NR 443 Assignments & Milestone

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NR 443 Caring for Populations: Milestone 1: Community Windshield Survey Form

Directions: Please refer to the Milestone 1: Community Windshield Survey Guidelines and grading rubric found in Doc Sharing for specific instructions in order to complete the information below. This assignment is worth 150 points.

Type your name above and your answers below directly on this form. Click Save as and save the file with the assignment name and your last name (e.g., “NR443 Windshield Survey Form_Smith”). When you are finished, submit the form to the Week 2 Caring for Populations: Windshield Survey Dropbox by the deadline indicated in your guidelines.

Criteria

1. Community introduction:

Identify the community you will be using for this assignment. It should be the area where you live or the area surrounding your work setting.

1. Windshield survey
2. vitality
3. Indicators of social and economic conditions
4. Health resources
5. Environmental conditions related to health
6. Social functioning
7. Attitude toward healthcare
8. Conclusion:

Provide a summary of your findings and your conclusion. What problems did you identify?

1. References:

OPTIONAL: List any references that you cited.

 

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NR443 Guidelines for Caring for Populations

Milestone 2: Assessment and Diagnosis

Purpose

The purpose of this paper is to provide an opportunity to utilize community assessment strategies, uncover a community health problem, and identify the components of the problem related to the community dynamics.

Course Outcomes

This assignment enables the student to meet the following Course Outcomes.

CO 1. Evaluate the planning of delivery of care to individuals, families, aggregates, and communities in a variety of healthcare settings based on theories and principles of nursing and related disciplines. (PO 1)

CO2. Integrate clinical judgment in professional decision-making and implementation of the nursing process through analysis of community health nursing practice. (PO 4)

CO7. Accept accountability for personal and professional development as part of the life-long learning process. (PO 5)

This paper is expected to be no more than four pages in length (not including the title page and reference list). Typical papers are usually three pages. Below are the requirements for successful completion of this paper.

• Introduction: This should catch the reader’s attention with interesting facts and supporting sources and include the purpose statement of the paper. This should be no more than one or two paragraphs.
• Community: Identify the community by name that you will be using for this paper and provide a brief, general description of the community. Your community should be the area where you live or work. This should be one or two paragraphs.
• Demographic and epidemiological data: Compile a range of demographic (population description) and epidemiological (causes of health problems and death) data for your community by examining census reports, vital statistic reports, city records, morbidity and mortality reports, and other agency sources. Using these data, describe the community and the problem. Compare your community data to state or national data. This comparison will help to identify a community health problem specific to your community. A summary of these data should beno more than one page.
• Windshield survey: Provide a brief summary of the findings from your first assignment. Make sure to discuss elements that link your observations to your identified problem. This should be no more than one or two paragraphs.
• Problem: Using the assessment data, identify the problem that you consider to be a priority concern. Provide a rationale for your choice and relate your choice to one of the Healthy People 2020 specific numbered objectives. Healthy People objectives are located within a topic area under the Objectives page. Your rationale should also include why this is specifically a problem in your community. This should be no more than three paragraphs. Include support of your rationale with at least two scholarly sources such as professional journal articles related to your problem.
• Summary: The summary paragraph of your paper should include a statement about the problem, the population at risk for this problem, and the major direct or indirect factors that contribute to this problem. This information should be no more than one or two paragraphs.
• Reference page: All references cited within the paper should be included on a separate References page.

Guidelines

• Application: Use Microsoft Word 2010™ to create this assignment.
• Use the categories above as APA headings for the sections of your paper.
• Length: This paper is expected to be no more than four pages in length (not including the title page and reference list). Typical papers are three pages.
• Submission: Submit your file via the basket in the Dropbox: Caring for Populations: Assessment and Diagnosis by 11:59 p.m. MT Sunday of Week 4.
• Technical writing: APA format is required. Review APA tutorials in Doc Sharing and use the resources of Smarthinking for writing tutors.
• Do not use first person (I, me, my, our) in this paper. Make the community the subject even in your windshield survey summary.
• Save your paper with your last name in the document title (e.g., “Smith Assessment and Diagnosis”).
• Late submission: See the course policy on late submissions.

