Spirituality and the Nursing Practice

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Spirituality and the Nursing Practice

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Nursing Practice and Spirituality

For this conversation:

Describe how methodology can be used to develop a theoretical framework for making spirituality meaningful in nursing practice using the unit textbook readings and articles.
How do you see this process influencing future decisions in your nursing practice?
Why is this an important factor to consider when developing a treatment plan for an individual or a group of patients?

Your first post should be at least 150 words long, and you must use another writer’s work (as a quotation, paraphrase, or summary) to back up your points. The course text, another relevant book, or any assigned reading can all be used as sources. Use the APA citation style to give credit to the other writer when you incorporate their ideas into your work. Keep in mind that an APA citation includes both the in-text citation (the author’s last name and the year of publication) and the full source reference.

Important information for writing discussion questions and participation

Welcome to class

Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to

I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.

Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.

If you think you would be needing accommodations due to any reasons, please contact the appropriate department to request accommodations.

Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.

Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

  • Your response needs to be a minimum of 150 words (not including your list of references)
  • There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
  • Include in-text citations in your response
  • Do not include quotes—instead summarize and paraphrase the information
  • Follow APA-7th edition
  • Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

  • A minimum of 6 responses per week, on at least 3 days of the week.
  • Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
  • Each response needs to be at least 75 words in length (does not include your list of references)
  • Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
  • Follow APA 7th edition
  • Points will be deducted if the above is not followed
  • Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
  • Here are some helpful links
  • The is a great resource

Psychiatric Mental Health Nursing

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Psychiatric Mental Health Nursing

 

Psychiatric Mental Health Nursing

Scope and Practice Standards for Psychiatric Mental Health Nursing Examine the APNA Scope and Standards of Practice (American Psychiatric Nurses Association). If you are an APNA member, you can download the book for free. The link in this section will take you to the book, but you must log in first. Joining APNA is a good idea. If you prefer, you can purchase a print copy for a reasonable price. It is not necessary to read the book. The standards are available here. The standards are taken directly from the second edition of the APNA Scope and Standards of Practice (2014). This module’s assignment is to take each Standard and provide several examples of how you will apply these standards in your practice. Please limit yourself to a few bullet points to address each standard. Ex: Standard 1: Evaluation—what screening tools will you employ? Will you meet with the patient and his or her family together, separately, or both? How much time will you set aside for a new patient evaluation? As a nurse practitioner, you must understand your scope of practice. You cannot rely on others to understand your scope. •Collect and synthesize comprehensive health data relevant to the health and/or situation of the healthcare consumer. •Develop standard psychiatric and substance use diagnoses. Standard 3: Identifying Expected Outcomes •Identify expected outcomes and the healthcare consumer’s goals for a plan tailored to the healthcare consumer or the situation. •Develop a plan that prescribes strategies and alternatives to assist the healthcare consumer in achieving expected outcomes. •Implement the identified plan •Coordinate care delivery •Utilize strategies to promote health and a safe environment •Offer consultation in order to influence the identified plan, improve the abilities of other clinicians to provide services to healthcare consumers, and effect change.

•In accordance with state and federal laws and regulations, use prescriptive authority, procedures, referrals, treatments, and therapies. •Combine pharmacological, biological, and complementary intervention knowledge with applied clinical skills to restore the health of the healthcare consumer and prevent further disability. •In collaboration with healthcare consumers, families, and other healthcare clinicians, provide structures and maintain a safe, therapeutic, recovery-oriented environment. •Assist healthcare consumers in their individual recovery journeys by improving and regaining previous coping abilities, fostering mental health, and preventing mental disorder and disability through the therapeutic relationship and counseling interventions. •Conducts individual, couples, group, and family psychotherapy using evidence-based psychotherapeutic frameworks and the nurse-client therapeutic relationship Standard 6: Evaluation •Incorporate ethical provisions into all areas of practice. •Acquire knowledge and competence that reflect current nursing practice under Standard 8: Education. •Incorporate evidence and research findings into practice according to Standard 9: Evidence-Based Practice and Research •Systematically improve the quality and effectiveness of nursing practice (standard 10) •Communication Standard 11: Communicate effectively in a variety of formats across all areas of practice. •Provide leadership in the professional practice setting and within the profession. •In the course of nursing practice, collaborate with the healthcare consumer, family, interprofessional health team, and others. • Evaluate one’s own practice in relation to professional practice standards and guidelines, as well as relevant statutes, rules, and regulations. •In the planning and delivery of nursing services, consider factors related to safety, effectiveness, cost, and impact on practice. •Practice in an environmentally safe and healthy manner in accordance with Standard 16: Environment Health.

