Max is an 80-year-old male with a history of gastroesophagea
Max is an 80-year-old male with a history of gastroesophageal reflux disease (GERD), hypertension (HTN) CC: “I have stomach pain.” HPI: Max is an 80-year-old male with a history of gastroesophageal reflux disease (GERD), hypertension (HTN), and a pacemaker placed 10 years ago for third-degree heart block. He presents today with a complaint of abdominal pain. You suspect a bowel obstruction in Max, an 80-year-old patient with complaints of cramping abdominal pain, nausea, and vomiting for 4 days. Describe six (6) ROS questions you would explore further with him to determine the location, severity, and timing of his pain. PE: On exam, the abdomen appears distended, Max has generalized tenderness over the epigastric region on palpation. He is guarding so the exam is limited. Bowel sounds are decreased. His vital signs are normal. He describes his abdominal pain as 7/10. As the APRN, you order an abdominal x-ray. Test results: The abdominal x-ray is indeterminate. What are your next diagnostic choices to determine a bowel obstruction in this patient? List at least three differential diagnoses for abdominal pain. The CT scan shows that Max has a small bowel obstruction. What is your next step? Expert Answer and Explanation Focused SOAP Note Small Intestine Obstruction Patient Information: Max, 80 years, male, African American S CC: “I have stomach pain.” HPI: Max is an 80-year-old male of African American origin who came to the health clinic complaining of abdominal pain. The pain is located in the abdominal area. It started four days ago. The character of pain is cramping and intermittent. Associated signs include nausea and vomiting. The patient notes that the severity of the pain is 7/10. Current Medications: No medications. Allergies: No food, dug, or environmental allergies. PMHx: Past major illnesses include hypertension (HTN), gastroesophageal reflux disease (GERD), and a pacemaker placed 10 years ago for third-degree heart block. He does not remember when he took tetanus or pneumonia shots. Soc and Substance Hx: He took alcohol in his thirties and quit over 45 years ago. He comes from a working family. No history of illicit drug or tobacco use. He says that he has smoke detectors in his house and wears seat belts while driving. His support system is his son and two daughters. Fam Hx: His father died from colon cancer. His mother died from type II diabetes. His older son died in an accident at the age of 28. His second child has type two diabetes. His grandchildren are healthy. Surgical Hx: He reports a knee operation at 33 years old. Mental Hx: No mental health disorder diagnosis and treatment. No history of self-harm. Violence Hx: No history of violence. Reproductive Hx: He is sexually inactive and has no reproductive health. ROS GENERAL: He reports fatigue and weakness. No fever or chills. HEENT: Eyes: No visual loss. Ears, Nose, Throat: No congestion, sneezing, hearing loss, sore throat, or runny nose. SKIN: No rash or itching. CARDIOVASCULAR: No chest discomfort, pressure, pain, or edema. RESPIRATORY: No shortness of breath. GASTROINTESTINAL: No diarrhea or anorexia. GENITOURINARY: No burning on urination. NEUROLOGICAL: No dizziness, headache, paralysis, or syncope. MUSCULOSKELETAL: No joint or muscle pain. HEMATOLOGIC: No anemia. LYMPHATICS: No enlarged nodes. O Physical exam: Vitals: BP 139/92, Temp 35, P 78, Ht. 5’9, Wt. 87kgs. Cardiovascular: No cracks in the chest. No edema. Respiratory: No breathing distress. No wheezes or crackles. No fluids in the lungs. Genitourinary: No urinary retention. No renal angle tenderness. No tender bowel loops. No abdominal masses. Gastrointestinal: Bowel sounds absent on inspection. Distension of the abdomen on auscultation. Diagnostic results: The abdominal x-ray is indeterminate. Since an x-ray is indeterminate, a CT scan should be ordered. A CT scan combined with X-ray images. Dou et al. (2022) noted that a CT scan combined with multiple X-ray images will show intestinal obstructions. Blood test: A blood test will be used to identify whether the patient has intestinal infections. A Differential diagnoses: Small intestine obstruction: The primary diagnosis for this case is small intestine obstructions. According to Jackson and Cruz (2018), the symptoms of small intestine obstructions include vomiting, crampy abdominal pain and comes and goes, constipation, loss of appetite, swelling of the abdomen, and inability to pass gas or have a bowel movement. Small intestine obstruction is the main diagnosis because the patient complains of crampy abdominal pain, nausea, and vomiting which are major symptoms of the disease (Jackson & Cruz, 2018). Physical exam results (bowel sounds absent on inspection, distension of the abdomen on auscultation) also show that the patient has a small intestine obstruction. Appendicitis: The second diagnosis is appendicitis. The symptoms of appendicitis include flatulence, loss of appetite, vomiting and nausea, sudden pain that starts in the lower abdomen, pain that worsens when one coughs, diarrhea and constipation, low-grade fever and might increase if the illness progresses, and abdominal bloating (Talan & Di Saverio, 2021). The disease has been included because the patient reports abdominal pain, nausea, and vomiting which are part of the clinical manifestations of appendicitis. However, it is a secondary diagnosis because the patient does not have a low-grade fever, diarrhea, or pain in the lower abdomen. Intestinal Infection: The last diagnosis is an intestinal infection. The symptoms of intestinal infection include headache, vomiting, nausea, diarrhea, crampy abdominal pain, and fever (Guo et al., 2021). The disease has been ruled out because the patient does not have a headache or fever. P The patient will be recommended to undergo a CT scan combined with a series of X-ray images of the small intestine. The patient will also undergo blood tests. These tests will help identify the actual disease affecting the patient. Since it is suspected that the patient has small intestine obstructions, he should be hospitalized (Ten Broek et al., 2018)). The pain should be stabilized by placing an intravenous (IV) line into the patient’s arm so that he can be given fluids. Abdominal swelling should be relieved by putting a nasogastric tube inside the patient’s nose into his stomach to suck out fluids
Rough Draft Qualitative Research Critique and Ethical Consid
Rough Draft Qualitative Research Critique and Ethical Considerations Rough Draft Qualitative Research Critique and Ethical Considerations Write a critical appraisal that demonstrates comprehension of two qualitative research studies. Use the “Research Critique Guidelines – Part 1” document to organize your essay. Successful completion of this assignment requires that you provide rationale, include examples, and reference content from the studies in your responses. Use the practice problem and two qualitative, peer-reviewed research article you identified in the Topic 1 assignment to complete this assignment. In a 1,000–1,250 word essay, summarize two qualitative studies, explain the ways in which the findings might be used in nursing practice, and address ethical considerations associated with the conduct of the study. 