Best Practices in Preparing the Paper

The following are best practices in preparing this project.

• Complete the demographic, epidemiologic, and windshield survey prior to choosing a problem to focus on.
• Choose a nursing problem specific to your community.
• Make sure all elements of the paper are addressed and headings for each category are included.
• Review directions thoroughly.
• Cite all sources within the paper as well as on the References page.
• Proofread prior to final submission.
• Check for spelling and grammar errors prior to final submission.
• Use the A column of the rubric below to ensure that you have included all the needed elements.
• Abide by the CCN academic integrity policy.

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NR 443 Milestone 3: Intervention and Evaluation

Purpose

The purpose of this PowerPoint presentation is to provide an opportunity to develop a community health nursing intervention and evaluation tool for your identified community health problem (described in Milestone 2: Assessment and Diagnosis) and identify the components of the nursing process as it applies to a community or population.

Course Outcomes

Scenario

You are a Community/Public Health Nurse (C/PHN) working in your setting of choice. You have identified a community health problem and have analyzed the data collected from your windshield survey and assessment & diagnosis assignments (the first two milestones). You have decided on one nursing intervention and need your organization’s approval for funding of this intervention. Your leadership team has agreed to listen to your proposal.

Directions

• Choose a community health nurse setting. Some examples of settings are school nurse, parish nurse, home health nurse, nurse working in the health department (be specific to what area in the health department, e.g., WIC, STD clinic, health promotion, maternal-child health, etc.)
• Introduction: Introduce the identified problem, the purpose of the presentation, and reiterate at least one or two important findings that demonstrate this problem in your community (average of 1–2 slides)
• Proposed Intervention: Propose one community health nursingintervention that would address one or more of the major direct or indirect factors that contribute to the problem. Keep in mind the Public Health Intervention Wheel (Nies& McEwen, p. 14, figure 1-3) as your framework (average of 3-4 slides). Your intervention needs to be specific:

o Who is your target population?

o Where is this intervention taking place?

o Will it take place one time or multiple times?

o How will you reach out to your target population?

• How will you get your target population involved?

o What is the CH Nurses role in this intervention?

o Will you collaborate with anyone (e.g., physician’s office, church, local resources, etc.?)

o Is anyone else involved besides yourself (C/PHN)?

• If yes, are they paid or volunteers?

o What level(s) of prevention is your intervention addressing (primary, secondary and/or tertiary prevention)?

• Intervention Justification: Justify why the problem and your nursing interventions should be a priority.

o Based on what you have found in the literature, discuss why these interventions are expected to be effective. Include summarized information from at least two professional scholarly sources related to your interventions (average of 2-3 slides).

• Proposed Evaluation: Your presentation must include at least one proposed quantitative or qualitative evaluation method that you would use to determine whether your intervention is effective. It should include the method you would use along with desired outcomes. Outcome measurement is a crucial piece when implementing interventions. There is a helpful tool in Doc Sharing to assist you with understanding qualitative and quantitative methods of evaluation. (average of 2-3 slides)

o Include discussion about the long-term and short-term impact on your community if the intervention is successful. Keep in mind your desired outcomes when analyzing the evaluation.

• Summary: The summary should reiterate the main points of the presentation and conclude with what you are asking to be accomplished, e.g., “Based on ABC, it is imperative our community has XYZ. Thank you for your consideration.”
• In addition to the slides described above, your presentation should include a title slide, and reference slide. Remember, you are presenting to your leadership team, so the slides should include the most important elements for them to know in short bullet pointed phrases. You may add additional comments in the notes section to clarify information for your instructor.

Guidelines

• Application: Use Microsoft PowerPoint 2010.
• Length: The PowerPoint slide show is expected to be no more than 20 slides in length (not including the title slide and reference list slide).
• Submission: Submit your files via the basket in the Dropbox: “Caring for Populations: Intervention and Evaluation” by 11:59 p.m. Sunday of Week 6.
• Save the assignment with your last name in the file title. Example: “Smith Intervention and Evaluation”
• Late Submission: See the course policy on late submissions.
• Tutorial: If needed, Microsoft Office has many templates and tutorials to help you get started.

