Nursing  Assessment 4 Instructions: Planning for Change: A Leader’s Vision

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Develop a presentation, augmented by 12-15 slides, for administrative leaders and stakeholders that outlines your plan to develop or enhance a culture of quality and safety within your organization or practice setting.IntroductionNote: Each assessment in this course builds on the work you completed in the previous assessment. Therefore, you must complete the assessments in this course in the order in which they are presented.As a nurse leader, you will be expected to communicate effectively with leaders and stakeholders at all levels in an organization in a variety of ways, depending on your purpose and your audience. Being able to deliver effective presentations is one important skill you will likely be called upon to use often.This assessment provides an opportunity to hone your presentation skills and enlist the support of stakeholder groups who will be key to achieving desired changes in the organization and developing or enhancing a culture of quality and safety.This assessment is based on the work you have completed in the previous three assessments.PreparationThe report you completed in the previous assessment has convinced the executive leadership team of the benefits to the organization of taking the next step toward changes aimed at improving outcomes and cultivating a culture of quality and safety. You have been asked to follow up your report with a presentation to administrative leaders and stakeholders that outlines your plan to develop or enhance the organization’s culture of quality and safety. A number of key stakeholders will be unable to attend your presentation for a variety of reasons, so you have decided to provide those individuals with a video recording of the presentation.You have the option of using Kaltura Media or another technology of your choice to record your presentation.If you decide to use Kaltura, you are encouraged to:Install and test your recording hardware (if you have not already done so), using the installation instructions provided by the manufacturer.Practice using your recording hardware to ensure adequate audio and video quality.Refer to theUsing Kalturatutorial for directions on recording and uploading your video in the courseroom.Note: If you require the use of assistive technology or alternative communication methods to participate in this activity, please contact Disability Services to request accommodations.Note: Remember that you can submit all or a portion of your draft presentation to Smarthinking for feedback, before you submit the final version for this assessment. However, be mindful of the turnaround time of 24–48 hours for receiving feedback, if you plan on using this free service.As you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. 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 your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as part of your assessment.How might you engage stakeholders to help develop, implement, and sustain a vision to actually change and improve patient outcomes?What arguments might be most effective in obtaining agreement and support?What recommendations would you make to implement a proposed plan for change?

 
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Nursing  100 work Positive reply due tomorrow morning 8am

