In clinical settings, pediatric patients often present with hematologic and metabolic disorders such as anemia and diabetes. Many of these disorders are manageable with drug therapy and lifestyle changes, but they can pose serious complications for patients if left untreated. In your role as the advanced practice nurse, you must identify patients at risk of hematologic and metabolic disorders and provide the appropriate education for them and their families. Consider potential treatment, management, and education strategies for the patients in the following case studies.

Case Study 1

You see a 1-week-old Asian infant for a weight check. The infant is back to his birth weight and is breastfeeding for 10 minutes every 2 hours with one 3-hour stretch a day. He is alert, has bowel movements with each feeding, and wets 8–10 diapers a day. His blood type is A+ and his mother’s blood type is A+. Coombs’ testing at birth was negative. You note slight scleral and skin jaundice.

Case Study 2

Jimmy is a 3-year-old “picky” eater according to his mother. He refuses to eat anything but waffles for breakfast and macaroni and cheese or chicken nuggets for lunch and dinner. He will eat apples and bananas but refuses all vegetables except corn. After a normal physical examination, you obtained blood testing that revealed the hemoglobin is 11.4 mg/dl and his hematocrit is 30% (both obtained by venipuncture). The CBC revealed microcytic hypochromic RBCs.

Case Study 3

Melissa is a 13-year-old who presents to your office for a well-child check. Physical examination reveals a thin child who is short of stature. Breast Tanner stage is II and pubic hair development is Tanner I. Neurologic, skin, heart, lung, abdominal, and HEENT examinations are normal.

To prepare:

• Review “Endocrine and Metabolic Disorders” and “Hematologic Disorders” in the Burns et al. text.
• Review and select one of the three provided case studies. Analyze the patient information.
• Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.
• Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or non-pharmacologic treatments.
• Consider strategies for educating patients and families on the treatment and management of the hematologic or metabolic disorder.

By Day 3

Post an explanation of the differential diagnosis for the patient in the case study you selected. Explain which is the most likely diagnosis for the patient and why. Include an explanation of unique characteristics of the disorder you identified as the primary diagnosis. Then, explain a treatment and management plan for the patient, including appropriate dosages for any recommended treatments. Finally, explain strategies for educating patients and families on the treatment and management of the hematologic or metabolic disorder.

  

Selecting a Population Health Problem

As you know, promoting positive social change is a part of the Walden mission. To be an effective agent for social change, nurses must be able to logically and critically analyze population health issues using epidemiologic concepts, and then communicate insights in a succinct and professional manner. This exercise will afford you such an experience.

This week, you will complete Assignment 1 in preparation for Major Assessment 7, in which you will apply epidemiologic principles and develop an intervention for a health problem.

For this Assignment, you will examine a health problem of interest to you, and you will develop a brief paper (2 pages) outlining the significance of the health problem and describing it in terms of person, place, and time. This outline will help your Instructor determine if the topic you selected is appropriate for the Major Assessment paper.

Prepare for Assignment 1 as follows:

• Review      the Major      Assessment Overview (see attached).
• Determine      a population health problem that is viable for completing this paper. You      may use the problem you identified in the Week 1, 2,      or Week 3 Discussion, or you may select a new one.
• Determine      the characteristics of the health problem in terms of person, place, and      time.
• Using      the Walden Library and credible websites, conduct additional research on      your selected population health problem. Consider the significance of this      health problem.
• Examine      how Healthy People 2020, listed in the Learning Resources, supports the      importance of addressing your selected health problem.
• Develop      a preliminary research question or hypothesis appropriate for your topic.

To complete:

Write a  2-page paper that addresses the following:

  

1) Introduction (must end with a purpose statement, e.g. “the purpose of this paper is …)

2) Describe the population health problem in terms of person, place, and time.

3) From the primary research literature and Healthy People 2020, briefly explain the significance of this health problem.

4) Include your preliminary research question or hypothesis. (PICOT format for the research question).

5) A conclusion

By Day 7 (tomorrow Sunday 03/18/2018 at 4 pm latest Submit your a 2-page paper in order to receive feedback on your topic

Required Readings

Friis, R. H., & Sellers, T. A. (2014). Epidemiology for public health practice (5th ed.). Sudbury, MA: Jones & Bartlett.

Chapter 6, “Study Designs: Ecologic, Cross-Sectional, Case Control”

Chapter 7, “Study Designs: Cohort Studies”

Chapter 6 presents an overview of analytic study designs used in epidemiology, differentiating between experimental studies (which will be addressed next week) and observational studies (the focus of this week). In the chapter, the authors address three varieties of observational studies—ecological, cross-sectional, and case control. Chapter 7 addresses cohort studies, another form of observational design.

Doll, R., & Hill, A. B. (1999). Smoking and carcinoma of the lung. Bulletin of the World Health Organization, 77(1), 84–93.