Best Practices in Preparing PowerPoint

The following are best practices in preparing this project:

• Be creative, but realistic with your intervention and evaluation tool.
• Incorporate graphics, clip art or photographs to increase interest.
• Slides should be easy to read with short bullet points and large font.
• Review directions thoroughly.
• Cite all sources within the slide show as well as on the reference page.
• Proofread prior to final submission.
• Spell check for spelling and grammar errors prior to final submission.
• Abide by the CCN academic integrity policy.

The Assignment

In 2–3 pages:

• Explain the controversy that surrounds your selected disorder.
• Explain your professional beliefs about this disorder, supporting your rationale with at least three scholarly references from the literature. 
• Explain strategies for maintaining the therapeutic relationship with a patient that may present with this disorder.
• Finally, explain ethical and legal considerations related to this disorder that you need to bring to your practice and why they are important.

RE: ROLE OF OPIOID EDUCATION FOR THE YOUTHS

 Data from the participants in this study were collected using a case study approach. A case study is usually a descriptive observation qualitative research method that focuses on evaluating and or investigating a phenomenon in real-life situations (Hennink, Hutter & Bailey, 2020). In the study, data or information from the participants were collected using various tools and approaches. Primary tools of data collection were both structured and unstructured interviews. The choosing of these two tools was informed by the study design, which focuses on obtaining detailed information about a phenomenon which, in this case, was the experience of the youths who abuse drugs and substance. The sampled group reported being using cannabis and other opioids on many occasions. Therefore, the objective of this case study was to evaluate the real-life experiences of the youth when they were using drugs.

    Case study research design is preferred for studying such a phenomenon because of so many reasons. First is that employees random sampling of participants to provide responses that would answer the research questions. Data from the interviews were stored or recorded in books, journals, and digital forms where video and audiotapes were used. Different forms of collected data were analyzed using different methods. Prior to analysis, data were cleaned to ensure validity and accuracy. Video and audio recordings were transcribed before the final analysis. The final analysis of data was done using descriptive statistics where the variables of research were measured in the frequency in which they occurred. Correlational analysis was used to determine the relationship between different variables in the study (Lune & Berg, 2016). Therefore, the findings of this qualitative research were presented as descriptive information detailing the experiences of the youths who use drugs and other substances.

References

      Hennink, M., Hutter, I., & Bailey, A. (2020). Qualitative research methods. SAGE Publications   Limited.

        Lune, H., & Berg, B. L. (2016). Qualitative research methods for the social sciences. Pearson Higher Ed.

Reply

what the professor said:
Re: RE: Role of Opioid Education for the Youth (2)You have incorrectly formulated this section. Please fix and resubmit.

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Discussion Forum: Writing the Discussion Section

Substance use results into vast majority of life years lost due to illnesses, disability and premature deaths among those aged 15 to 24. It is arguably the most important modifiable health behavior that has impacted the youth. Due to the times we are in, youth are faced by a vast landscape of more potent products, new delivery methods, and synthetic alternatives such as electronic cigarettes, fentanyl, codeine products and potent cannabinoids. These are far more addictive than psychoactive substances that were available to teenagers in the past (Reid, Wild, & Bozarth, 2020). Marijuana, alcohol and tobacco products are more commonly used in high school students as compared to opioids abuse thus the secondary prevention that is to say, initiating treatment of other substance use way before the use of opioids ever begin as logical strategy.

 The American academy of pediatrics has called on pediatricians to screen all young adults as well as adolescents for use of substance use and manage the whole spectrum, starting from preinitiation to SUD. Integrating SUD treatments within a pediatrics primary care, as well as engaging primary care providers in managing of substance use as they do to people with other disorders, it has the potential to radically revise as well as dramatically increasing access to SUD treatment for the youths (Drake, 2017).

Among adolescents, Opioid Use Disorder (OUD) are not as common as tobacco, marijuana and alcohol disorders although the death rate of patients with untreated OUD is high. The treatment of OUD include prescription medications, there is use of model that combines both primary care management as well as an integrated behavioral health specialists while at the same time having an expert backup which has demonstrated as being acceptable in the pediatric primary care as well as being feasible with the subspecialist support (Pfeiffer, 2019).