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. Refer to the LopesWrite Technical Support articles for assistance. Expert Answer and Explanation Research Critique Guidelines – Part II (Quantitative Studies) Dealing with postoperative pain, nausea, and vomiting is one of the issues that patients encounter after surgical procedures that affect their comfort and satisfaction and outcomes. Dealing with these challenges can affect the recovery process of the patient and may even prolong the discharge period. Several studies have tried to pinpoint different interventions that can assist in dealing with the issue of postoperative pain nausea and vomiting, with each having different results. The PICOT question, therefore, aimed to establish whether in adult patients undergoing general anesthesia, does giving preoperative analgesic and antiemetics decrease pain, nausea and vomiting postoperatively and provide better patient outcomes as compared to not receiving preoperative meds. Quantitative Studies To answer the PICOT question, this paper selected two quantitative research studies that had evidence-based interventions of dealing with postoperative pain nausea and vomiting. The selected studies were conducted by Elgohary et al. (2017) and Chetna et al. (2014). Some of the elements identified from the studies are detailed in the subsequent sections Background The first quantitative article reviewed was an article by Elgohary et al. (2017). The study wanted to carry out a comparison between the effectiveness of the ERAS program and the conventional perioperative care in patients who have undergone elective colorectal surgery. The author notes that the ERAS program has been revolutionary is assisting patients who have undergone colorectal surgery, among other surgical procedures, to respond better to stress and improving postoperative outcomes. The authors also note that the main aim of the ERAS pathway is to reduce the duration of hospitalization and allow the patient to recover quickly. However, the adoption of the program, especially in developing countries, has been slow despite sufficient evidence showing the effectiveness of the program. Therefore, the authors wanted to carry out a supportive investigation on the effectiveness of the ERAS pathway in patients after undergoing elective colorectal surgery. The findings collected in this study holds major significance in nursing practice since the results collected will facilitate the adoption of the ERAS pathway as a viable intervention in improving postoperative patient outcomes. The main aim of the research conducted by Elgohary et al. (2017), was to examine the feasibility and safety of the ERAS pathway in elective colorectal surgery. The research question identified from this objective can be quoted as “is the ERAS pathway feasible and safe for use in patients who have undergone elective colorectal surgery. The second quantitative study selected was conducted by Chetna et al. (2015). The study elaborated on the use of gabapentin for postoperative pain relief for patients who have undergone upper abdominal surgery. The researcher noted that in patients who have undergone upper abdominal surgeries, postoperative pain not only causes them distress but also leads to inadequate respiratory effort and cough reflexes, therefore, a need to have a pain relief strategy. The authors go further to site the efficacy of gabapentin in dealing with pain on patients who have undergone other types of surgical procedures. Therefore, the study was purposed at identifying whether the drug will still be effective in dealing with postoperative pain, for patients who have undergone upper abdominal surgery. The findings obtained in that research are relevant in enhancing patient recovery period and outcomes by eliminating postoperative pain, and in turn, improving respiratory efforts and cough reflex of the patient. The research question used in the study can be quoted as follows “How effective is gabapentin in reducing postoperative pain in patients who have undergone upper abdominal surgery?” How do these two articles support the nurse practice issue you chose? The main aim of the PICOT question was to establish viable methods of dealing with postoperative pain, nausea, and vomiting. The two articles provide evidence-based interventions on how postoperative pain can be dealt with. The first article by Elgohary et al. (2017) focuses on the ERAS pathway on reducing postoperative pain while the second article by Chetna et al. (2015) focuses on gabapentin on dealing with postoperative pain in patients who have undergone upper abdominal surgery. The finding on both studies will be used as a basis of assessing the effectiveness of using preoperative analgesics and antiemetics to decrease pain, nausea, and vomiting in patients postoperative as intended by the PICOT question. The first study was majorly focused on patients who have undergone elective colorectal surgery, while the second article was focused on patients who have undergone upper abdominal surgery. For both studies, the participants were placed in two groups. The first study by Elgohary et al. (2017) used the conventional recovery pathway as their comparison group, while the second study placed their comparison group under placebo. The intervention groups were placed under different perioperative pain regimen. This will be the same approach to be used by the PICOT question, with the difference being the target participants. The PICOT question used adult patients who had undergone general anesthesia
Identify your selected healthcare concern in your city or
Identify your selected healthcare concern in your city or state that needs your advocacy Identify your selected healthcare concern in your city or state that needs your advocacy with an elected official. What is the impetus and rationale for your selection? What is your solution to this concern? Describe the model of policy making that you feel would be best applied to your policy concern and the rationale for selecting this model. Expert Answer and Explanation The selected Healthcare Issue and Rationale for the Selection Mental health is the selected concern, and it encompasses various mental disorders and conditions. Examples are depression, phobia and schizophrenia. There is disparity in access to the mental health services, and people with mental health problems often face discrimination. In Texas, these concerns can impede efforts focused on meeting the health needs of people with mental illnesses. This is a key rationale for the selection of the mental illness as a problem that requires advocacy (Boehme, Biehl, & Mühlberger, 2019). Another reason why healthcare professionals need to advocate for the issue is to help reduce mortality rates based on mental health concerns. The Solution for the Concern The key solution for this concern is the expansion and funding of programs focused on increasing screening and treatment of people with mental health problems. In this case, it is important to call for the state government to allocate more funds into programs which address this particular health concern. The funds can be used to purchase medications, and resources which create awareness about mental health problems. However, subsidizing costs of treating this healthcare concern, through government-managed insurance plans, can equally help address the problem (Li et al., 2021). The Suitable Model of Policy Making and Rationale The institutional model would apply to the policy concern. Under this model, the authority lends legitimacy to the laws, and these laws equally apply to everyone. This is the rationale for the selection of the model. Using this model, the government can come up with policies which require the allocation of resources and funds to help manage the mental health challenges (Niedziałkowski & Putkowska-Smoter, 2020). It can use the local authorities or agencies which are responsible of enforcing the laws. References Boehme, S., Biehl, S. C., & Mühlberger, A. (2019). Effects of Differential Strategies of Emotion Regulation. Brain sciences, 9(9), 225.Doi: https://doi.org/10.3390/brainsci9090225. Li, Y., Scherer, N., Felix, L., & Kuper, H. (2021). Prevalence of depression, anxiety and post-traumatic stress disorder in health care workers during the COVID-19 pandemic: A systematic review and meta-analysis. PLoS ONE 16(3), e0246454.Doi: https://doi.org/10.1371/journal.pone.0246454. Niedziałkowski, & K., Putkowska-Smoter, R. (2020). What makes a major change of wildlife management policy possible? Institutional analysis of Polish wolf governance. PLoS ONE 15(4), e0231601. Doi: https://doi.org/10.1371/journal.pone.0231601. Place your order now on the similar assignment and get fast, cheap and best quality work written from scratch by our expert level assignment writers. Other Solved Questions: SOLVED! How would your communication and interview SOLVED! Describe the difference between a nursing practice SOLVED! Discuss how elimination complexities can affect SOLVED! Case C 38-year-old Native American pregnant ANSWERED! In a 1,000–1,250 word essay, summarize two [ANSWERED] Students will develop a 1,250-1,500 word paper that includes [ANSWERED] Post a description of the national healthcare ANSWERED!! Explain how you would inform this nurse ANSWERED!! In a 4- to 5-page project proposal written to the
