 Polit, D. E. & Beck, C. T. (2018). Essentials of nursing research: Appraising evidence for nursing practice(9th. ed.). Philadelphia, PA: Wolters Kluwer. 

Nursing researches, evidence-based practice (EBP), and theories can be subject to reviews and readings. Nursing is an ever-changing science and profession, even though nurses based their knowledge on previous studies. Literature review is significant to the research process because it balances the strength of the knowledge obtained and review the previous information obtained. The nursing research process includes the review or creation of concepts and theories (Polit & Beck, 2018). Therefore, a deep reading and investigation of the research allows for either confirmation, or exclusion, of that research. As Bernhofer (2015) expresses, a thorough review of the literature can show that there is no need to change the practice or, in the other hand, it can show that there is a possibility to improve the outcomes desired by changing the practice protocols. A literature review may influence new researches process and practices as it proves the knowledge already obtained is based on strong and appropriate evidences that were not biased.

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2023 Question 1 A researcher designs a study as a quantitative descriptive study Which of the

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Nursing 2023 UTA NURS3375 Module 3 Knowledge Check 1 Latest

Question 1 A researcher designs a study as a quantitative descriptive study Which of the 2023 Assignment

  

Question 1

A researcher designs a study as a quantitative descriptive study.  Which of the following would NOT typically be part of the research methodology for the study?

Describing a causal effect between the variables.

Using valid and reliable instruments.

Clear conceptual definition of study variables.

Finding a representative sample.

Question 2

Which of the following study designs focuses on finding a cause and effect relationship among variables, but uses a lower level of control?

experimental

descriptive

quasi-experimental

phenomenology

Question 3

A nurse researcher wants to design a study that looks at the relationship between two variables.  She is considering an experimental research design.

True

False

Question 4

A questionnaire has an ID number in one corner that allows the research team to identify the subject. This is an example of:

informed consent.

confidentiality.

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2023 Respond using one or more of the following approaches Ask a probing question substantiated with additional background information and evidence

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Nursing 2023 Post- Jessica-EBP

Respond using one or more of the following approaches Ask a probing question substantiated with additional background information and evidence 2023 Assignment

Respond using one or more of the following approaches:

Ask a probing question, substantiated with additional background information, and evidence

Offer and support an alternative perspective using readings from the classroom or from your own review of the literature in the Walden Library.

Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.

Reference:

Skloot, R. (2010). The immortal life of Henrietta Lacks. New York, NY: Crown Publishing Group.

                                                            MAIN POST

INITIAL POST

            Research drives innovation in health care and establishes evidence-based practice. The medical community relies on research to promote better practice, develop new technology, work more efficiently, and to develop life-saving medicines and treatments. The standards that guide research are of paramount importance. Research must be carefully planned, rigorously executed, replicable, and above all else, it must be ethical. Fouka and Mantzorou (2011) contend that within the context of research, ethics must be applied to the daily work of the study, the protection and dignity of research subjects, and to the publication of research. The primary ethical issues involving research are informed consent, beneficence, non-maleficence, respect for anonymity and confidentiality, and respect for privacy (Fouka & Mantzorou, 2011).

Lenzer (2016) reports that The Individualized Comparative Effectiveness of Models Optimizing Patient Safety and Resident Education (iCOMPARE) was a study that aimed to analyze the effects of extending work hours for first-year internal medicine residents on patient mortality and negative outcomes at a 30-day interval (Lenzer, 2016). Shea et al. (2018) maintain that the study analyzed several patient safety issues including readmission rates, prolonged length of stay, various medical complications, and overall costs associated with care. The iCompare research study was a randomized control trial conducted in the 2015-2016 academic year. It was funded by the National Institute of Health and included resident-subjects from 40 medical programs that agreed to sign an Institutional Affiliation Agreement. The University of Pennsylvania served as the institutional review board for all the participating medical programs. The researchers randomly assigned residents to work in one of two groups. Residents belonging to the first group worked a maximum 16 consecutive hours, which is the maximum number of hours allowed by the Accreditation Council for Graduate Medical Education, while residents belonging to the second group worked as many as 30 hours consecutively (Shea et al., 2018).  

Ethical Breaches in the iCOMPARE Study

Informed Consent

While it is true that the various academic institutions agreed to participate in the iCOMPARE study, and even assisted in facilitating the research, the residents nor the patients were informed that they were active participants in the iCOMPARE study (Lenzer, 2016). Informed consent is arguably the primary ethical issue for research that involves human participants. Informed consent requires that “a person knowingly, voluntarily, and intelligently and in a clear and manifest way, gives his consent” (Fouka & Mantzorou, para. 8, 2011). In order for informed consent to occur, research participants must be provided with an introduction of the study as well as the risks and benefits. Moreover, in denying informed consent the residents and patients were also denied autonomy and self-determination (Fouka &Mantzorou, 2011).