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Patient InformationFA, 42-year-old Caucasian maleSubjective.CC “Lowest back pain for the past month”HPI: FA is a 42-year-old Caucasian male who presents to the clinic due to lower back pain that c has been ongoing for the past one month. FA stated that his pain started after attempting to lift a heavy table in his home from one part of the house to another one month ago. Patient reports that resting and taking Ibuprofen to reduce the pain, while his pain increases with activity. FA rates his pain at 5 on the 0-10 pain scale, as aching/dull that radiates to her left leg intermittently.Current medications Ibuprofen 600mg as needed for pain.Allergies: Denies any allergy.PMHx: Up to date to immunization. Last influenza and pneumonia vaccine was November 2019. No past medical history noted. No previous hospitalization or blood transfusion.Soc Hx: FA owns a local car repair shop. He is married with 2 young kids 10 and 8 years old. Patient is deeply involved in the local catholic church and is a choir master. Denies use of illicit drug and tobacco. States he is a social drink and consumes 2-3 beer weekly. Exercises regularly.Fam Hx:  Father, Alive 72, HTN.Mother, Alive 68 Diabetes.Paternal Grandfather: HTN, deceased at age 78 from stroke.Paternal Grandmother: Alive, 95, Anxiety.Maternal Grandfather: Alive, 93 HTN, Hyperlipidemia.Paternal Grandmother: Alive, 88 Type 11 diabetes (controlled with diet).Daughter: No medical history, age 10.Son: No medical history, age 8.ROS:General: Pt denies fever and fatigue. Denies weight loss.Neurological: Pt headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control.HEET: Eyes: T denies visual changes. Ears: denies hearing loss. Nose: Denies rhinorrhea. No hearing loss. Sneezing, runny nose or sore throat.Throat: Denies sore throat.Skin: Pt denies rash, abrasions, or bruising denies rash.Cardiovascular: Pt denies chest pain, chest pressure or chest discomfort. palpitation, and tachycardia.Respiratory: Pt denies SOB, Cough congestion or congestion. Respiratory:Musculoskeletal: Reports aching/dull lower back pain. Reports a limited range of motion with bending. Pain occasionally radiated to left leg.Objective.Diagnostic results: Vitals: T: 98.0, HR: 78, RR: 18, BP: 128/70, O2sat: 98% on RA. Pain 5/10General: Pt is AAOx4. Well-groomed male calm and cooperative Able to communicate fluently, with a good eye contact. Appears in no acute distress.Neurological: No signs of dizziness, no problems with gait or posture noted. 4/5 strength with dorsiflexion and toe extension in LLE. 5/5 strength with dorsiflexion and toe extension in RLE. No decreased sensation to BUE and BLE.HEENT:  EOMI, PERRLA, pupil round and reactive to light, moist mucus membrane noted. No head injury noted, oral mucosa dry.Skin: No edema noted on extremities No abrasions, and cyanosis. Skin taut, non-tenting, and atraumatic.Cardiovascular: S1, S2 noted with a regular rhythm. No murmur, gallops, or extra heart sounds.Respiratory: Lungs sound clear on auscultation. No adventitious breath sounds noted.Musculoskeletal: No scoliosis noted.  Negative Sciatic Nerve, Negative Mackiewicz sign in bilateral lower extremifies. Negative Lasegue’s sign in left lower extremity. Pain noted on palpation of L5. Patellar reflex 2+ bilaterally. Full range of motion in torso extension and lateral flexion. Limited range of motion with flexion and lateral rotation of torso related to pain.AssPrimary Diagnosis: Lumbosacral RadiculopathyDifferential DiagnosesLumbosacral radiculopathy (Disc herniation):  describes the types of pain caused by compression or irritation of nerve roots in the lower back, caused by lumbar disc herniation, degeneration of the spinal vertebra, and narrowing of the foramen from which the nerves exit the spinal canal. L5 is the most common injury in the lumbar spine (Hsu, Armon, & Levin, 2019). An L5 disc herniation typically presents