In a 4 to 5 page project proposal written to the leadership
In a 4 to 5 page project proposal written to the leadership In the Discussion for this module, you considered the interaction of nurse informaticists with other specialists to ensure successful care. How is that success determined? Patient outcomes and the fulfillment of care goals is one of the major ways that healthcare success is measured. Measuring patient outcomes results in the generation of data that can be used to improve results. Nursing informatics can have a significant part in this process and can help to improve outcomes by improving processes, identifying at-risk patients, and enhancing efficiency. To Prepare: Review the concepts of technology application as presented in the Resources. Reflect on how emerging technologies such as artificial intelligence may help fortify nursing informatics as a specialty by leading to increased impact on patient outcomes or patient care efficiencies. The Assignment: (4-5 pages) In a 4 to 5 page project proposal written to the leadership of your healthcare organization, propose a nursing informatics project for your organization that you advocate to improve patient outcomes or patient-care efficiency. Your project proposal should include the following: Describe the project you propose. Identify the stakeholders impacted by this project. Explain the patient outcome(s) or patient-care efficiencies this project is aimed at improving and explain how this improvement would occur. Be specific and provide examples. Identify the technologies required to implement this project and explain why. Identify the project team (by roles) and explain how you would incorporate the nurse informaticist in the project team. Expert Answer and Explanation The Impact of Nursing Informatics on Patient Outcomes and Patient Care Efficiencies Among the ways that informatics has helped to transform care is improved documentation systems, where care providers can easily access important patient and staff information that leads to coordinated care. The introduction of nurse informatics also helps to improve the processes in care and hence to generate improved care outcomes (Robert, 2019). Also, with informatics, healthcare givers can identify at-risk patients in a timely fashion and give them more priority to care. Description of Proposed Project: The Integration of Artificial Intelligence in Nurse Informatics Artificial intelligence, commonly known as AI, is the simulation of intelligence of humans to machines to make these machines adopt human functions. Over the years, there have been improvement of the AI functions as technologies continue improving. Today AI applications include but are not limited to speech recognition, machine vision, natural language processing, and expert systems. Healthcare implements AI by using complex software and algorithms to interpret and comprehend complex medical data (Clancy, 2020). The fact that AI uses technologies that can gain information and process it to refined outputs means that it can have limitless applications in healthcare. In this project, the implementation of AI in the field of nurse informatics is closely examined. Stakeholders Impacted by the Project There are several stakeholders who are impacted by the project, with the patients being on the first line. Most of the actions in the project involve patient care, as the objective of the project is to improve the patient care outcomes. The second most impacted stakeholders are the healthcare givers and specifically the nurses, who also play a crucial role in coordinating patient care with other healthcare givers. Nurses are the individuals who are in contact with the patients for the longest periods hence it becomes easy to monitor them. Patient families are also influential stakeholders in this project as much of the actions will require their consent as well as their opinion output on the options available. Regulators will also take a primary position in the project, especially because machine learning and other elements of artificial intelligence can also have drastic patient outcomes if reckless researchers or healthcare providers are allowed to take the center-stage in implementing non-proven measures. Lastly, the healthcare financiers will be part of the stakeholders since AI is an expensive field that requires strategic financing. Patient Outcomes or Patient Care Efficiencies that the Project is aimed at Improving The first patient outcome that the project is aimed at improving is the diagnostic procedures of care. Through application of AI in nursing informatics, nurses can efficiently perform nursing diagnoses to improve the detection of the presence of absence of disease and determine the best care operations for specific patents. Among the diseases that can be efficiently diagnosed using AI is cardiovascular disease and diabetes, which are among the leading causes of mortality worldwide. AI is also expected to help in the integration of telehealth in the care of patients. Telemedicine or telehealth helps in monitoring of patient information using strategic and remote techniques, and using automated means. It allows patients with chronic conditions to have long contact with the healthcare providers regardless of the physical barriers (Erikson & Salzmann-Erikson, 2016). Using AI in telehealth improves the efficiency of administration of drugs, as patients can consult physicians at their convenience of their homes. Also, these programs allow the education and advice of patients, remote admissions, as well as constant monitoring. The project is also aimed at showing the relevant drug interactions that could help the patients achieve synergy of the drugs and improve the effects. Also, in the same way, AI technology can help to identify lethal interactions that could lead to risking of the patients’ lives. Specifically, the project helps patients to identify the most suitable options when it comes to drug administration. It is easy to find that most chronic disease patients experience polypharmacy, and they are confused whether taking an additional drug would lead to improved outcomes. With AI, healthcare givers do not have to take multiple lab tests to determine the suitability of an additional medication for the patient. The project is aimed at boosting the interaction of the patients as well as the healthcare givers with electronic health records. The digitization of information in facilities has often been cited to have some drawbacks such as having burnout among users and also cognitive overloads. Automation of these processes can help to
[ANSWERED] Developing Organizational Policies and Practices