Important information for writing discussion questions and participation

Welcome to class

Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to

I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.

Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.

If you think you would be needing accommodations due to any reasons, please contact the appropriate department to request accommodations.

Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.

Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

  • Your response needs to be a minimum of 150 words (not including your list of references)
  • There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
  • Include in-text citations in your response
  • Do not include quotes—instead summarize and paraphrase the information
  • Follow APA-7th edition
  • Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

  • A minimum of 6 responses per week, on at least 3 days of the week.
  • Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
  • Each response needs to be at least 75 words in length (does not include your list of references)
  • Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
  • Follow APA 7th edition
  • Points will be deducted if the above is not followed
  • Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
  • Here are some helpful links
  • The is a great resource

APA 5 sources Psychiatric Mental Health Nursing Paper

CLICK HERE TO ORDER A PLAGIARISM-FREE PAPER

Health information technology

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Health information technology

CLICK HERE TO ORDER A PLAGIARISM-FREE PAPER

The National Institute of Standards and Technology (NIST) sets standards for the United States, and especially for the Federal government. The Federal Information Security Management Act of 2002 (“FISMA”) required risk-based management of security for Federal information systems. NIST produced a Guide for Conducting Risk Assessmentsin 2002 that was revised in 2012.

You will find the revised guide here: http://nvlpubs.nist.gov/nistpubs/Legacy/SP/nistspecialpublication800-30r1.pdf

Although the PDF document is about 100 pages, there are only 38 pages in the guide proper. You will need to review at least a few of the appendices for this assignment in addition to reading the Guide.

You can find more background material with Google and especially Good Scholar. Please note that you can set a date range with Google Scholar, and so get only material published after the rule changes were announced. Try to find at least one publication that is a peer-reviewed scientific journal.

Questions to answer:

  1. What was the target audience of this document, and how does it apply to health care institutions? To vendors of health care
    Health information technology Assessment

    information technology? [25 point]

  2. What are the key concepts of risk, risk assessment, risk management, and risk communication? [25 point]
  3. What are the essential elements of a risk assessment reports? [25 point]
  4. Appendix D of the Guide divides threat sources into categories of adversarial, accidental, structural, and environmental. Based on your reading to date, which category to you believe represents the biggest danger to health information technology? Support your choice with arguments from the Guide and at least one other source. [25 point]

Important information for writing discussion questions and participation

Welcome to class

Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to

I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.

Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.

If you think you would be needing accommodations due to any reasons, please contact the appropriate department to request accommodations.

Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.

Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

  • Your response needs to be a minimum of 150 words (not including your list of references)
  • There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
  • Include in-text citations in your response
  • Do not include quotes—instead summarize and paraphrase the information
  • Follow APA-7th edition
  • Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

  • A minimum of 6 responses per week, on at least 3 days of the week.
  • Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
  • Each response needs to be at least 75 words in length (does not include your list of references)
  • Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
  • Follow APA 7th edition
  • Points will be deducted if the above is not followed
  • Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
  • Here are some helpful links
  • The is a great resource

Health information technology Assessment

Submission requirements:

  1. Times New Roman, 12 font size, Double-space, Margin 1″. No more than 4 pages not counting the “Works Cited” page.
  2. Be sure to have in-text citation, and Works Cited page. You can use Google Scholar or other online citation generation tools to generate citation in MLA format.

Nervous System Case Study

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Nervous System Case Study

CLICK HERE TO ORDER A PLAGIARISM-FREE PAPER

Nervous System Case Study Paper

A 30 year old Marsha Lansing presented reporting of daily headaches, irritability, and sadness, difficulty concentrating and getting out of bed some days, as well as having stressful home life with constant worries about family, finances, work, home and pets. A physical exam, blood work, and PHQ-9 patient depression Questionnaire was provided. Ms. Lansing physical and blood work WNL was performed to rule out other medical conditions. Ms. Lansing completed the PHQ-9 Depression and screening there were 5 in the shaded area indicating Major Depression. I provided to her a diagnosis of Major Depressive Disorder, as outlined by the DSM5 (2013). There are so many different type of treatment for depression, so it is possible you may see different physicians for different treatments. I as your Primary Care Practitioner I will prescribe you antidepressants. These medications are designed to elevate your mood and ease your sadness. It is important for you to know that it takes time for the antidepressant to have its full affect about a month. The antidepressants work with three chemicals in your brain norepinephrine, serotonin and dopamine, often with depression you might have difficulty with theses chemicals, a brain that has depression does not uptake these chemical properly.