as back pain that radiates to the leg and foot (Hsu et al., 2019). In a disc herniation, the nerve root becomes compressed from cancer, infection, injuries from falls (Hsu et al., 2019). The straight leg test is the most helpful assessment tool when assessing for a disc herniation (Hsu et al., 2019). A magnetic resonance imaging (MRI) scan is used to diagnose a disc herniation by evaluating the intraspinal spaces for abnormalities (Hsu et al., 2019).Vertebral Osteomyelitis: is a bone infection usually caused by bacteria. In the spine, it is often found in the vertebrae, although the infection can spread into the epidural and intervertebral disc spaces. Osteomyelitis is rare and most common in young children and the elderly, but it can occur at any age (McDonald & Peel, 2019). The infection to the bone could result from surgery or other soft tissue infection (McDonald & Peel, 2019). Symptoms include pain localized to the disc that is infected and is aggravated with palpitation or physical activity (McDonald & Peel, 2019). A computerized axial tomography (CT scan) is used to diagnose Vertebral Osteomyelitis, using a guided biopsy of the vertebral disc space to culture the bacteria (McDonald & Peel, 2019). Treatments of Vertebral Osteomyelitis include antibiotic therapy for six weeks (Roblot et al., 2007).Paraspinal muscle strain: Is defined as over stretch injury or tear of paraspinal muscles and tendons in the low back. Muscle strains are common injury (Patricios, 2019). Overstretching of a muscle leads to a small tear in the tissue causing a strain (Crowley, n.d.). To assess for such muscle strain is by asking about trauma to the painful area (Patricios, 2019). Symptoms include sudden lower back pain, muscle spasms, inflammation, bruising, and soreness (Crowley, n.d.). Most times, treatment is not needed or treatments with rest, ice, pain medication and physical therapy (Cooper, 1993).Piriformis syndrome: Piriformis syndrome is a condition in which the piriformis muscle, located in the buttock region, spasms and causes buttock pain. The piriformis muscle can also irritate the nearby sciatic nerve and cause pain, numbness and tingling along the back of the leg and into the foot (like sciatic pain). Piriformis syndrome is marked by hip and gluteal pain (Boyajian-O’Neill, McClain, Coleman, & Thomas, 2008). Clinical manifestations include acute back pain for less than four weeks (Wheeler, Wipf, Staiger, Deyo, & Jarvik, 2019). Symptoms includes worsened pain after sitting down for about 15 minutes (Boyajian-O’Neill et al., 2008). Assessments includes inspecting the back and posture, palpating the spine, performing the straight leg test, and assessing psychological distress (Waddell’s sign) (Wheeler et al., 2019). Diagnoses are made through electromyography (EMG) by differentiating between piriformis syndrome versus disc herniation (Boyajian-O’Neill et al., 2008).Lumbar Stenosis: The lumbar spine consists of five vertebrae in the lower part of the spine, between the ribs and the pelvis. Lumbar spinal stenosis is a narrowing of the spinal canal, compressing the nerves traveling through the lower back into the legs. (Ball, Dains, Flynn, Solomon, & Stewart, 2019). Symptoms include pain with activities, such as walking or standing. The pain from Lumbar Stenosis radiates down the leg, slight relief in a sitting position, and increased pain with prolonged standing/walking (Ball et al., 2019). To assess, the patient exhibits a forward gait and lower extremity weakness in progressing lumbar stenosis (Ball et al., 2019).  