This landmark case-control study established the relationship between smoking and lung cancer.

Framingham Heart Study. (1998). Epidemiological background and design: The Framingham study. Retrieved from https://biolincc.nhlbi.nih.gov/static/studies/framcohort/Epidemiological_Background_and_Design.pdf

The Framingham Heart Study is one of the first and largest cohort studies that measured the distribution of suspected risk factors in a large population and then tracked the development of heart disease in that cohort.

Papathanasiou, A. A., & Zintzaras, E. (2010). Assessing the quality of reporting of observational studies in cancer. Annals of Epidemiology, 20(1), 67–73. 

In this article, the authors assess the quality of reporting of observational cancer studies, noting opportunities for improvement.

Von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gøtzsche, P. C., & Vandenbroucke, J. P. (2007). Strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies. Annals of Internal Medicine, 147(8), 573–577.

A consortium of scientists and medical researchers created a checklist of 22 recommended items that should be included in reports about three common observational study designs: case-control, cohort, and cross-sectional studies. This collaborative effort is an important step toward the goal of improving the quality, credibility, and generalizability of analytical research.

Healthy People 2020. (2011). Topics & objectives index. Retrieved from http://healthypeople.gov/2020/topicsobjectives2020/default.aspx

Healthy People 2020 focuses on improving population health locally and nationally. Review the topics and objectives of Healthy People 2020 as you prepare for Assignment 2.

Required Media

Laureate Education, Inc. (Executive Producer). (2012). Epidemiology and population health: Observational studies [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 9 minutes.

In this week’s program, the presenters discuss observational studies as a means of establishing an association between an exposure or risk factor and a disease outcome. Two types of observational designs are featured: cohort and case control studies.

Optional Resources

The following ERIC notebook guides present information in a reader-friendly study guide format.

Ibrahim, M., Alexander, L., Shy, C., & Farr, S. (1999). Cohort studies. ERIC Notebook, 3, 1–4. Retrieved from http://cphp.sph.unc.edu/trainingpackages/ERIC/eric_notebook_3.pdf

Ibrahim, M., Alexander, L., Shy, C., & Farr, S. (1999). Incidence measures in cohort studies. ERIC Notebook, 4, 1–4. Retrieved from http://cphp.sph.unc.edu/trainingpackages/ERIC/eric_notebook_4.pdf

Ibrahim, M., Alexander, L., Shy, C., & Farr, S. (1999). Case-control studies. ERIC Notebook, 5, 1–4. Retrieved from http://cphp.sph.unc.edu/trainingpackages/ERIC/eric_notebook_5.pdf

Ibrahim, M., Alexander, L., Shy, C., & Farr, S. (1999). Cross-sectional studies. ERIC Notebook, 7, 1–4. Retrieved from http://cphp.sph.unc.edu/trainingpackages/ERIC/eric_notebook_7.pdf

Ibrahim, M., Alexander, L., Shy, C., & Farr, S. (2000). Ecologic studies. ERIC Notebook, 12, 1–4. Retrieved from http://cphp.sph.unc.edu/trainingpackages/ERIC/eric_notebook_12.pdf

 

PREPARATION

Consider the hospital-acquired conditions that are not reimbursed for under Medicare/Medicaid. Among these conditions are specific safety issues such as infections, falls, medication errors, and other safety concerns that could have been prevented or alleviated with the use of evidence-based guidelines. Hospital Safety Score, an independent nonprofit organization, uses national performance measures to determine the safety score for hospitals in the United States. The Hospital Safety Score Web site and other online resources provide hospital safety scores to the public.

Read the scenario below:

Scenario
As the manager of a unit, you have been advised by the patient safety office of an alarming increase in the hospital safety score for your unit. This is a very serious public relations matter because patient safety data is public information. It is also a financial crisis because the organization stands to lose a significant amount of reimbursement money from Medicare and Medicaid unless the source of the problem can be identified and corrected. You are required to submit a safety score improvement plan to the organization’s leadership and the patient safety office.

Select a specific patient safety goal that has been identified by an organization, or one that is widely regarded in the nursing profession as relevant to quality patient care delivery, such as patient falls, infection rates, catheter-induced urinary infections, IV infections, et cetera.

DELIVERABLE: SAFETY SCORE IMPROVEMENT PLAN

Develop a 3–5 page safety score improvement plan.

• Identify the health care setting and nursing unit of your choice in the title of the mitigation plan. For example, “Safety Score Improvement Plan for XYZ Rehabilitation Center.”
• You may choose to use information on a patient safety issue for the organization in which you currently work, or search for information from a setting you are familiar with, perhaps from your clinical work.
  • Demonstrate systems theory and systems thinking as you develop your recommendations.