The medication helps the chemicals work properly and can improve your mood. There are several different types of antidepressants, the most common and the one that I will be prescribing is called selective serotonin reuptake inhibitors or SSRI’s. I have chosen Escitalopram (Lexapro ) 10 mg daily, to be taken at the same time each day. While we wait for a blood level of your medication, which can take a month, there are other treatments available to help you with your depression. Talking with a professional about what is

Nervous System Case Study Paper

happening in your life through psychotherapy. This type of therapy means you will meet with a psychiatrist, psychologist, and social worker or other trained mental health professional. They will assist you and teach you new ways to address challenges and change the way of thinking about certain situation that depression affects. Exercise has also proven as a extremely beneficial treatment along with medicine and psychotherapy. Another treatment that can ease your depression is your diet. A diet that is high in nutrients, antioxidants, and vitamins. I would also provide patient education regarding Lexapro and potential side effects according PubMed Health, U.S. national Library of Medicine (Depression 2010): severe side effects to Lexapro include allergic reactions such as skin irritation or generalized hives, swelling of the face, mouth, and extremities, a feeling of a thickened tongue, difficulty swallowing or speaking, chest tightness, difficulty breathing, a feeling of doom and gloom, restlessness, increased sweating, fever, nausea, vomiting, diarrhea, seeing or hearing things that are not there, muscle spasms, confusion or fuzzy thoughts, muscle weakness and twitching, eye pain, seeing aura around objects, increased heart rate , palpitation, or feeling a skip beat, racing thoughts, insomnia, seizure, thoughts of hurting self or others, unexplainable bleeding or bruising. These side effects must be reported to me right away and be seen at the clinic.

I also would encourage Ms. Lansing to speak to me if she is experiencing less serious side effects such as dizziness, drowsiness, dry mouth, headaches, nausea , constipation, diarrhea, or sexual problems. I would further educate Ms. Lansing that Lexapro should not taken with any other MAOIs as this interaction could lead to an increased bleeding risk as well as Serotonin Syndrome that could be life-threatening. I educated Ms. Lansing the need to take Lexapro and that I would continue to monitor for side effects , and for her to plan to return to the clinic in 4 weeks to discuss the progress of the medication and treatment plan.

Important information for writing discussion questions and participation

Welcome to class

Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to

I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.

Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.

If you think you would be needing accommodations due to any reasons, please contact the appropriate department to request accommodations.

Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.

Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

  • Your response needs to be a minimum of 150 words (not including your list of references)
  • There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
  • Include in-text citations in your response
  • Do not include quotes—instead summarize and paraphrase the information
  • Follow APA-7th edition
  • Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

  • A minimum of 6 responses per week, on at least 3 days of the week.
  • Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
  • Each response needs to be at least 75 words in length (does not include your list of references)
  • Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
  • Follow APA 7th edition
  • Points will be deducted if the above is not followed
  • Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
  • Here are some helpful links
  • The is a great resource

References

American Psychiatric Association. (2013). Diagnosis and statistical manual of mental disorders DSM-5. Washington, D. C: American Psychiatric Association.

Depression: The treatment and Management of Depression in Adults. NICE Clinical Guidelines, No. 90. National Collaborating Centre for Mental Health (UK). Leicester (UK) : British Psychological Society; 2010.

Lowe B. Kroenke K. Herzog W, Grafe K. Measuring depression outcome with a short self-report instrument: sensitivity to change of the Patient Health Questionnaire (PHQ-9). J Affective Disorders. 2009: 78: 131-140.

Medscape (2017). Retrieved February 9, 2018. Retrieved from: http://reference.medscape.com/

APA format and clean up grammar and plagiarism, if possible have it by 10PM eastern standard time

Health information technology skills

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Health information technology skills

 

As a health information technology manager at your organization, what are some vital technical skill sets you would seek in a new hire?

Please use 7th edition APA format, intext citations, references and italiacs.

As a health information technology manager at your organization, what are some vital technical skill sets you would seek in a new hire? In which technical areas is your organization strong and in which areas do you see room for improvement?