To diagnose, a radiology imaging (X-ray), CT scan, and an MRI are used (American Association of Neurological Surgeons [AANS], n.d.).ConclusionAccording to the scenario presented, the probable nerve that are involved are L4-S1. The cause could also be from lumbar two, three, and four (L2,3,4) (Ball, Dains, Flynn, Solomon, & Stewart, 2019). The straight leg test is used to test for L4-S1 abnormalities (Standford Medicine 25, n.d.). The femoral stretch test is used to test for L2,3,4 abnormalities (Mackiewicz sign). Also, using the patient’s history, such as pain onset, location, duration, character, aggravating and relieving factors could help in diagnoses (Ball et al., 2019). I chose these 5-differential diagnosis, disc herniation, vertebral osteomyelitis, lumbar stenosis, paraspinal muscle strain, and piriformis syndrome. The assessment and diagnosis of the lower back pain should involve examination of gait, posture, range of motion, inspection, and palpation of the painful location (Bratton, 1999). Assessment should include asking the patient to bend forward in flexion, extension, lateral flexion, and lateral rotation to evaluate the range of motion and limitation (Bratton, 1999).ReferencesAmerican Association of Neurological Surgeons. (n.d.). Lumbar spinal stenosis. Retrieved January 13, 2020, fromhttps://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Lumbar-Spinal-StenosisBall, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.Boyajian-O’Neill, L. A., McClain, R. L., Coleman, M. K., & Thomas, P. P. (2008). Diagnosis and management of Piriformis Syndrome: An osteopathic approach. The Journal of the American Osteopathic Association, 108, 657-664. Retrieved fromhttps://jaoa.org/article.aspx?articleid=2093614Bratton, R. L. (1999). Assessment and management of acute low back pain. American Family Physician, 60(8), 2299-2306. Retrieved fromhttps://www.aafp.org/afp/1999/1115/p2299.htmlCooper, R. G. (1993). Understanding paraspinal muscle dysfunction in low back pain: A way forward? Annals of the Rheumatic Diseases, 52(6), 413. https://doi.org/10.1136/ard.52.6.413Crowley, K. (n.d.). Patient education: Muscle strain (The Basics). Retrieved January 12, 2020, fromhttps://www.uptodate.com/contents/muscle-strain-the-basics?search=back%20muscle%20strain&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H276646807Engle, A. M., Chen, Y., Marascalchi, B., Wilkinson, I., Abrams, W. B., He, C., Yao, A. L., Adekoya, P., Cohen, Z. O., & Cohen, S. P. (2019). Lumbosacral Radiculopathy: Inciting Events and Their Association with Epidural Steroid Injection Outcomes. Pain Medicine, 20(12), 2360–2370. https://doi-org.ezp.waldenulibrary.org/10.1093/pm/pnz097Hsu, P. S., Armon, C., & Levin, K. (2019). Acute lumbosacral radiculopathy: Pathophysiology, clinical features, and diagnosis. Retrieved January 12, 2020, fromhttps://www.uptodate.com/contents/acute-lumbosacral-radiculopathy-pathophysiology-clinical-features-and-diagnosis?search=disc%20herniation&source=search_result&selectedTitle=1~101&usage_type=default&display_rank=1#H17McDonald, M., & Peel, T. (2019). Vertebral osteomyelitis and discitis in adults. Retrieved January 12, 2020, fromhttps://www.uptodate.com/contents/vertebral-osteomyelitis-and-discitis-in-adults?search=disc%20herniation&topicRef=5262&source=see_link#H1Patricios, J. (2019). Adductor muscle and tendon injury. Retrieved January 12, 2020, fromhttps://www.uptodate.com/contents/adductor-muscle-and-tendon-injury?search=paraspinal%20muscle%20strain&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2#H6959568Roblot, F., Besnier, J. M., Juhel, L., Vidal, C., Ragot, S., Bastidies, F., … Godet, C. (2007). Optimal duration of antibiotic therapy in vertebral osteomyelitis. Seminars in Arthritis and Rheumatism, 36(5), 269-277. https://doi.org/10.1016/j.semarthrit.2006.09.004Standford Medicine 25. (n.d.). Approach to the low back exam. Retrieved January 12, 2020, fromhttps://stanfordmedicine25.stanford.edu/the25/BackExam.htmlWheeler, S. G., Wipf, J. E., Staiger, T. O., Deyo, R. A., & Jarvik, J. G. (2019). Evaluation of low back pain in adults. Retrieved January 13, 2020, fromhttps://www.uptodate.com/contents/evaluation-of-low-back-pain-in-adults?search=piriformis%20syndrome&source=search_result&selectedTitle=4~29&usage_type=default&display_rank=4#H7