Developing Organizational Policies and Practices Competing needs arise within any organization as employees seek to meet their targets and leaders seek to meet company goals. As a leader, successful management of these goals requires establishing priorities and allocating resources accordingly. Within a healthcare setting, the needs of the workforce, resources, and patients are often in conflict. Mandatory overtime, implementation of staffing ratios, use of unlicensed assisting personnel, and employer reductions of education benefits are examples of practices that might lead to conflicting needs in practice. Leaders can contribute to both the problem and the solution through policies, action, and inaction. In this Assignment, you will further develop the white paper you began work on in Module 1 by addressing competing needs within your organization. To Prepare: Review the national healthcare issue/stressor you examined in your Assignment for Module 1, and review the analysis of the healthcare issue/stressor you selected. Identify and review two evidence-based scholarly resources that focus on proposed policies/practices to apply to your selected healthcare issue/stressor. Reflect on the feedback you received from your colleagues on your Discussion post regarding competing needs. The Assignment (1–2 pages): Developing Organizational Policies and Practices Add a section to the 2–3 page paper you submitted in Module 1. The new section should address the following in 1–2 pages: Identify and describe at least two competing needs impacting your selected healthcare issue/stressor. Describe a relevant policy or practice in your organization that may influence your selected healthcare issue/stressor. Critique the policy for ethical considerations, and explain the policy’s strengths and challenges in promoting ethics. Recommend one or more policy or practice changes designed to balance the competing needs of resources, workers, and patients, while addressing any ethical shortcomings of the existing policies. Be specific and provide examples. Cite evidence that informs the healthcare issue/stressor and/or the policies, and provide two scholarly resources in support of your policy or practice recommendations. Due to the nature of this assignment, your instructor may require more than 7 days to provide you with quality feedback. Expert Answer and Explanation Developing organizational Policies and Practices The United States’ healthcare industry is facing a decline in supply of nurses, and this issue can worsen if conflicting needs arise in the organization. In an organizational setting, leaders have interests, and these interests may conflict those of the employees. The clash of these interests may negate the advancement of the organization’s goals considering that it can exacerbate the impact of the issues which plague the healthcare industry. In the United States (U.S.), the inadequate availability of the nurses is growing into a problem considering that it contributes to the high rates of occurrence of adverse of clinical events. For instance, it can cause the surge in the cases of patient falls as well as rise in the rates of nosocomial infections (Maresova et al., 2020). Thus, a hospital should pay attention to the existing competing needs, and adopt effective interventions to limit the impact of these conflicting needs on the nurse shortage as this study explores. The Competing Needs Nursing professionals grapple with various conflicting needs, and the impact of these needs can be worse for nurses in under-staffed hospitals. A nurse may want to optimize the treatment outcomes by delivering patient-focused, and quality-based intervention. As they pursue this interest, they may have to deal with the issue of the burnout. This is because putting too much efforts into work can be exhausting, and it can cause stress (Maresova et al., 2020). Also, a nurse may want to adopt Evidence-Based Practice (EBP) when the management feels that the adoption of the EBP may cause the wastage of the resources. Each of the competing needs affects the issue pertaining to the shortage of nurses. When a nurse is unable to deliver care as they should because of the concern associated with burnout, this may leave hospitals with a gap in nursing care, and cause the surge in the needs for clinical services. Accordingly, this may worsen the problem of the shortage of the clinicians by contributing to the increase in the demand for the medical services. The use of the EBP is associated with benefits such as reduced rates of re-hospitalization. It can additionally improve the safety of the clinical interventions, and help improve the quality of care. The lack of adoption of the EBP can have the opposite effect. For example, it can negatively affect the quality of care, and this can in turn contribute to the demand for nursing services (Halter et al., 2017). For this reason, this conflicting interest equally has a potential of affecting the concerns linked to the under-supply of nurses. The Practice which may affect the Stressor Hospitals have practices which may affect the nurse shortage as a stressor. The hospital which I am aware of, for instance, has a history of not utilizing the informatics to guide the delivery of the care. Currently, the hospital relies on the paperwork, and it does not want to invest in the portal technology. Because the hospital is reluctant when it comes to adopting this particular technology, the hospital’s clinical staff face the risk of making medical errors. When a clinician makes a medical mistake due to misreading of the clinical instructions, the patient may face the risk of injury or harm. An example is a scenario in which a nurse misses a diagnosis information, and they administer higher drug dosage, causing complications which may require nursing intervention (Fagerström, Kinnunen, & Saarela, 2018). The practice in which the hospital is struck on the paperwork can affect the nurse shortage in undesirable manner. It can contribute to the rise in the number of cases of adverse clinical events such as nosocomial infections. Other effects include the increase in the number of days which patients spend in hospitals, and the surge in the number of falls. Falls can cause injuries which may require clinical intervention. Therefore, the laxity in adopting informatics may continue affecting the shortage of the nurse in
[ANSWERED] Recommend one FDA-approved drug, one off-label drug, and
Recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating your assigned disorder in children and adolescents Assignment 1: Prescribing for Children and Adolescents Off-label prescribing is when a physician gives you a drug that the U.S. Food and Drug Administration (FDA) has approved to treat a condition different than your condition. This practice is legal and common. In fact, one in five prescriptions written today are for off-label use. —Agency for Healthcare Research and Quality Psychotropic drugs are commonly used for children and adolescents to treat mental health disorders, yet many of these drugs are not FDA approved for use in these populations. Thus, their use is considered “off-label,” and it is often up to the best judgment of the prescribing clinician. As a PMHNP, you will need to apply the best available information and research on pharmacological treatments for children in order to safely and effectively treat child and adolescent patients. Sometimes this will come in the form of formal studies and approvals for drugs in children. Other times you may need to extrapolate from research or treatment guidelines on drugs in adults. Each individual patient case will need to be considered independently and each treatment considered from a risk assessment standpoint. What psychotherapeutic approach might be indicated as an initial treatment? What