Organize your report with these headings:

Study of Factors

• Identify a patient safety issue.
• Describe the influence of nursing leadership in driving the needed changes.
• Apply systems thinking to explain how current policies and procedures may affect a safety issue.

Recommendations

• Recommend an evidence-based strategy to improve the safety issue.
• Explain a strategy to collect information about the safety concern.
  • How would you determine the sources of the problem?
• Explain a plan to implement a recommendation and monitor outcomes.
  • What quality indicators will you use?
  • How will you monitor outcomes?
  • Will policies or procedures need to be changed?
  • Will nursing staff need training?
  • What tools will you need to do this?

Additional Requirements

• Written communication: Written communication should be free of errors that detract from the overall message.
• APA formatting: Resources and in-text citations should be formatted according to current APA style and formatting.
• Length: The plan should be 3–5 pages.
• Font and font size: Times New Roman, 12 point, double-spaced.
• Number of resources: Use a minimum of three peer-reviewed resources.

Write a 3–5 page safety score improvement plan for mitigating concerns, addressing a specific patient-safety goal that is relevant to quality patient care. Determine what a best evidence-based practice is and design a plan for resolving issues resulting from not maintaining patient safety.Quality improvement and patient safety are health care industry imperatives (Institute of Medicine’s Committee on Quality of Health Care in America, 2001). Effective quality improvement results in system and organizational change. This ultimately contributes to the creation of a patient safety culture

Context

• Quality improvement and patient safety are health care industry imperatives (Institute of Medicine’s Committee on Quality of Health Care in America, 2001). Effective quality improvement results in system and organizational change. This ultimately contributes to the creation of a patient safety culture. Quality improvement and patient safety are central to the nursing leadership role. They are analyzed from many perspectives. Types of quality improvement and patient safety programs may range from internal, organization-based quality improvement team reports to external benchmarks from The Joint Commission, the Agency for Healthcare Research and Quality (AHRQ), Magnet, and numerous other organizations.A landmark publication by the Institute of Medicine’s Committee on Quality of Health Care in America (2001) identified the imperative to focus on quality care and patient safety. The initiative to create cultures of patient safety and quality care remain at the forefront of the health care leadership landscape. Nursing leadership sub-competencies include the understanding of components and use of effective tools for successful quality improvement programs within the practice setting.For a more recent snapshot of progress in the arena of patient safety, you may review a recent executive summary database report on safety cultures from the U.S. Department of Health & Human Services (n.d.). Lessons learned and tools presented within the directed readings provide a rich set of resources from which to draw for improved nurse leadership in the area of patient safety.References
  Institute of Medicine’s Committee on Quality of Health Care in America. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press.U.S. Department of Health & Human Services. (n.d.). HHS.Gov. Retrieved from http://www.hhs.gov/
• QUESTIONS TO CONSIDER
  To deepen your understanding, you are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of the health care community.Consider a performance measurement criteria or best practice guideline used in your work setting (or one that you are familiar with).
  • How was this criterion or guideline implemented?
    • Has it been successful?
    • Is it used consistently?
  • What evidence-based practices were used in developing the criteria or guideline?
  • How was nursing involved in the criteria or guideline development?
• RESOURCES

  Internet Resources
  Access the following resources by clicking the links provided. Please note that URLs change frequently. Permissions for the following links have been either granted or deemed appropriate for educational use at the time of course publication.

  • Hospital Safety Score. (n.d.). What is patient safety? Retrieved from http://www.hospitalsafetyscore.org/what-is-patient…
  • Agency for Healthcare Research and Quality. (n.d.). AHRQ. Retrieved from http://www.ahrq.gov
  • National Academy of Medicine. (n.d.). Retrieved from http://nam.edu
  • Centers for Medicare & Medicaid Services. (n.d.). Hospital-acquired conditions. Retrieved from https://www.cms.gov/medicare/medicare-fee-for-serv…
  • American Nursing Informatics Association. (n.d.). ANIA. Retrieved from https://www.ania.org/
  • HIMSS. (n.d.). Nursing informatics. Retrieved from http://www.himss.org/ASP/topics_nursingInformatics…
  • Chao, S., Anderson, K., & Hernandez, l. (2009). Toward health equity and patient-centeredness: Integrating health literacy, disparities reduction, and quality improvement: Workshop Summary (2009). Washington, DC: The National Academies Press. Retrieved from http://www.nap.edu/catalog.php?record_id=12502
  • The Joint Commission. (n.d.). National patient safety goals. Retrieved from http://www.jointcommission.org/standards_informati…
  • AHRQ. (n.d.). Quality and patient safety. Retrieved from http://www.ahrq.gov/professionals/quality-patient-…
  • AONE. (n.d.). Retrieved from http://www.aone.org/
  • National Academies: Health and Medicine Division. http://www.nationalacademies.org/hmd/
  • American Nurses Association. (n.d.). NursingWorld. Retrieved from http://nursingworld.org/
  • American College of Healthcare Executives. (n.d.). Retrieved from http://www.ache.org/
  • Institute for Healthcare Improvement. (n.d.). Retrieved from http://www.ihi.org/Pages/default.aspx
  • U.S. Department of Health & Human Services. (n.d.). HHS.Gov. Retrieved from http://www.hhs.gov/
  • National Institutes of Health. (n.d.) Retrieved from http://www.nih.gov/
  • NCQA. (n.d.) Retrieved from http://www.ncqa.org/
  • QSEN Institute. (n.d.). Retrieved from http://www.qsen.org/
  • Agency for Healthcare Research and Quality. (2009). Hospital survey on safety culture: 2009 comparative database report. Retrieved from http://www.ahrq.gov/professionals/quality-patient-…
  • Hospital Safety Score. (n.d.). Retrieved from http://www.hospitalsafetyscore.org/
  • I have provided the example given =)