 
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Nursing  db1

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nit 1  – Advanced NurUnit 1 Discussion – AdvancedIt is anticipated that the initial discussion response should be in the range of 250-300 words. Response posts must demonstrate topic knowledge and scholarly engagement with peers. This is not the only criteria utilized for evaluation; substantive content is imperative. All questions in the topic must be addressed. Please proofread your response carefully for grammar and spelling. Do not upload any attachments. All responses need to be supported by a minimum of one scholarly resource. Journals and websites must be cited appropriately. Citation and reference must adhere to APA format (6th Ed.).Advanced Nursing Practice SituationScenario: Today is a busy day at the community health center since yesterday was a holiday. I am seeing walk-ins, and my three examination rooms are full. I hope I will be able to see more than 20 patients today—the expectation of ‘management’—and will be rewarded with a productivity bonus. My next patient is John, a 42-y.o. man I have known for several years. He is accompanied as usual by his wife Mary. Today, John is complaining of lower extremity swelling and pain in most of his joints. He is worried about losing his job as a truck driver, because he is having difficulty climbing in and out of his truck. He is afraid that he may have lupus, because all of his siblings and his mom have this disorder. He also requests a refill on his antidepressant, which doesn’t seem to be working as well as it did a month ago. While reviewing his chart, I notice that John has gained weight—he now weighs over 300 lbs. In reviewing his medications, I see that the antidepressant he is taking may be contributing to his weight gain. John’s physical examination is unremarkable. His heart rate is regular without murmur or irregularity, and his lung sounds are without wheezes or crackle. Since John is a large man, all of his joints areas are large, but they are all symmetrical, with good range of motion and only mild palpation tenderness in his wrists. His ankles are large but without erythema or other skin discoloration or disruption, and his pedal pulses are strong and equal bilaterally.I ponder how to manage this visit. Do I take the time to investigate John’s depression more thoroughly, wondering about his 11 y.o. daughter, who at his last visit was on chemotherapy for a neuroblastoma? Should we discuss the pros and cons of different antidepressants? Should we discuss the possibility of a gastric bypass again, even though I know the thought of anesthesia terrifies him? Do we again discuss the importance of a healthy diet and increased exercise, giving consideration to his joint pain? I am torn between what I feel this patient deserves and the call of the clock. Would it be unreasonable to order the necessary lab tests to investigate the possibility of lupus, hypothyroidism, or some other disorder and postpone these time-consuming discussions until his next visit?If I am expedient with this visit, the other patients waiting also will be grateful. Maintaining a caring practice in an economically driven discipline requires skill and grounding in those values that are essential for quality patient care. In the context of the caring theory and analysis of the Advanced Practice Nursing Situation above, let’s discuss this situation using “multiple ways of knowing.”Questions for this week’s Postings:In your posting this week please provide a word metaphor that might express the meaning of this situation as described above?Remember this is your opportunity to tap into the aesthetics of knowing that is seeing the beauty and uniqueness in this situation so think about it a bit before responding.Make it your own word and not just what someone else said.Please explain why you chose this word and if you have experienced this type of situation before and what did feel about that situation?Please be sure to validate your opinions and ideas with citations and references in APA format.Estimated time to complete: 1 hourSearch entries or author Filter replies by unreadUnread   Collapse replies Expand replies Subscribe ReplyReply to Unit 1 Discussion – Advanced Nursing Practice Situationsing Practice Situation

 
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Nursing  homework help Week 3 A2

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Alzheimer-Related DisabilitiesThis assignment will help you understand the disabilities that are caused due to Alzheimer’s disease.Ellen is a 64-year-old Chinese American, who has recently been  diagnosed with dementia of the Alzheimer’s type. She has been working  steadily as a secretary but recently due to the disease has found it  harder to perform her duties. She has worked for 34 years. She has  recently become widowed and has two adult kids who live in the same area  as her. But they rarely agree on how to provide care for her. Ellen has  asked her children to help her navigate her decision to retire.Based on the above scenario, create a 5- to 6-page report in a  Microsoft Word document that describe the issues that Ellen and her  children need to address regarding:Ellen’s retirementEllen’s future health care plansEllen’s housingEllen’s financial situationEllen’s ability to perform her job effectivelyThe disease progression and its effect on her activities of daily living (ADL)Advanced directivesFuneral plansSocial supports available to EllenRole her culture may play on her family’s decisionSubmission DetailsSupport your answers with appropriate research and reasoningCite any sources in APA format

 
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Nursing  week 2 discussion

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Effective communication is a staple of our healthcare culture.  Working with patients, peers, and interprofessional teams requires that nurses manage information and evidence toward influencing safe and positive patient outcomes.Please address the following:Describe caring attributes of the culture where you currently practice.Which attributes stand out as having significant influence on patients, nurses, and other healthcare professionals?How do you see effective communication relating to patient outcomes in this setting?What is the evidence for this?