Reply

what the professor said 

Re: Role of Opioid Education for the YouthYou need to compare the Results with your initially stated Hypothesis and interpret them.  

Using evidence-based research, design and develop a Parent Guide for your assigned disorder.

 My assigned disorder was conduct disorder.

I need to do treatment options, including psychopharmacology and psychotherapeutic for conduct disorder. Also a conclusion part. Citation and APA academic references need it. 

Reference 

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

• “Neurodevelopmental Disorders” 
  • “Intellectual Disabilities”
  • “Communication Disorders”
• “Disruptive, Impulse-Control, and Conduct Disorders”

Note: You will access this book from the Walden Library databases.

Assignment:

Analyze the possible conditions from your colleagues’ differential diagnoses.

 

Determine which of the conditions you would reject and why. 

Identify the most likely condition, and justify your reasoning.  

42-year-old White Male

S.

Chief Complaint: “low back pain for the past month that sometimes radiates to my left leg.”

HPI: The patient is a 42-year-old white male who is complaining of low back pain that began one month ago.  He explains that the pain will intermittently radiate to his left leg as well.  He reports that the pain is constant and is also “sharp” at times.  He describes the pain that radiates to his left leg as a “tingling” sensation and can sometimes even feel it “all the way down to his toes.”  He rates the pain at an “8” when he is standing or walking but describes that the intensity decreases to a “4” when he is sitting or lying down.  The patient complains of intermittent numbness and tingling in his left leg that seems to have gotten worse “in the past week.”  He explains that the numbness and tingling is always worse first thing in the morning.  He also describes the pain as almost “unbearable” after working a 12-hour shift and that he even has experienced a loss of appetite on those days after working long hours.  He explains that the pain does wake him up sometimes at night. The patient explains that Aleve has been his “lifesaver,” as he does not feel that he could have worked at all if it wasn’t for taking it routinely before work.  He proceeded to verbalize that the Aleve only “took the edge off,” but that he is worried about the effect it may be having on his stomach.    

Current Medications:  Centrum Vitamin for Men, one PO daily; Aleve capsule, one PO every 8 hours; over-the-counter Zantac 150 mg PO, “occasionally” at bedtime for heartburn.

Allergies:  PCN- experienced hives after taking as a teenager; Denies food or environmental allergies.

PMH:  Occasional acid reflux, history of childhood asthma, hospitalized last year with pneumonia.  Reports only surgery being tonsillectomy at age 5.  Reports that he is current with immunizations and received a tetanus injection two years ago when he cut his finger at work. 

FH:  Father died at age 60 with a heart attack, mother is living and has HTN.  Maternal grandparents are living with no history of heart disease or cancer.  Maternal grandmother-type 2 diabetes; Maternal grandfather- HTN, controlled with medication.  Paternal grandmother- living and in excellent health, with no history of heart disease or cancer. Paternal grandfather died at age 72 with a heart attack.  Reports that both children are in excellent health.  Denies a history of back pain or scoliosis with maternal or paternal relatives.

SH:  Works as a nurse in the ICU at a local hospital and has been married for 15 years; they have two school-aged children.  He reports that he and his family love to spend time outdoors and that they usually hike on the weekends together.  He explains that he is very active in his local church and teaches a class there on Wednesday nights.  He denies any past tobacco use, including smokeless tobacco.  He also denies any history of illicit drug use.  The patient explains that he drank beer on the weekends in college but denies alcohol use at this time.  He reports that his family lives in the country, but states that he and his wife’s family only live one hour away and are all very supportive.  The patient reports regular use of a seat belt and was reminded of the danger of texting and driving, as he admitted that this is something that he is in the habit of doing.

