Research Critiques and PICOT Statement Final Draft

Prepare this assignment as a 1,500-1,750 word paper using the instructor feedback from the previous course assignments and the guidelines below.

PICOT Question 

Revise the PICOT question you wrote in the Topic 1 assignment using the feedback you received from your instructor.

The final PICOT question will provide a framework for your capstone project (the project students must complete during their final course in the RN-BSN program of study).

Research Critiques

In the Topic 2 and Topic 3 assignments, you completed a qualitative and quantitative research critique on two articles for each type of study (4 articles total). Use the feedback you received from your instructor on these assignments to finalize the critical analysis of each study by making appropriate revisions.

The completed analysis should connect to your identified practice problem of interest that is the basis for your PICOT question.

Refer to “Research Critiques and PICOT Guidelines – Final Draft.” Questions under each heading should be addressed as a narrative in the structure of a formal paper.

Proposed Evidence-Based Practice Change

Discuss the link between the PICOT question, the research articles, and the nursing practice problem you identified. Include relevant details and supporting explanation and use that information to propose evidence-based practice changes.

General Requirements

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 LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

AttachmentsNRS-433V-RS-Research-Critique-Guidelines.docx
RUBRIC

Attempt Start Date: 12-Aug-2019 at 12:00:00 AM

Due Date: 18-Aug-2019 at 11:59:59 PM

Maximum Points: 300.0

APA format 3 peer review references Response needs to be why you disagree or agree with diffential diagnosis and why

 

Patient Information:

TB, 20-year-old, Male, Caucasian

S.

CC Intermittent headaches.

HPI: T.B. is a 20-year-old Caucasian male who presents with intermittent, diffuse headaches.  His headaches have been occurring every week or so since Spring, 2018.  These headaches last for 2 to 3 days and occur over entire head but is worse above the eyes and radiates the nose, cheekbones, and jaw. The pain is described as a pressure that is intense above the eyes. There are no associated signs or symptoms, other than mild relief when enters a dark room.  T.B has not discovered a condition that makes headaches occur or worsen. Currently, the pain is rated as 7/10 pain scale.

Current Medications: Intermittent Acetaminophen Extra Strength 2 several times a day with headaches

Allergies: None is known to date. 

PMHx: Reports has received all recommended immunizations and last tetanus is in 2016.  Appendectomy at age 15.

Soc Hx: Patient is a part-time student at local community college and works part-time as a Barista.  He denies tobacco or recreational drug use, no alcohol use since 2017 in high school. He reports recently beginning to vape.  He lives with a roommate in an apartment and reports has been more active as walks 3 miles daily to work and school.

Fam Hx: Mother is living and in good health.  Father has not been in the patient’s life since infancy.  Sister was diagnosed with epilepsy several years ago.   Patient reports no known family history of cancer or neurological issues

ROS:

GENERAL:  Patient reports no weight loss or fever

HEENT:  Eyes:  Patient reports no visual changes

Ears, Nose, Throat:  Patient reports no hearing loss, congestion, runny nose or sore throat.

SKIN:  Patient reports no rash or itching.

CARDIOVASCULAR:  Patient reports no chest pain, chest pressure or chest discomfort.

RESPIRATORY:  Patient reports no shortness of breath, cough or sputum.

NEUROLOGICAL:  Patient reports no dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities.

LYMPHATICS:  Patient denies knowledge of enlarged nodes. No history of splenectomy.

PSYCHIATRIC:  No history of depression or anxiety reported.

ENDOCRINOLOGIC:  No reports of sweating, cold or heat intolerance. No polyuria or polydipsia reported.

ALLERGIES:  No history of asthma, hives, eczema or rhinitis reported.

O.

Physical exam:

Diagnostic results: MRI should be considered to determine if there is a demyelinating disease or tumor triggering pain. There is no actual diagnostic tool for trigeminal neuralgia temporal, but other causes should be ruled out (Ball, Dains, Flynn, Solomon, & Stewart, 2015).