  

Community Teaching Work Plan Proposal 

Directions: Develop an educational series proposal for your community using one of the following four topics: 

1) Bioterrorism/Disaster 

2) Environmental Issues 

3) Primary Prevention/Health Promotion 

4) Secondary Prevention/Screenings for a Vulnerable Population 

Planning Before Teaching:

  

Name and Credentials of   Teacher:

 

Estimated Time Teaching   Will Last:

Location of Teaching:

 

Supplies, Material,   Equipment Needed:

Estimated Cost:

 

Community and Target   Aggregate:

 

Topic:

Epidemiological Rationale for Topic (statistics related to topic):

Nursing Diagnosis:

Readiness for Learning: Identify the factors that would indicate the readiness to learn for the target aggregate. Include emotional and experiential readiness to learn.

Learning Theory to Be Utilized: Explain how the theory will be applied. 

Goal: Healthy People 2020 (HP2020) objective(s) utilized as the goal for the teaching. Include the appropriate objective number and rationale for using the selected HP2020 objective (use at least one objective from one of the 24 focus areas). If an HP2020 objective does not support your teaching, explain how your teaching applies to one of the two overarching HP2020 goals.

How Does This HP2020 Objective Relate to Alma Ata’s Health for All Global Initiatives (See page 116 in the textbook)? 

Develop Behavioral Objectives (Including Domains), Content, and Strategies/Methods: 

  

Behavioral   Objective
  and Domain

Example – Third-grade   students will name one healthy food choice in each of the five food groups by   the end of the presentation. (Cognitive Domain) 

Content  
(be specific)

Example – The Food Pyramid   has five food groups which are….

Healthy foods from each   group are….
  Unhealthy foods containing a lot of sugar or fat are….

Strategies/Methods

(label and describe)

Example – Interactive   poster presentation of the  Food Pyramid. After an explanation of the poster   and each food category, allow students to place pictures of foods on the   correct spot on the pyramid. Also, have the class analyze what a child had   for lunch by putting names of foods on the poster and discussing what food   group still needs to be eaten throughout day.

 

1.

1.

1.

 

2.

2.

2.

 

3.

3.

3.

 

4.

4.

4.

Creativity: How was creativity applied in the teaching methods/strategies? 

Planned Evaluation of Objectives (Outcome Evaluation): Describe what you will measure for each objective and how.

1)  

2)  

3)  

4)  

Planned Evaluation of Goal: Describe how and when you could evaluate the overall effectiveness of your teaching plan. 

Planned Evaluation of Lesson and Teacher (Process Evaluation):

Barriers: What are potential barriers that may arise during teaching and how will those be handled?

Communication: How will you begin your presentation (hook them in)? How will you end your presentation (go out with a bang)? What nonverbal communication techniques will you employ?

 In order to undertake this 1500 word essay you will need to research the topic using current and relevant peer reviewed literature and review of:  The lecture and tutorial material associated with the relevant topic.  Your knowledge and understanding related to: 1. The physiology and pathophysiology of the primary diagnosis and associated clinical data identified within the chosen case study; 2. The physiological assessments relevant to the features within the case study. The assessment tasks requires you to: 1. Identify and discuss two (2) signs or symptoms of clinical deterioration associated with the presenting problem, from chosen case study. This discussion should consider the potential impact of case study data (e.g. pathology results, past medical history) on the health status of the patient in the chosen case. 2. Following on from your presented discussion associated with point one (1), develop a clinical plan of care which identifies:  One (1) priority of clinical care and; Discuss three (3) nursing interventions that directly address the identified clinical priority. The discussion should refer to relevant clinical assessments. Measurable outcome parameters for each intervention will be discussed to justify the intervention and evaluate its efficacy. Discussion is to be supported with contemporary research