 
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Nursing  NSG 6101

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Please write a comment on this post. APA, citation  and reference. prefer CDC, healthy people 2020.Mr. Barley is a 58-year-old well-developed male with a chief complaint of “a bad cough, mainly in the morning, last winter and this winter.” Cough produces “whitish phlegm”.  The history of present illness includes no complaint of chest pain, weight loss, or fever. There is also no noted nausea, vomiting or diarrhea. Also, of note, the coughing is not precipitated by choking, trembling/shaking, palpitations, sweating or chills.  Mr. Barley notes that he does have contact with chemicals on his farm, however, is cautious to use protective equipment.  He also notes that he has a long (26 year) history of smoking up to two packs of cigarettes per day though recently he has cut back to a half a pack per day. Mr. Barley also notes that he has no known allergies, has not traveled or been exposed to tuberculosis.  He also does not have leg swelling, orthopnea, or proximal nocturnal dyspnea (PND). Mr. Barley has no chronic illness noted in his past, only being seen for minor injuries, and has never been admitted to the hospital and only surgical history is a tonsillectomy at age 12. Mr. Barley takes no medications at this time. Mr. Barley’s social history includes being married for thirty-five years and has two adult daughters. He currently resides with his wife on their farm. Both of his daughters have families of their own. His past family history includes his mother whom he thinks has hypertension, and father who died of a stroke when he was seventy. His sisters and daughters have no known medical history.To complete a focused physical exam a differential diagnosis must first be established. There are several potential causes of acute dyspnea with a cough including asthma, acute bronchitis, and new onset chronic obstructive pulmonary disease (COPD), lung cancer, and congestive heart failure (CHF).  (Buttaro, Trybulski, Polgar-Bailey, and Sandberg-Cook, 2017). It is unlikely that Mr. Barley has an active infection due to the lack of fever (current temp 98.9), chills, or change in color and consistency of the phlegm. At this time CHF may be set aside due to the lack of chest pain, edema in lower extremities, the absence of PND, and a blood pressure of 128/78. Therefore, a focused assessment relating to the respiratory system is warranted at this visit.  According to Petty (2001), the National Lung Health Education Program (NLHEP) began a campaign to introduce early assessment, intervention, and diagnosis of chronic lung disease in individuals who smoke.  It was recommended that individuals older than forty-five complete an in-office spirometry exam to indicate risk for chronic lung diseases such as asthma, chronic bronchitis, COPD, and lung cancers.A general physical exam will assess Mr. Barley’s general appearance, vital signs, head, eyes, ears, nose, throat, neck, lungs, heart, abdomen, and extremities. The focused assessment for COPD will include auscultation of breath sounds specifically looking for wheezing/end expiratory wheezing, assessment of anterior-posterior (AP) diameter of the chest, and prolonged expiratory phase and evidence of a change in the suprasternal notch.  Mr. Barley is noted to have a laryngeal height of 2cm from the sternal notch, increased AP diameter, and diffuse end-expiratory wheezes in addition to self-admittance of long-term smoking.  These findings are indicative of a COPD diagnosis.The GOLD standard for assessment of COPD is the use of spirometry to assess for airway obstruction. (Global Initiative for Chronic Obstructive Lung Disease (GOLD), 2016). Buttaro, Trybulski, Polgar-Bailey, and Sandberg-Cook (2017) state that additional tests should include pulse oximetry, laboratory studies of complete blood count (CBC) with differential, arterial blood gas (ABG), and alpha 1 antitrypsin, and that imaging including a chest x-ray is suggested. Within the case study, pulmonary function testing (spirometry) is completed indicating that the diagnosis of COPD was accurate.  At this time, I would also have completed baseline blood work including the suggested CBC, ABG, alpha 1 antitrypsin, and imaging of chest x-ray. Though the spirometry exam is the gold standard and indicative of COPD, identifying baseline images and laboratory information will provide information when an exacerbation occurs or the disease progresses.This diagnosis may be a shock for Mr. Barley and written information will need to be provided about COPD, what changes in symptoms will mean, and the addition of maintenance medications. Studies have shown that patient education and nonpharmacologic interventions are factors which decrease the incidence of COPD emergencies. (Lloyd and Garside, 2017).  It is also necessary to discuss with Mr. Barley the need to quit smoking, assessment of his readiness to quit because smoking is the primary cause of chronic lung disease. (Lloyd and Garside, 2017). Mr. Barley should also be aware that smoking cessation will also decrease his current risk of premature morbidity related to COPD related illnesses. (Petty, 2001).At this point, it is necessary to support Mr. Barley emotionally as well.  Information about support groups both in person and online should be provided. Resources for additional information about COPD should be supplied as well.Education on medications including the use of metered dose inhalers (MDI)/inhaled bronchodilators and corticosteroids should also be discussed. It is important to reinforce that no medication will reverse the disease process however, these medications will reduce the severity of the symptoms felt by Mr. Barley. (Buttaro, Trybulski, Polgar-Bailey, and Sandberg-Cook, 2017). An assessment of Mr. Barley’s current knowledge on how to use MDI’s and preferred learning style is necessary to determine the type of education utilized.  The use of demonstration/ return demonstration was utilized within the case study and is a measurable way to assess assimilated knowledge from teaching. It is also important to discuss with Mr. Barley when to seek medical attention in the future relating to his COPD which includes changes in breathing quality (i.e. increased dyspnea) and productive cough with changes in phlegm amount, color or thickness. (Bostock-Cox, 2017). A preventative measure that Mr. Barley can take is to be sure to stay current on his immunizations including pertussis (DTaP), influenza, and pneumococcus. Seo, Hong, Kim, Choi, Baek, Lee, Song, Lee, Cheong, and Kim (2013) indicate that the influenza vaccine does decrease the risk of COPD exacerbations requiring hospitalization by 27 %. Follow up appointments should be set up to ascertain the effectiveness of the medications and further understanding of Mr. Barley’s diagnosis, perhaps to include his wife and or daughters. Follow up appointments also yield information about depression related to changes in health status as well as an opportunity to assess for weight gain related to corticosteroid use and assessment of smoking cessation.