are the potential side effects of a particular drug? For this Assignment, you consider these questions and others as you explore FDA-approved (“on label”) pharmacological treatments, non-FDA-approved (“off-label”) pharmacological treatments, and nonpharmacological treatments for disorders in children and adolescents. Reference: Agency for Healthcare Research and Quality. (2015). Off-label drugs: What you need to know. https://www.ahrq.gov/patients-consumers/patient-involvement/off-label-drug-usage.html To Prepare • Your Instructor will assign a specific disorder for you to research for this Assignment. Persistent Depressive Disorder • Use the Walden library to research evidence-based treatments for your assigned disorder in children and adolescents. You will need to recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating this disorder in children and adolescents. The Assignment (1–2 pages) • Recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating your assigned disorder in children and adolescents. • Explain the risk assessment you would use to inform your treatment decision making. What are the risks and benefits of the FDA-approved medicine? What are the risks and benefits of the off-label drug? • Explain whether clinical practice guidelines exist for this disorder and, if so, use them to justify your recommendations. If not, explain what information you would need to take into consideration. • Support your reasoning with at least three scholarly resources, one each on the FDA-approved drug, the off-label, and a non-medication intervention for the disorder. Attach the PDFs of your sources. By Day 7 of Week 3 Submit your Assignment. Answer and Explanation Special Considerations Related to Prescribing for Children and Adolescents Anxiety disorder is a psychiatric health condition under the category of mood disorders. It is a condition characterized by intense panic and worries, even during usually day-to-day events. The CDC estimates that 9.4% of children aged 3-17 years, roughly 6 million children have some form of anxiety disorder (CDC, 2021). This post will evaluate the available treatment options for anxiety disorder, the risk assessment for the FDA-approved drug, and the clinical practice guidelines for the condition FDA-Approved Medication Treatment of anxiety disorder in children needs special consideration, given the nature of medication and attached side effects. Selective serotonin reuptake inhibitors (SSRI) are the first-line medication for anxiety disorders among children. One of the SSRIs that can be used to treat anxiety disorders is Escitalopram. In a study by Strawn et al. (2020), the researchers found that Escitalopram is effective in reducing anxiety disorder symptoms in adolescents and is well tolerated. Other than SSRIs, there are other classes of medication that are off-label but still effective in treating anxiety disorder. One of the off-label medications that can be used to treat anxiety disorder is Gabapentin. This is a drug that is usually used to treat patients who have depression with anxiety and bipolar (which is quite a common occurrence). In a study by Markota and Morgan (2017), there was a positive response pattern of gabapentin on anxiety disorder. Another article by Ahmed et al. (2019) also supported the same findings. Pharmacological approaches are usually more effective when combined with other behavioral interventions. One of the effective nonpharmacologic approaches is the use of cognitive behavioral therapy (CBT) to assist the patient in coping with situations that cause anxiety. CBT such as cognitive restructuring has been found effective in reducing the symptoms attached to anxiety disorder (Carpenter et al., 2018). Risk Assessment One of the risk assessments that I would conduct to inform the treatment plan for a child with anxiety disorder is a suicide risk assessment. Some of the medications that help relieve the symptoms attached to anxiety disorder have suicide ideation as one of the side effects. As such more tolerable medication should be given priority. One of the benefits attached to Escitalopram is that is well tolerated. However, its risk is that it has certain side effects that may affect an individual functioning like insomnia, lethargy, and headaches. One of the risks of using gabapentin is that it may not be as effective as an SSRI medication and, at the same time, can result in mood changes, sleepiness, nausea, and swelling o the arms and legs. Clinical Practice Guidelines for Anxiety Disorder According to Gautam et al. (2017), patients should be placed on medication for 6 to 12 months. Therefore, one should consider how the side effects will impact the patient in the long run before prescribing a medication. Additionally, Gautam et al. (2017) recommend the combination of both pharmacological approaches and physiotherapeutic approaches to further improve patient outcomes. This is also a way of reducing overdependence on psychopharmacological treatment. Conclusion Various treatment modalities can be used to help children and adolescents with anxiety disorder, some of which include SSRI medication, benzodiazepines, psychotherapy, and prescription of off-label
Explain your state laws for involuntary psychiatric holds
Legal and Ethical Issues Related to Psychiatric Emergencies The diagnosis of psychiatric emergencies can include a wide range of problems—from serious drug reactions to abuse and suicidal ideation/behaviors. Regardless of care setting, the PMHNP must know how to address emergencies, coordinate care with other members of the health care team and law enforcement officials (when indicated), and effectively communicate with family members who are often overwhelmed in emergency situations. In their role, PMHNPs can ensure a smooth transition from emergency mental health care to follow-up care, and also bridge the physical–mental health divide in healthcare. In this week’s Assignment, you explore legal and ethical issues surrounding psychiatric emergencies, and identify evidence-based suicide and violence risk assessments. To Prepare Review this week’s Learning Resources and consider the insights they provide about psychiatric emergencies and the ethical and legal issues surrounding these events. The Assignment In 2–3 pages, address the following: Explain your state laws for involuntary psychiatric holds for child and adult psychiatric emergencies. Include who can hold a patient and for how long, who can release the emergency hold, and who can pick up the patient after a hold is released. Explain the differences among emergency hospitalization for evaluation/psychiatric hold, inpatient commitment, and outpatient commitment in your state. Explain the difference between capacity and competency in mental health contexts. Select one of the following topics, and explain one legal issue and one ethical issue related to this topic that may apply within the context of treating psychiatric emergencies: patient autonomy, EMTALA, confidentiality, HIPAA privacy rule, HIPAA security rule, protected information, legal gun ownership, career obstacles (security clearances/background checks), and payer source. Identify one evidence-based suicide risk assessment that you could use to screen patients. Identify one evidence-based violence risk assessment that you could use to screen patients. Expert Answer and Explanation Mental Health Laws in Texas There are various guiding PMHNP when providing mental health services to patients. Mental health laws play a significant role in the integration of mental health in primary health care, community integration of people with mental health problems, and provision of high-quality care. In the US, states have different laws prescribing how their citizens should be handled when mental health