CT Scan could be ordered if felt to be sinusitis that does not respond to conservative or antibiotic treatment can lead to rare but dangerous sphenoid sinusitis affecting nerves (Velayudhan, Chaudhry, Smoker, Shinder, & Reede, 2017). CT scan is preferred over MRI for sinusitis diagnosis. 

A dental referral would be recommended if another diagnosis is ruled out or pain has oral pain or sign of dental inflammation.

Additional questions for the patient would be

Do you associate the pain with a specific event or timing?

How long have you experienced this pain?

Is the pain increasing, decreasing, or staying the same?

What makes the pain better?

Have you experienced similar pain before?

Do you have pain with chewing?

Do you grind your teeth?

Do you have nasal or postnasal drainage?

Do you have a fever?

A.  Headache with facial pain

Differential Diagnosis:

Trigeminal neuralgia temporal: The trigeminal nerve sends impulses to the upper, middle, and lower portions of the face. In this case, more than one nerve branch may be irritated and sending signals of pain to the upper head and the middle including the nose, cheekbones, and jaw.  It is possible for this pain to be bilateral (National Institute of Neurological Disorders and Stroke, n.d).  Some possible triggers of trigeminal pressure might be pressure from blood vessels or rarely a tumor. Another trigger could be demyelination, such as Multiple Sclerosis (MS). Ball, Dains, Flynn, Solomon, & Stewart (2015) report this condition occurs in older patients. An MRI should be considered to determine if another diagnosis such as MS is triggering the pain.

Headache due to reaction from electric cigarette/Vaping.  Cai & Wang (2017) shared the strong evidence of neurological effects from e-cigarette solvents and flavor additives.  The substances produced from vaping are acrolein, glycerol, propylene oxide, ethyl, ethyl matol, and methol which are toxic and related to neurological issues. Li, Zhan, Wang, Leischow, and Zeng (2016) reported severe headaches occurred after e-cigarette use due to high nicotine and propylene glycol. Fruit flavors also contributed

Sinusitis:  The frontal sinuses lie above the eyes which could contribute to the primary site of pain. The maxillary sinus could be inflamed causing the upper jaw, teeth, nose and cheek pain. One concern is sinusitis typically has postnasal discharge (Ball, Dains, Flynn, Solomon, & Stewart, 2015)

Tension-type headache (TTH):  A primary symptom of TTH is a hatband pain distribution (Ball, Dains, Flynn, Solomon, Stewart (2015).  Although rare, Wagner and Moreira Filho (2018) studied a TTH combined with temporomandibular junction sleep bruxism occurs during periods of anxiety.  This combined scenario could reflect the upper eye and jaw, cheek pain.

Dental Caries or Malocclusion: Ball, Dains, Flynn, Solomon, and Stewart (2015) reports dental disease is a primary source of pain in the jaw, but also could cause pain at top of the head.  In our patient’s case, the pain starts below the forehead and radiates lower making this diagnosis less likely.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.

Hua Cai, & Chen Wang. (2017). Graphical review: The redox dark side of e-cigarettes; exposure to oxidants and public health concerns. Redox Biology 3(C) 402-406 https://doi-org.ezp.waldenulibrary.org/10.1016/j.redox.2017.05.013

Li, Q., Zhan, Y., Wang, L., Leischow, S. J., & Zeng, D. D. (2016). Analysis of symptoms and their potential associations with e-liquids’ components: a social media study. BMC public health, 16, 674. doi:10.1186/s12889-016-3326-0

National Institute of Neurological Disorders and Stroke. (n.d). Trigeminal neuralgia fact sheet. Retrieved from https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Trigeminal-Neuralgia-Fact-Sheet

Velayudhan, V., Chaudhry, Z. A., Smoker, W. R. K., Shinder, R., & Reede, D. L. (2017). Imaging of intracranial and orbital complications of sinusitis and atypical sinus infection: What the radiologist needs to know. Current Problems in Diagnostic Radiology, 46(6), 441–451. https://doi-org.ezp.waldenulibrary.org/10.1067/j.cpradiol.2017.01.006