Matthew Alvin (2017) was a resident participant in the iCOMPARE research study. While he admits he did not give informed consent, he asserts that he gave implied consent to participate in the study. Alvin bases his assertion on the fact that prospective medical students were sent information about the iCOMPARE research study via email during the months in which they interviewed for residency assignments. And, that by participating in the residency program itself, he consented implicitly to any and all integral components of the academic program (Alvin, 2017). I respectfully disagree with Dr. Alvin’s assessment of implied consent, and would argue that information about a potential research study sent via email is informal and does not meet the legal or ethical litmus test for implied consent. Furthermore, the patient participants received no such informal email communication. They were not provided any information about the research, nor were the risks and benefits explained to them. The iCOMPARE study exposed both residents and patients to unnecessary risks and denied both groups the option of opting out of the study. The gross disregard for informed consent in the iCOMPARE study violated the very foundation for which reliable research is based.

Beneficence and Non-Maleficence 

Beneficence and non-maleficence are ethical principles which require researchers to have good intentions for the welfare of participants when conducting research. These principles require researchers to above all else, do no harm (Fouka &Mantzorou, 2011). The researchers in the iCOMPARE study showed blatant disregard for the ethical principles of beneficence and non-maleficence. Inexperienced first-year residents were pushed to the physical limits of exhaustion, working more than double the hours allowed by the Accreditation Council for Graduate Medical Education. This undoubtedly had both physical and psychological implications. Errors made by residents during this research could have potentially impacted the perceived quality of their residency experience, and contributed to internalized feelings of self-doubt. Moreover, Patients’ lives were put in the hands of residents who were purposely overworked simply to find out if fatigue contributes to medical errors. I did not find any data which corroborated or eliminated any undue harm incurred by either residents or patients during the iCOMPARE research study.

Suggestions for the iCOMPARE Study

Because ethical standards were not upheld during this research, the validity of the study is questionable. The designers of this research should have facilitated informed consent with the resident-participants, since some of them were working more hours than recommended by the Accreditation Council for Graduate Medical Education. Obtaining informed consent from the patient-participants is more of a gray area, because technically, medical residents are supervised by attending physicians who are ultimately responsible for the care provided. However, since the aim of the research was to determine if fatigue played a significant role in patient mortality and medical errors, I believe that patients had a right to be informed of the study.

It is likely that the researchers did not provide informed consent to the participants because they believed the participants, especially the residents would have behaved differently had they known they were part of a study, this phenomenon is known as the Hawthorne Effect (Poilt & Beck, 2015). Had the residents been provided with informed consent, they would have known which experimental group they were based upon the hours they were assigned, essentially negating any attempt at randomization. Nonetheless, these reasons are not significant enough to violate research ethics. The researchers should have chosen a quasi-experimental design for this study because it lacks randomization, and would have facilitated informed consent (Polit & Beck, 2017). When research is being conducted on sensitive issues, researchers should choose a design that maintains ethical standards, even if that design ranks lower on the evidentiary pyramid.

The researchers of iCOMPARE, leaders of 40 graduate medical programs including John Hopkins, The National Institute of Health, and an institutional review board at the University of Pennsylvania were all complicit in violating the ethical principles of informed consent, beneficence, and non-maleficence. The iCOMPARE study not only violated ethical principles and exposed medical residents and patients to potential dangers; it also compromised the value of any conclusions or statistical information deduced from the results of the study. Ethically flawed research negatively impacts the medical profession. The iCOMPARE study violated the relationship of trust which must be maintained between patients and medical providers. And, although Dr. Alvin believes implied consent is applicable to the participating residents in this case, he cannot speak for the countless other residents, nor the patients who unwillingly participated in this research study.  

 

References

Alvin, M. D. (2017). ICOMPARE: An interns perspective. Journal of Graduate Medical Education,9(2), 261-262. doi:10.4300/jgme-d-16-00711.1

Fouka, G., & Mantzorou, M. (2011). What are the major ethical issues in conducting research? Is there a conflict between the research ethics and the nature of nursing. Health Science Journal. Retrieved from http://www.hsj.gr/medicine/what-are-the-major-ethical-issues-in-conducting-research-is-there-a-conflict-between-the-research-ethics-and-the-nature-of-nursing.php?aid=3485

Lenzer, J. (2016). Groups call for “dangerous” trial of doctors’ working hours to stop. Bmj,I1070. doi:10.1136/bmj.i1070

Shea, J. A., Silber, J. H., Desai, S. V., Dinges, D. F., Bellini, L. M., Tonascia, J., . . . Asch, D. A. (2018). Development of the individualised Comparative Effectiveness of Models Optimizing Patient Safety and Resident Education (iCOMPARE) trial: A protocol summary of a national cluster-randomised trial of resident duty hour policies in internal medicine. BMJ Open,8(9). doi:10.1136/bmjopen-2018-021711

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