emergency occurs. The state that will be focused on in this assignment in Texas. The legislative body of Texas has enacted various guiding PMHNP on how to provide mental health services among various populations. It is the responsibility of PMHNP to understand these laws and follow them to avoid legal problems. This assignment has discussed legal and ethical principles regarding mental health emergencies in the state of Texas. Texas Laws The law guiding involuntary psychiatric holds for child and adult psychiatric emergencies is known as the Texas Health and Safety Code – HEALTH & SAFETY § 574.014 (FindLaw.com, 2021). The involuntary psychiatric holds can be initiated by an adult by applying detention, evaluation, and treatment of the individual with the county courts. A law enforcement officer is also allowed to detain an individual they believe to be a threat due to substance abuse or mental disorders and transport the individual to a mental health facility for evaluation for admission under their police powers. Mental health facilities recognized by the Department of Mental Health can initiate the process of holding a patient if they believe that the individual has a serious mental health problem and needs emergency psychiatric treatment (FindLaw.com, 2021). Mental health professionals allowed to begin an on-site civil involuntary detention for an individual in need of emergency mental health care include psychiatric residents, licensed physicians, psychiatrists, licensed professional counselors, a qualified addiction professional, and PMHNP. An individual should only be detained for 72 hours, excluding holidays and weekends (FindLaw.com, 2021). However, if the psychiatrist still believes that the individual needs further treatment beyond 72 hours, they can begin a court hearing to get court permission to continue holding the patient. The mental health professional can release the emergency hold if they believe that the individual does not need emergency care (FindLaw.com, 2021). The emergency hold can be picked by their family members or people they chose. Differences Emergency hospitalization for psychiatric hold or evaluation can be initiated by an adult, a police officer, or a health professional qualified to handle mental health services. This process does not need a court order (FindLaw.com, 2021). However, for a person to be committed to receiving mental health services as an inpatient or outpatient, a court order must be sought. The guardian or applicant must go to court and seek a court order. The individual patient must also be given a chance to explain themselves (FindLaw.com, 2021). Therefore, the difference is emergency hospitalization for evaluation/psychiatric hold does not need a court order while inpatient and outpatient commitment need a court order. Capacity and Competency In the mental health context, capacity is a clinical determination and functional assessment of a specific decision that can be made by a health professional who has interacted with the patient’s case (Keene et al., 2019). However, competency is a legal determination and global assessment made in court by a judge. In other words, competency is determined by a judge while capacity by a health professional (Keene et al., 2019). HIPAA Privacy Rule HIPAA privacy rule requires that healthcare professionals protect patients’ information and prevent unauthorized persons from accessing them (Edens et al., 2018). The healthcare professionals are only allowed to share the information with the courts during hearing on whether the patients should receive involuntary inpatient or outpatient care. The healthcare professionals are only allowed to share the information with patient’s family member when the patient is incapacitated ad cannot make informed decisions (Edens et al., 2018). Suicide Risk Assessment The suicide risk assessment tool I could use to screen patients is the Columbia-suicide severity rating scale. This tool is validated to be used in adults, adolescents, and children (Matarazzo et al., 2019). The authors argue that it assesses both active and passive suicidal ideation, plan, method, suicidal behavior, and intent to act
Reflect on the mission, vision, values, and goals of your
Reflect on the mission, vision, values, and goals of your healthcare organization and provide examples of how individual employees, departments Assignment: This assignment has two parts: an essay and a business plan. PART I – develop an essay to address the following information: Reflect on the mission, vision, values, and goals of your healthcare organization and provide examples of how individual employees, departments, and work units support all four of these as a foundation for directional strategies. Describe positive and negative aspects of abandoning traditional healthcare strategic planning processes and adopting a contemporary approach. How does complexity influence budget strategies and their implementation? Give examples. Discuss the process of external and internal environmental analyses, and then speculate on scenarios that may result if these steps in strategic planning are omitted or are not done well. Discuss mechanisms that nurse manager can use to ensure they make the best decisions for supporting the financial goals of the organization. PART II – develop a Business Plan Identify an opportunity for implementing a new service or a cost-reducing idea in your organization and write a business plan to describe your idea: explain the need (why) for it, identify stakeholders (who) will be impacted, discuss the benefits versus the disadvantages, describe the costs/expenses for the idea, and outline the implementation plan. Expert Answer and Explanation PART 1: Strategic Healthcare Management Planning is a concept that is used every day in our personal lives and the same behavior also translates into the management of organizations. The top leadership of organizations usually formulate strategies to meet the mission and vision of their organization. It is important because with every organizational activity, risk and resources are usually involved and they have to be adequately managed lest the organization loses its ability to function properly. The purpose of this paper will be to expound on different aspects concerning the application of strategic management practices in healthcare. Support for Mission Vision, Values, and Goals The organization is usually driven by its mission, vision, values, and goals formulated. The efforts of all individuals and organs functioning within the organization should be aligned to realize the accomplishment of these elements. A mission statement is one that highlights where the organization is going (Cronin & Bolon, 2018). For example, the mission for the healthcare facility I work for is “to provide quality and compassionate healthcare accessible to everyone.” Vision on the other hand is the future position of where the organization wants to be, while the values are the beliefs and practices uphold by the organization (Lahey & Nelson, 2020). The values for the organization I work for include teamwork, integrity, excellence, innovation, and compassion. Our goals are aligned to meet the said mission and vision of the organization while using our core values during our transactions with other stakeholders. The role of individual employees, departments, and work units in accomplishing this mission is to ensure that they channel all their efforts into fulfilling this mission. This includes identifying and removing any barriers that may hinder collaboration or promote conflicts due to differences in personal goals and objectives (Lahey & Nelson, 2020). It is also the role of individual employees and work teams to collect information on behalf of the organization on what other