ROS:

• General:  Reports 7 lb. weight loss in the past month; Denies fevers or chills.  Reports increased fatigue due to pain waking him up at night.  Reports increased anxiety that he relates to the constant pain.
• Skin:  Negative for rash, lesions, cysts, or wounds.
• Cardiovascular:  Negative for chest pain, tightness, or chest pressure.  Negative for palpitations.  Denies any issues with swelling in extremities.
• Respiratory:  Negative for shortness of breath, cough, or sputum.  Denies shortness of breath even after long hikes.
• Gastrointestinal:  Negative for abdominal pain.  Reports some nausea when back pain is intensified but denies vomiting.  Reports normal bowel movements with no issues of diarrhea, constipation, or blood in stools.  Positive for heartburn for at least the past couple of years, especially at night.  Negative for bowel incontinence.
• Genitourinary:  Negative for burning upon urination or frequency.  Negative for urinary incontinence.
• Neurological:  Negative for headaches, dizziness, or fainting.  Denies head trauma. Positive for intermittent numbness and tingling in left leg, foot, and toes.  Denies numbness or tingling in any other extremities.  Denies any problems with balance or coordination.
• Musculoskeletal:  Denies muscle weakness. Positive for constant low back pain. Positive for back and left leg stiffness upon getting up in the mornings.  Denies any other joint pain or issues. 
• Hematologic:  Negative for a history of bleeding problems.  Denies any back trauma, wounds, or lesions.  Denies any unusual bruising.
• Lymphatics:  Negative for any swollen lymph nodes.
• Psychiatric:  Reports no history of depression or mental disorders.  Admits to current anxiety that he relates to constant back pain.

O.

Vital signs:  B/P 135/72; Pulse 83; RR 18; O2 Sat 98%; Temp. 98.3; Wt. 205 lbs.; Ht. 72”

General:  Patient sitting on edge of the exam table, appears restless and anxious.  He is alert and oriented x3 and responds appropriately to all questions.

Skin:  Warm, dry, and intact.  No evidence of rashes, lesions, wounds, or cysts. Adequate turgor.

Respiratory:  Breath sounds clear and equal upon auscultation in all 4 lobes anteriorly and posteriorly.  No adventitious sounds heard.  Symmetrical chest wall expansion noted.  No difficulty in breathing patterns noted. 

CV:  Heart RRR, no audible murmurs or gallops.  No peripheral edema noted.  Tibial and dorsalis pedal pulses present, 2+ bilaterally.  Capillary refill less than 3 seconds in fingers and toes bilaterally, with no cyanosis noted.

Abdomen:  Soft and nontender.  No distention; no palpable masses.  Bowel sounds normoactive in all 4 quadrants.  No evidence of guarding. No flank tenderness noted bilaterally.

Rectal:  No prostate tenderness or enlargement noted upon palpation.

Back:  Spine straight with no obvious curvature.  Full ROM of the spine, but tenderness reported upon palpation of the sacroiliac region.    

Musculoskeletal:  full weight-bearing.  No evidence of gait disturbances.  Full ROM noted in all 4 extremities. Leg measurements are equal.  Positive FABER test upon placing the left leg on right knee, pain reported in the sacroiliac region. Straight leg raises performed bilaterally, with complaints of pain verbalized upon 45 degrees of elevation.  Pain in the sacroiliac region also voiced upon left ankle dorsiflexion (Dains, Baumann, & Scheibel, 2019, Chapter 24).  

Neurological:  Alert and oriented x 3; appropriate mood and affect in the present circumstance of constant pain.  No foot drop noted when examined bilaterally (Dains et al., 2019). Reflexes are 2+ and equal bilaterally, including deep tendon (Dains et al., 2019).  Strength is 5/5 in all extremities except for left leg, which is assessed at 4/5 (Sullivan, 2019, Chapter 2).  No evidence of limping with ambulation.

Diagnostic Results:

CBC:  WBC 14, 500; HgB 12.3; Hct 46%.  While this patient’s WBC is only slightly elevated, it is important to consider the presence of an infection in the back or spinous processes.  While he has not reported any fever or chills, clinicians can never be too certain that there is not a hidden bacterium that would be the causative agent for the reported symptoms (Dains et al., 2019).  Additionally, as the thought of a malignant condition is always in the minds of patients and clinicians, alike, it is essential to assess the H & H of the individual (Dains et al., 2019).  While anemia is commonly present amongst cancer diagnoses, ranging anywhere from 30% to 90% of diagnosed patients, the extent of such a condition will vary according to the type of tumor (Krasteva, Harari, & Kalsi, 2019).     

