Case Study:

Chief complaint: “I’m here for a medication refill because I ran out of my medicines”. 

HPI:  Mrs. Allen is a 68-year-old African American who presents to the clinic for prescription refills. The patient indicates that she has noticed shortness of breath which started about 3 months ago. The SOB gets worse with exertion, especially when she is walking fast, and it is resolved when she is resting. She reports that she is also bothered by shortness of breath that wakes her up intermittently during her sleep. Her symptoms of shortness of breath resolve after sitting upright on 3 pillows. She also has lower leg edema pitting 1+ which started 2 weeks ago. She indicates that she often feels light headed at times with intermittent syncope episodes while going up a flight of stairs, but it resolves after sitting down to rest. She has not tried any over the counter medications at home.

She started taking her medications, but failed to refill the prescriptions because she cannot afford the medications as she only works part-time and lives alone. In addition, she reports that she does not think taking all these medications would help her condition anyway. 

PMH: Primary Hypertension, Previous history of MI 1 year ago

Surgeries:

1 year ago-Left Anterior Descending (LAD) cardiac stent placement

Allergies: Penicillin

Vaccination History:  Up-to-date

Social history:

High school graduate married and no children. Drinks one 4-ounce glass of red wine daily. She is a former smoker and stopped 5 years ago.

Family history:

Both parents are alive. Father has history of MI and valvular heart disease; mother alive and cardiac history is unknown. He has one brother who is alive and has history of MI 5 years ago at age 52.

ROS:

Constitutional: Lightheaded and faint with exertion. Respiratory: Shortness of breath with exertion. + Orthopnea. Cardiovascular: + 2 pitting leg edema for 3 weeks.

Psychiatric: Non-contributory.

Physical examination:

Vital Signs: Height: 5 feet 1 inches Weight: 175 pounds BMI: 32, Obese, BP 160/92, T 98.0, P 111,  R 22 and non-labored

HEENT: Normocephalic/Atraumatic, Bilateral cataracts; PERRLA, EOMI; Teeth intact. Negative for gum disease. NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement. LUNGS: + Mild Crackles on inspiratory phase not clearing with cough. Equal breath sounds. Symmetrical respiration. No respiratory distress. HEART: Normal S1 with S2 during expiration. An S4 is noted at the apex; + systolic murmur noted at the right upper sternal border without radiation to the carotids. Pulses are 2+ in upper extremities and 2+ in pedal pulses bilaterally. 2+ pitting edema to her knees noted bilaterally. ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses. GENITOURINARY: No CVA tenderness bilaterally. GU exam deferred. MUSCULOSKELETAL: + Heberden’s nodes at the DIP joints, hands. + Crepitus, bilateral knees. Slow gait but steady. No Kyphosis. PSYCH: Normal affect. Cooperative. SKIN: No rashes. Positive for dry skin.

Labs: Hgb 13.2, Hct 38%, K+ 4.0, Na+137, Cholesterol 228, Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98.

A:

Primary Diagnosis: Congestive Heart Failure (CHF) 

Secondary Diagnoses: Primary Hypertension, Obesity, Osteoarthritis (OA) 

Differential Diagnosis: Peripheral Vascular Disease (PVD) 

Plan: 

Medications: Tylenol 650 mg PO Q4 hours as needed for arthritis pain

Labs: UA; Brain natriuretic peptide (BNP); LFTs and TSH; 12-lead EKG, Chest X-ray; Initial 2D echo with Doppler; Ankle-brachial index.

Additional lab results: Echo results 1 week ago: Left ventricular EJ Fraction decreased to 35 %

BNP – not available. 

As a future FNP, you need to determine the medications for CHF/ASCVD. (Arteriosclerotic Cardiovascular Disease). 

Questions:

1.     According to the ACC/AHA guidelines, what medications should this patient be prescribed?

2.     Does he need medication(s) given his history of MI? 

Requirements:

-APA style 6th edition

-NO PLAGIARISM.

-2-3 REFERENCES NO MORE THAN 5 YEARS OLD.

-ANSWER TWO QUESTION ABOVE BASED ON THE CASE STUDY PROVIDED.

-1 INTRODUCTION PAGE.

-2 PAGE OF CONTENT and short CONCLUSION.

 

In 1,000-1,500 words, provide a description of the methods to be used to implement the proposed solution. Include the following:

1. Describe the setting and access to potential subjects. If there is a need for a consent or approval form, then one must be created. Although you will not be submitting the consent or approval forms in Topic 5 with the narrative, you will include the consent or approval forms in the appendices for the final paper.
2. Describe the amount of time needed to complete this project. Create a timeline. Make sure the timeline is general enough that it can be implemented at any date. Although you will not be submitting the timeline in Topic 5 with the narrative, you will include the timeline in the appendices for the final paper.
3. Describe the resources (human, fiscal, and other) or changes needed in the implementation of the solution. Consider the clinical tools or process changes that would need to take place. Provide a resource list. Although you will not be submitting the resource list in Topic 5 with the narrative, you will include the resource list in the appendices for the final paper.
4. Describe the methods and instruments, such as a questionnaire, scale, or test to be used for monitoring the implementation of the proposed solution. Develop the instruments. Although you will not be submitting the individual instruments in Topic 5 with the narrative, you will include the instruments in the appendices for the final paper.
5. Explain the process for delivering the (intervention) solution and indicate if any training will be needed.
6. Provide an outline of the data collection plan. Describe how data management will be maintained and by whom. Furthermore, provide an explanation of how the data analysis and interpretation process will be conducted. Develop the data collection tools that will be needed. Although you will not be submitting the data collection tools in Topic 5 with the narrative, you will include the data collection tools in the appendices for the final paper.
7. Describe the strategies to deal with the management of any barriers, facilitators, and challenges.
8. Establish the feasibility of the implementation plan. Address the costs for personnel, consumable supplies, equipment (if not provided by the institute), computer-related costs (librarian consultation, database access, etc.), and other costs (travel, presentation development). Make sure to provide a brief rationale for each. Develop a budget plan. Although you will not be submitting the budget plan in Topic 5 with the narrative, you will include the budget plan in the appendices for the final paper.
9. Describe the plans to maintain, extend, revise, and discontinue a proposed solution after implementation.