competing organizations are doing to accomplish goals employees can also support all the four elements by ensuring that they align how they discharge their duties with the values of the organization. Impact of Adopting a Contemporary Approach to Strategic Planning Strategic planning was developed due to the increased complexity of how the economy and organizations operate (Esfahani et al., 2018). The used traditional approach was a systematic process that emphasized on the mission and vision of the organization without considering other factors as equally important. The processes also involved coming up with the short term, medium, and long-term objectives, which were to be followed to the latter to gain a competitive edge. However, this approach had its drawbacks which made it be abandoned for a contemporary approach that was considered to be more responsive to the current business environment (Grube & Crnkovich, 2017). One of the positive aspects of abandoning the traditional approach to strategic management and transitioning to the contemporary approach is that a more responsive process that factors in day to day operational issues is considered. This means that organizations can easily make adjustments to their strategic decisions based on the current changes in operations. Another positive aspect of adopting a contemporary approach is that it treats strategic planning as a process and not an event (Grube & Crnkovich, 2017). This means that it is continuous and adjustable to changes in both the internal and external organization environment. The negative aspect is that the contemporary approach does not offer a predictable methodology or timeframe to strategic planning as it was with the traditional approach. Budget Strategies The current environment in the management of healthcare organizations has become more and more complex with increasing risks and stakeholders to transact with. This has also made healthcare financial managers restructure their methods to adjust to these complexities; this includes the budget-making process and implementation. One of the complexities has been the adoption of the contemporary approach to strategic planning that requires adjustment of organizational strategies with changes in the internal and external business environments (Walsh, 2016). Given that these adjustments can be abrupt, it becomes difficult to forecast and give accurate budgetary figures in an environment of uncertainty (Hill, 2016). Another factor is the addition of more stakeholders involved in decision making. This means that more data needs to be collected to make accurate budgetary forecasts which can also be time-consuming (Hill, 2016). As such, there is also a likelihood that the budget implementation timelines will also be affected. Process of External and Internal Environmental Analyses In the strategic management process, one of the core steps is to carry out an internal and external organization analysis. This allows the organization to collect its efforts in response to the findings of the two analyses. The process of carrying out environmental analysis is a five-step process that includes; first an analysis of the external environment (Esfahani et al., 2018). This
Compare and contrast each of the three questions related to
Compare and contrast each of the three questions related to Managed Care Organizations, Medicare Compare and contrast each of the three questions related to Managed Care Organizations, Medicare, and Medicaid with one another and explain how they were similar and different to each other. Managed care organizations emphasize physicians’ responsibilities to control patient access to expensive hospitalization and specialty care, a principle dubbed “gatekeeping.” Some argue that “gatekeeping” is unethical because it introduces financial factors into treatment decisions. Others say it improves quality by promoting the use of the most appropriate levels of care. Medicare is an area that often gets overlooked and is seen as a burden financially. Discuss alternatives to ease the drain on Medicare resources. Medicaid is shouldering an ever-increasing burden of cost for long-term care for the elderly, with enormous impacts on state budgets throughout the nation. Discuss alternatives to ease this drain on Medicaid resources. Develop an APA-formatted essay discussing the three entities. Describe what they are and how they differ. Include an introduction to let the reader know what will be found in the essay. Create a table to provide comparison of the three entities. The table can be used as the body of the paper, or it can be added as an addendum after the Reference page. If you opt to add it as an addendum, refer to the table in the narrative in the body of the essay. As in all essays, include a conclusion to provide a summary of the material. This assignment highlights your ability to do research and display information in a table format. Include citations, as appropriate, for information in the table. Refer to chapter 7 in the APA manual, specifically pages 223 -224 for information on tables using words for displaying information. Required Source Sultz, H. A., & Young, K. A. (2017). Health care USA: Understanding its organization and delivery (9th ed.). Jones & Bartlett. Read Chapter 8. The following specifications are required for this assignment: Length: 750 words Structure: Include a title page and reference page in APA style. These do not count towards the minimal word amount for this assignment. References: Use the appropriate APA style in-text citations and references for all resources utilized to answer the questions. Include at least two (2) scholarly sources to support your claims. Format: Save your assignment as a Microsoft Word document (.doc or .docx). File Name: Name your saved file according to your first initial, last name, and the module number (for example, “RHall Module 1.docx”) Expert Answer and Explanation Healthcare Finance In the United States (US), healthcare is paid for or financed in a variety of ways. One of the ways is the out-of-pocket method where individuals pay directly for services they have been offered. The second way is private insurance. Other people have health insurance coverage as a tax-free benefit from their employer (Sultz & Young, 2017). Most working individuals are covered by employer-provided healthcare insurance, a managed care plan, such as a Health Maintenance Organization, or traditional indemnity insurance. The third method is public insurance and programs. For instance, the government has Military Health Insurance to cover the health of military personnel and their dependents as well as veterans. Other health insurance programs run by the government include Medicare, Medicaid, and the State Children’s Health Insurance Program (SCHIP) (Sultz & Young, 2017). People often confuse Medicare, Managed Care Organizations (MCOs), and Medicaid. The purpose of this essay is to compare and contrast Medicare, Managed Care Organizations (MCOs), and Medicaid by giving their similarities and differences. The Three Entities The first entity is MCO. MCOs are integrated organizations in the healthcare system focused on managed care as a method of reducing care costs while maintaining a high quality of care. The focus of MCOs is to reduce the cost of care while keeping the quality high. There are four types of MCOs (Seiler et al., 2022). The first type is Health Maintenance Organization (HMO). HMO manages care by requiring beneficiaries to see a network of health providers at a much lower cost. It also needs beneficially to see their primary care provider (PCP) before any provider who is not in the network. The second type is Preferred Provider Organization (PPO). This form of MCO allows one to see any doctor they like, in the network