Wagner, B. de A., & Moreira Filho, P. F. (2018). Painful temporomandibular disorder, sleep bruxism, anxiety symptoms and subjective sleep quality among military firefighters with frequent episodic tension-type headache. Arquivos De Neuro-Psiquiatria, 76(6), 387–392. https://doi-org.ezp.waldenulibrary.org/10.1590/0004-282X20180043

Mental Health Research Paper –

Student will be provided a Psychiatric/Mental health disorder that they might have encountered or will encounter in nursing practice. Student will write a five (5)-page paper (not including reference or title page) with at least 4 references from a credible source in APA format. Please use LIRN platform for your research. Paper and presentation must include the require elements presented below. 

SCHIZOPHRENIA

Required elements        Points 

Introduction with a full description of the disorder                                         15

(including DSM V criteria and ICD 10 code)       

Cultural Component/History & Background                                                      15

Epidemiology/ Prevalence/Prognosis of the Disorder                                     10

(must include some statistics)                                                                     

Clinical features/ manifestations                                                                         10 

Sub-types of the Disorder / Differential Diagnosis                               10 

Treatment Approaches                                                                                          10

Patient and Family teaching       10

Conclusion/ Summary                      10

Cites four (4) APA format references (at least 5 years old)                             10  

TOTAL                                                   100

Writing Requirements (APA format)

• Length: 2 pages (not including title page or references page)
• Use standard essay writing process by including an introduction, body paragraphs, and a conclusion.
• 1-inch margins
• Double spaced
• 12-point Times New Roman font
• Title page
• References page (minimum of 2 scholarly source)
• No abstract is required
• In-text citations that correspond with your end references

 Women in Colonial America 

• Pick two colonies (New England, Middle, or Southern colonies) and explain how women’s roles differ in the two colonies of your choice.
• Describe what legal rights women held during the colonial period.
• Analyze how Native women’s lives were different from colonial women’s lives.

This assignment is designed to assist you in developing a thoughtful process for advocating about an issue as a nurse, from identifying a problem that needs to be solved through articulating a process for doing so.

This assignment consists of answering each of the questions listed below from the “Political Analysis and Strategies” chapter of your course textbook. Write each question as a new topic area; then follow with a paragraph or two to answer the question. Be sure to use APA guidelines for writing style, spelling and grammar, and citation of sources, if any used. This project should be no longer than 4 pages.

Let us assume that you are a school nurse in a high school. At a recent school athletic event, a spectator suffered a cardiac arrest in the stands. A coach of the home team went into the high school to fetch the automatic emergency defibrillator (AED) only to find out that it was not readily available. In the meantime, an emergency squad arrived and resuscitated the spectator. On Monday morning, you learn of the absence of the AED only to find out that it had been locked in the custodian’s closet. Reflect on the following questions outlined in the “Political Analysis and Strategies” chapter:

• What is the issue?
• Is it my issue, and can I solve it?
• Is this the real issue or merely a symptom of a larger one?
• Does it need an immediate solution, or can it wait?
• Is it likely to go away by itself?
• Can I risk ignoring it?
• What are the possible solutions? Are there risks to these solutions?
• What steps would you need to take in order to solve the issue?
• Does anyone else at the school need to be involved in the solution?
• Where is the power leverage in the school to reach the preferred solution?

Reaching a solution requires the use of power vested in the nurse. Review Box 9-1 (Sources of Power) and determine which type(s) of power the school nurse has in this situation. State your reasons for your answer.

Submission Details:

• Submit your response in a 4-page Microsoft Word document.
• Name your document SU_NSG4068_W4_Project_LastName_FirstInitial.doc.
• Submit your document to the Submissions Area by the due date assigned.
• Cite sources in the APA format on a separate page.