Health Information Technology Skills

Health care organizations continue improving in many ways, and integrating technology in practice is among the reliable methods of improving health outcomes. As data continue to become central in the health practice, it is vital to ensure that most of the workforce is tech-savvy. Also, health informatics professionals should efficiently work with health information, and it is crucial to possess the right technical skills set for any new hire in information technology departments. This paper examines the vital technical skills and organization’s status on health information technology.

Vital Skills Set

As data continues to be a critical resource in health informatics, new hires should possess various skills to handle data and work with teams proficiently. The first vital skill is the ability to work with data health systems. Sweeny (2017) posited that most of the work for health informatics professionals and other professionals handling health information revolves around data systems. As a result, the ability to manipulate data systems is crucial. Also, interpersonal skills are essential. Holden et al. (2018) noted that success in health informatics depends on interprofessional collaboration since it is rare to work solely. The job’s nature requires collaboration between IT staff, executive officers, and clinical staff. Well-developed interpersonal skills are vital to delivering the desired outcomes.

Organization’s Status

Regarding strengths, one of the strong organizational areas is data security. As health care organizations continue integrating health technology in care, data security is crucial as a requirement from Health Insurance Portability and Accountability Act (HIPAA) rules. The HIPAA requires health organizations to assess risks and address vulnerabilities by implementing risk management programs (Grama, 2020). However, improvement is necessary in the programming aspect of the organization. As responsibilities change, programming languages such as Python and Java will continue to be useful, and updating this area is essential.

In conclusion, health care organizations rely a lot on data today. Many IT departments’ roles involve data handling, and all employees must understand data systems’ essentials and their handling. Working in teams is crucial too. For better outcomes, organizations must advance in all health technology areas. Data security should be a concern and knowledge that improves data handling and manipulation, such as programming skills.

Important information for writing discussion questions and participation

Welcome to class

Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to

I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.

Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.

If you think you would be needing accommodations due to any reasons, please contact the appropriate department to request accommodations.

Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.

Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

  • Your response needs to be a minimum of 150 words (not including your list of references)
  • There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
  • Include in-text citations in your response
  • Do not include quotes—instead summarize and paraphrase the information
  • Follow APA-7th edition
  • Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

  • A minimum of 6 responses per week, on at least 3 days of the week.
  • Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
  • Each response needs to be at least 75 words in length (does not include your list of references)
  • Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
  • Follow APA 7th edition
  • Points will be deducted if the above is not followed
  • Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
  • Here are some helpful links
  • The is a great resource

References

Grama, J. L. (2020). Legal and privacy issues in information security. Jones & Bartlett Learning.

Holden, R. J., Binkheder, S., Patel, J., & Viernes, S. H. P. (2018). Best practices for health informatician involvement in interprofessional health care teams. Applied clinical informatics, 9(1), 141-148. doi:

Sweeny, J. (2017, Feb 2). Healthcare informatics. HIMSS. https://www.himss.org/resources/healthcare-informatics

 

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NURS-FPX 601-Evidence-Based Practice

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NURS-FPX 601-Evidence-Based Practice

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NURS-FPX 601-Evidence-Based Practice

Create an evidence-based, patient-centered concept map that illustrates an individualized approach to patient care

Question

Create an evidence-based, patient-centered concept map that illustrates an individualized approach to patient care, based on a patient case file of your choice.

Evidence-based practice is a key skill in the toolkit of the master’s-prepared nurse. Its goal is to ensure that health care practitioners are using the best available evidence to ensure that patients are receiving the best care possible (Godshall, M., 2015.). In essence, evidence-based practice is all about ensuring quality care.

In this assessment, you have an opportunity to apply evidence-based practice and personalized care concepts to ensure quality care and improve the health of a single patient.

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

Competency 1: Apply evidence-based practice to plan patient-centered care.
Analyze the needs of a patient, and those of their family, with regard to how they will influence a patient-centered concept map.
Design an individualized, patient-centered concept map, based upon the best available evidence for treating a patient’s specific health, economic, and cultural needs.
Competency 3: Evaluate outcomes of evidence-based interventions.
Propose relevant and measurable criteria for evaluating the outcomes of a patient-centered concept map.
Competency 4: Evaluate the value and relative weight of available evidence upon which to make a clinical decision.
Justify the value and relevance of evidence used as the basis of a patient-centered concept map.
Competency 5: Synthesize evidence-based practice and academic research to communicate effective solutions.
Develop a strategy for communicating with patients and their families in an ethical, culturally sensitive, and inclusive way.
Integrate relevant and credible sources of evidence to support assertions, correctly formatting citations and references using APA style.