or outside (Opoku et al., 2022). The beneficially may pay less for seeing an in-network provider and higher for the outside network provider. The third is Point of Service (POS). This program combines HMO and PPO where one can see providers in and outside the network but at slightly higher costs. The last type is Exclusive Provider Organization (EPO) (Opoku et al., 2022). It also combines HMOs and PPOs’ features. Its costs are less than PPO but higher than HMO. The second entity is the Medicare program. Medical is a federal health insurance program for some young people with disabilities, adults aged 65 years or older, and individuals with End-Stage Renal Disease (Agarwal et al., 2021). Drain in Medicare resources can be eased through the following alternatives. First, reducing unnecessary complications and preventable readmissions. Complications and readmission increase the cost of care and thus puts more burden on Medicare (Committee for a Responsible Federal Budget, n.d). Second, the drain can be reduced by decreasing the use of high-cost drugs. Lastly, the program should use the value-based model to pay physicians where they are paid based on efficiency, quality, and care coordination. The third entity is the Medicaid program. Medicaid is a health insurance program that provides health coverage to millions of US citizens, including children, low-income adults, elderly adults and people with disabilities, and pregnant women (Linder et al., 2018). States administer the program based on federal requirements. The program is funded both by the federal government and state governments. Drain in Medicaid resources can be eased through the following alternatives. First. Physician payment should be modified to decrease unnecessary care. physicians should be paid using the salaried system with a relatively modest bonus for quality (Linder et al.,
Mrs. J is a 63-year-old married woman who has a history of
[ANSWERED] Mrs. J is a 63-year-old married woman who has a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD) It is necessary for an RN-BSN-prepared nurse to demonstrate an enhanced understanding of the pathophysiological processes of disease, the clinical manifestations and treatment protocols, and how they affect clients across the life span. Evaluate the Health History and Medical Information for Mrs. J., presented below. Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below. Health History and Medical Information Health History Mrs. J is a 63-year-old married woman who has a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD). Despite requiring 2L of oxygen/nasal cannula at home during activity, she continues to smoke two packs of cigarettes a day and has done so for 40 years. Three days ago, she had sudden onset of flu-like symptoms including fever, productive cough, nausea, and malaise. Over the past 3 days, she has been unable to perform ADLs and has required assistance in walking short distances. She has not taken her antihypertensive medications or medications to control her heart failure for 3 days. Today, she has been admitted to the hospital ICU with acute decompensated heart failure and acute exacerbation of COPD. Subjective Data Is very anxious and asks whether she is going to die. Denies pain but says she feels like she cannot get enough air. Says her heart feels like it is “running away.” Reports that she is exhausted and cannot eat or drink by herself. Objective Data Height 175 cm; Weight 95.5kg. Vital signs: T 37.6C, HR 118 and irregular, RR 34, BP 90/58. Cardiovascular: Distant S1, S2, S3 present; PMI at sixth ICS and faint: all peripheral pulses are 1+; bilateral jugular vein distention; initial cardiac monitoring indicates a ventricular rate of 132 and atrial fibrillation. Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%. Gastrointestinal: BS present: hepatomegaly 4cm below costal margin. Intervention The following medications administered through drug therapy control her symptoms: IV furosemide (Lasix) Enalapril (Vasotec) Metoprolol (Lopressor) IV morphine sulphate (Morphine) Inhaled short-acting bronchodilator (ProAir HFA) Inhaled corticosteroid (Flovent HFA) Oxygen delivered at 2L/ NC Critical Thinking Essay In 750-1,000 words, critically evaluate Mrs. J.’s situation. Include the following: Describe the clinical manifestations present in Mrs. J. Discuss whether the nursing interventions at the time of her admissions were appropriate for Mrs. J. and explain the rationale for each of the medications listed. Describe four cardiovascular conditions that may lead to heart failure and what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each condition. Taking into consideration the fact that most mature adults take at least six prescription medications, discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide a rationale for each of the interventions you recommend. Provide a health promotion and restoration teaching plan for Mrs. J., including multidisciplinary resources for rehabilitation and any modifications that may be needed. Explain how the rehabilitation resources and modifications will assist the patients’ transition to independence. Describe a method for providing education for Mrs. J. regarding medications that need to be maintained to prevent future hospital admission. Provide rationale. Outline COPD triggers that can increase exacerbation frequency, resulting in return visits. Considering Mrs. J.’s current and long-term tobacco use, discuss what options for smoking cessation should be offered. You are required to cite to a minimum of two sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice. 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. Refer to the LopesWrite Technical Support articles for assistance. EXPERT ANSWER AND EXPLANATION Patient Assessment and Treatment One’s physiological wellbeing depends on a wide range of factors including lifestyle behaviors. The prolonged use of the psychotic substances, for example, can expose one to the risk of developing health problems, and the nature of the medical condition one develops depends on the substance they use. For instance, smoking tobacco exposes smokers to the risk of developing respiratory issues. Equally, the type of food one eats and their levels of physical activity can have a certain level of impact on their physiological wellbeing. It is imperative to explore the case of patient with COPD, in terms of the effectiveness of the intervention she receives, and examine the contributors to the heart failure. Mrs. J’s Clinical Manifestations Based on the Mrs. J’s medical history and subjective data, she exhibits a number of clinical manifestations. One of these manifestations is the acute exacerbation of the chronic obstructive pulmonary disease (COPD). Another clinical manifestation present in the patient is acute decompensated heart failure. These two conditions explain the reason why she experiences difficulties breathing, and her heart rate is irregular. She has Congestive Heart Failure (CHF). Mrs. J also shows sign of hypertension considering that her blood pressure level is 90/58, and this is more than the 120/80 average (Lin et al., 2016). Additionally, the patient has fever, and besides this fever, she cannot perform Activities of Daily Living (ADLs). She coughs blood-tinged sputum, and this indicates a possible respiratory problem. Assessment of the Effectiveness of the Nursing Interventions Mrs. J takes a number of medications to help promote her recovery, and while these medications are effective, some may not be necessary in her case. She takes IV furosemide, and this intervention is appropriate based on her case. This is because this medication would help relieve her heart failure problem by helping improve the heart’s blood-pumping capacity. Given the patient’s