 
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Nursing  Discussion – Learning Theories and Principles

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Which learning theories and principles do you think are most useful to the advanced practice nurse (APN) in providing high quality health care to clients, and why?Post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.

 
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Nursing  APA Peripheral Vascular Disease

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Peripheral Vascular Disease Case StudiesA 52-year-old man complained of pain and cramping in his right calf caused by walking two blocks. The pain was relieved with cessation of activity. The pain had been increasing in frequency and intensity. Physical examination findings were essentially normal except fordecreased hair on the right leg. The patient’s popliteal, dorsalis pedis, and posterior tibialpulses were markedly decreased compared with those of his left leg.StudiesResultsRoutine laboratory workWithin normal limits (WNL)Doppler ultrasound systolic pressuresFemoral: 130 mm Hg; popliteal: 90 mm Hg; posterior tibial: 88 mm Hg; dorsalis pedis: 88 mm Hg (normal: same as brachial systolic blood pressure)Arterial plethysmographyDecreased amplitude of distal femoral, popliteal, dorsalis pedis, and posterior tibial pulse wavesFemoral arteriography of right legObstruction of the femoral artery at the midthigh levelArterial duplex scanApparent arterial obstruction in the superficial femoral arteryDiagnostic AnalysisWith the clinical picture of classic intermittent claudication, the noninvasive Doppler and plethysmographic arterial vascular study merely documented the presence and location of the arterial occlusion in the proximal femoral artery. Most vascular surgeons prefer arteriography to document the location of the vascular occlusion. The patient underwent a bypass from the proximal femoral artery to the popliteal artery. After surgery he was asymptomatic.Critical Thinking QuestionsWhat was the cause of this patient’s pain and cramping?Why was there decreased hair on the patient’s right leg?What would be the strategic physical assessments after surgery to determine theadequacy of the patient’s circulation?What would be the treatment of intermittent Claudication for non-occlusion?

 
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Nursing  2-Mar

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What do the four parts of the Christian biblical narrative (i.e., creation, fall, redemption, and restoration) say about the nature of God and of reality in relation to the reality of sickness and disease? From where would one find comfort and hope in the light of illness according to this narrative? Explain in detail each part of the narrative above and analyze the implications.

 
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Nursing  Complementary healthcare

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Research a traditional cultural practice on the InternetThis is for a nursing class. Please use 2 references. this post must be 150-200 words and written in proper apa format

 
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