Reference

Godshall, M. (2015). Fast facts for evidence-based practice in nursing: Implementing EBP in a nutshell(2nd ed.). New York, NY: Springer Publishing Company.

Preparation

You have been presented with a number of patient case files in the Evidence-Based Patient-Centered Care media piece. You reviewed each case, selected one case for further research, and created draft evidence-based concept map to illustrate an approach to individualized care for the patient. In this assessment, you will build upon and refine your draft concept map and develop a supporting narrative.

Create your concept map and narrative as separate documents. Be sure to note the areas where you need to include your evidence-based support and where you need to make clear your strategies for communicating information to the patient and the patient’s family.

Note: Many organizations use the spider style of concept maps (see the Taylor & Littleton-Kearney article for an example). Also, if a specific style of concept map is used in your current care setting, you may use it in this assessment.

Create your concept map and narrative as separate documents. Be sure to note the areas where you need to include your evidence-based support and where you need to make clear your strategies for communicating information to the patient and the patient’s family.

Requirements

Note: The requirements outlined below correspond to the grading criteria in the scoring guide, so be sure to address each point. In addition, you may want to review the performance level descriptions for each criterion to see how your work will be assessed.

Supporting Evidence and APA Style

Integrate relevant evidence from 3–5 current scholarly or professional sources to support your assertions.

Apply correct APA formatting to all in-text citations and references.
Attach a reference list to your narrative.

Concept Map

Develop a concept map for the individual patient, based upon the best available evidence for treating your patient’s health, economic, and cultural needs.

Narrative

Develop a narrative (2–4 pages) for your concept map.

Analyze the needs of your patient and their family, and determine how those needs will influence a patient-centered concept map.
Consider how your patient’s economic situation and relevant environmental factors may have contributed to your patient’s current condition or affect their future health.
Consider how your patient’s culture or family should influence your concept map.
Justify the value and relevance of the evidence you used as the basis of your concept map.
Explain why your evidence is valuable and relevant to your patient’s case.
Explain why each piece of evidence is appropriate for both the health issue you are trying to correct and for the unique situation of your patient and their family.
Propose relevant and measurable criteria for evaluating the degree to which the desired outcomes of your concept map were achieved.
Explain why your proposed criteria are appropriate and useful measures of success.
Explain how you will communicate specific aspects of the concept map to your patient and their family in an ethical, culturally sensitive, and inclusive way. Ensure that your strategies:
Promote honest communications.
Facilitate sharing only the information you are required and permitted to share.
Are mindful of your patient’s culture.
Enable you to make complex medical terms and concepts understandable to your patient and their family, regardless of language, disabilities, or level of education.

Additional Requirements

Be sure to include both documents when you submit your assessment.

NUR 2868 Political Issues for Nursing

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NUR 2868 Political Issues for Nursing

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NUR 2868 Political Issues for Nursing

Go to the ANA home page and search for their Advocacy Policy.
Read through the ANA Advocacy Policy’s web pages.

Look at issues at a federal, state, or local level for which
the ANA is advocating change or new policies.

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Which one are you most eager to see enacted? Why does it
interest you? How will passage of such legislation affect you or your patients?

Thanks to their frontline role, nurses offer a unique, expert perspective on every aspect of the health care system, and have a key voice in ongoing efforts to improve public health. As the lead organization representing the interests of the nation’s 4 million registered nurses, ANA’s role is to articulate that voice at the highest levels in order to influence health policy.

Our efforts are directed at those responsible for creating the modern U.S. health care environment the policy makers and agencies whose decisions will affect patients and those who care for them. We are dedicated to ensuring that the voice of nursing is heard at all levels where these decisions are made.

Health System Reform

ANA believes every single person, including nurses, should have access to the highest quality and safest care. Health care is a basic human right. For decades, we have used the experience and expertise of our members to fight for that right, and for meaningful health care reform.

The passage of the 2010 Patient Protection and Affordable Care Act (often referred to as the ACA) – and recent high-profile attempts to change it – demonstrates how health care legislation is one of the most important issues facing our leaders today.

Agencies and regulations

While Congress makes the laws, much of the critical federal-level advocacy that ANA carries out is geared towards those whose role it is to interpret, and enforce, legislation that may affect our profession and its members – the numerous agencies of the federal government.