UA:  negative for blood, nitrites, or bacteria.  As the advanced practice nurse, it is equally important to ensure that there is no specific visceral involvement, such as what can occur with the kidneys when there is infection present (Dains et al., 2019).  The U/A results would be helpful information to rule out a condition known as pyelonephritis (Dains et al., 2019). 

ESR:  25 mm/hr.  A hematologic test, known as an erythrocyte sedimentation rate, is very useful when trying to conclude if infection, inflammation, trauma, or even malignant disease is present (Patil, Muduthan, & Kunder, 2019).  While the ESR can be initially elevated in the acute stages of an illness, it is a significant enough diagnostic test to perform when trying to rule out infection as the underlying cause of the condition (Patil et al., 2019).   

PSA:  9.2.  The elevated PSA level in this gentleman does warrant enough suspicion for the advanced practice nurse, as there is always a potential for prostate cancer with bony metastasis in the spinal region (Bakhsh et al., n.d.).  The bony lesions that are found in metastatic prostate cancer are typically osteoblastic in nature (Bakhsh et al., n.d.). 

MRI:  awaiting the radiologist report.  The condition of the soft tissue in the spinal region is best visualized with magnetic resonance imaging (Dains et al., 2019).  There are medical conditions that need to be ruled out as a source of the back pain, such as disc herniations, tumors, and various diagnoses that originate from the spinal cord (Dains et al., 2019). 

A.

1.) Sciatica:  While it is vital that other medical conditions that originate from the spine are reviewed, sciatica is a presumptive diagnosis for this male patient that is experiencing low back pain.  The long-standing nursing career of this male patient often involves a great deal of twisting, bending, and lifting that has become repetitive (Dains et al., 2019).  The bowel and bladder functions are not usually compromised, but the patient will experience a significant amount of pain, burning, and even numb sensations in the buttock and leg of the affected side (Dains et al., 2019).  The straight leg raises test (SLR) will usually reveal positive results, which was the case of this male patient (Dains et al., 2019). 

2.) Primary or metastatic tumor:  The advanced practice nurse must rule out the presence of a tumor type, first and foremost, before proceeding on to other differential diagnoses.  While this patient may not have all the “classic” indicators of malignancy, it is vital that clinicians understand that no one patient will present with a malignant condition in the same exact fashion.  The elevated PSA in this young 42-year-old male is enough indication to ensure that a malignant condition is not the underlying cause for his symptomology.  The weight loss that the patient has reported is a symptom that does require further exploration. 

3.) Disc Herniation:  Although numbness and tingling are not as common with a disc herniation, patients with such a condition will usually complain of pain that radiates throughout the leg of the affected side (Dains et al., 2019).  The patient with a herniated disc will quite frequently have positive straight leg tests, and an MRI is undoubtedly warranted if the patient has experienced back pain for at least one month (Dains et al., 2019). 

4.) Infection:  A condition known as osteomyelitis can often occur in the spine, especially if the patient has experienced recent infection in a neighboring anatomical region or if they have undergone a type of invasive procedure where various instrumentation was utilized (Dains et al., 2019).  Sadly enough, infection ranks high in the medical community as one of the most overlooked conditions by well-intended clinicians (Mohamed, Finucane, & Selfe, 2019).  The cause for many of these errors that pertain to spinal infections is because of the extended period between the time of initial onset to the time of full development of the condition (Mohamed et al., 2019).  The consideration of infection is very prudent with this male patient, as his slight WBC elevation and ESR level do require further exploration. 

5.) Spinal Stenosis:  While this condition is typically diagnosed in those patients over 50 years of age, the advanced practice nurse must take into consideration the length of time that this male patient has endured long hours on his feet in his nursing career.  Spinal stenosis of the lumbar region is a common location and is usually associated with degenerative changes of the three-joint complex (Abbas, Peled, Hershkovitz, & Hamoud, 2019).  The presence of neurogenic claudication is an anticipated clinical symptom, with pain levels increasing upon long periods of standing (Abbas et al., 2019).  The pain will normally radiate to one or both buttocks, legs, and feet (Abbas et al., 2019).