You are required to cite five to 10 sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

Prepare this assignment according to the 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. Please refer to the directions in the Student Success Center.

Note: After submitting the assignment, you will receive feedback from the instructor. Use this feedback to make revisions for your final paper submission. This will be a continuous process throughout the course for each section.

 

Read Chapter 8

1. Describe a situation in which the nurse manager would use problem resolution in the workplace. Describe a situation in which the nurse manager would use negotiation to resolve a conflict (or potential conflict) in the workplace. 

2. Compare and contrast strategies for resolving a conflict, using first the informal negotiation method and then the formal negotiation method. 

3. Explore the American Nurses Association website for information on collective bargaining for nurses. Which states have nursing unions? Debate the issue of joining a union with another group of students. 

4. PART 1: Log onto the website of your state nurses association and search for information on collective bargaining. Search for news articles, union websites, and other recent information on collective bargaining for nurses in your state. Is there a great deal of collective bargaining activity in your state? If not, why? If yes, what are the primary issues under discussion?

PART 2: Review the pros and cons of becoming part of a collective bargaining unit. If you were a full-time staff nurse, would you want to join a union? Why or why not?

APA style (in text citations and references)

plagiarism FREE

  

Instructions:

Read the evidence representing the three forms of nursing inquiry (QI, research, and EBP) on provided articles (attached). selected problem/ articles: (Improving the control of blood sugar in diabetic patients). Analyze the aim, methods used, and outcomes sought for each type of inquiry. Determine how teamwork and critical thinking processes were implemented. Create a PowerPoint presentation using Microsoft PowerPoint. 

Material provided (attached): three articles related to Diabetes using QI, research, and EBP approach: 

– American Diabetes Association. (2018). Diabetes Care in the Hospital: Standards of Medical Care in Diabetes-2019. doi: 10.2337/dc19-S015 Link (Links to an external site.)

– Russell, N.M., Vess, J., Durham, C., & Johnson, E. (2017). Text-messaging to support diabetes self-management in a rural health clinic: A Quality Improvement project. Online Journal of Nursing Informatics, 21(2). Link (Links to an external site.)

– Whitehead, L.C., Crowe, M.T., Carter, J.D., Maskill, V.R., Caryle, D., Bugge, C., & Frampton, C.M.A. (2017). A nurse-led education and cognitive behavior therapy-based intervention among adults with uncontrolled type 2 diabetes: A randomized controlled trial. Journal of Evaluation in Clinical Practice, 23(4). 821-829. doi: 10.1111/jep.12725 Link (Links to an external site.)

Purpose: The purpose of this assignment is to analyze the differences and similarities between the three forms of nursing inquiry: quality improvement (QI), research, and evidence-based practice (EBP). This assignment will allow for a discovery into the aim, methods and outcomes associated with each type of inquiry, including how these forms of inquiry are distinct yet similar in addressing a nursing practice problem. Formulation of a PowerPoint presentation which is inclusive of comprehensive speaker notes that supports professional formation, communication, and dissemination skills relevant to the DNP practice scholar. 

Include the following sections addressing the three forms of nursing inquiry (detailed criteria listed below and in the Grading Rubric).

– Introduction (1-2 slides)

– Describes purpose of the presentation

– Identifies selected nursing problem

– Includes significance and scope of the practice problem (including citation)

– Differentiation of the three forms of nursing inquiry (2-4 slides)

– Compares and contrasts QI, research, and EBP as forms of nursing inquiry

– Discusses the impact of each form of inquiry on nursing practice

– Describes how the DNP practice scholar applies each form of inquiry

– Analyses of the evidence representing the three forms of nursing inquiry (5-7 slides)

–  Identifies selected evidence representing the three forms of nursing inquiry (including citations)

– Compares and contrasts the aims of the selected evidence in addressing the practice problem

– Compares and contrasts the methods used in the selected evidence

– Examines the impact of teamwork, when used, in the selected evidence

– Compares outcomes in the selected evidence

– Conclusion (2-3 slides)

– Includes an evaluation of the impact of the three forms of evidence on the selected nursing practice problem /

– Includes a summative statement of the impact of the forms of inquiry on nursing

– Includes a summative statement of the impact of the forms of inquiry on the role of the DNP practice scholar

– References (1-2 slides). Includes all references cited in the presentation. Can be the three provided for analysis (attached material) and at least another to address the differences between quality improvement (QI), research, and evidence-based practice (EBP). 

PowerPoint Requirements:

– Includes 10-18 PowerPoint slides

– Maintains the 6 x 6 rule for a professional PowerPoint presentation: (no more than 6 lines per slide, 6 words per line).

–  Include speaker notes that support professional formation, communication, and dissemination skills.

– Grammar and mechanics are free of errors 

– Uses appropriate APA format (6th ed.) and is free of errors