The day-to-day work of agencies such as the Centers for Medicare and Medicaid Services (CMS), Centers of Disease Control (CDC), The Federal Drug Administration (FDA), and Health Resources and Services Administration (HRSA) have a huge impact on all who work in the health care system. It is vital that the voice of nursing is heard during their decision-making processes.

Care Coordination

With the transformation of the health care system well underway, care coordination is now being highlighted by hospitals, health systems, and insurers as a key tool in improving patient health and satisfaction, and controlling health care costs.

ANA is leading the way through a number of initiatives to bring attention to nurses’ essential role in care coordination and to demand payment for these essential services as a distinct component of patient care.

Health Information Technology

Health Information Technology (HIT) has enabled the pursuit of better care coordination, allowing health care providers to quickly capture standardized data, use it to inform patient care, and communicate it to their colleagues across a range of clinical settings.

But with such potential comes a greater level of responsibility for nurses who, thanks to their place on the frontline, are key stakeholders in the implementation of any new practices and procedures. This is why ANA has taken a particular interest HIT and its implications for nurses – both in terms of opportunities and additional workload.

NUR643E Musculoskeletal Exam Guide

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NUR643E Musculoskeletal Exam Guide

NUR643E Develop  Problem-Focused Exam Involving  Musculoskeletal System And Extremities

DQ1 As an instructor, you are working with a nursing student to develop a problem-focused exam involving the musculoskeletal system and extremities.  Formulate potential questions to support the student in soliciting specific information about the patient related to past history, drugs that may adversely affect the musculoskeletal system, family history, psychosocial profile, and provide rationale.

DQ2 The goal of a complete musculoskeletal assessment is to detect risk factors, potential problems, or musculoskeletal dysfunction early and then to plan appropriate interventions, including teaching health promotion and disease prevention, and implementing treatment measures. By doing so, you can play a signi?cant role in preventing pain and dysfunction in your patients. Describe a plan to provide patient teaching that incorporates health promotion and disease prevention. Provide rationale.

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Technique

In examining the musculoskeletal system it is important to keep the concept of function in mind. Note any gross abnormalities of mechanical function beginning with the initial introduction to the patient. Continue to observe for such problems throughout the interview and the examination.

On a screening examination of a patient who has no musculoskeletal complaints and in whom no gross abnormalities have been noted in the interview and general physical examination, it is adequate to inspect the extremities and trunk for observable abnormalities and to ask the patient to perform a complete active range of motion with each joint or set of joints.

If the patient presents complaints in the musculoskeletal system or if any abnormality has been observed, it is important to do a thorough musculoskeletal examination, not only to delineate the extent of gross abnormalities but also to look closely for subtle anomalies.

To perform an examination of the muscles, bones, and joints, use the classic techniques of inspection, palpation, and manipulation. Start by dividing the musculoskeletal system into functional parts. With practice the examiner will establish an order of approach, but for the beginner it is perhaps better to begin distally with the upper extremity, working proximally through the shoulder. Then, beginning with the temporomandibular joint, pass on to the cervical spine, the thoracic spine, the lumbar and sacral spine, and the sacroiliac joints. Finally, in the lower extremity, again begin distally with the foot and proceed proximally through the hip.

Use the opposite side for comparisons: it is easier to spot subtle differences as well as identify symmetrical problems. If there is any question, use your own anatomy as a control.

Glean the maximum information from observation. Concentrating on one area at a time, inspect the area for discoloration (e.g., ecchymoses, redness), soft tissue swelling, bony enlargement, wasting, and deformity (abnormal angulation, subluxation). While noting these changes, attempt to determine whether they are limited to the joint or whether they involve the surrounding structures (e.g., tendons, muscles, bursae).

Observe the patient’s eyes while palpating the joints and the surrounding structures. A patient’s expression of pain depends on many factors. For this reason the verbalization of pain often does not correlate directly with the magnitude of the pain. The most objective indicator of the magnitude of tenderness produced by presence on palpation is involuntary muscle movements about the eyes. Therefore, the examiner should observe the patient’s eyes while palpating the joints and surrounding structures. With practice the examiner will become skilled in evaluating the magnitude of pain produced by the examination and will be able to do a skillful evaluation without producing excessive discomfort to the patient. Note areas of tenderness to pressure, and if possible identify the anatomic structures over which the tenderness is localized.

One should also note areas of enlargement while palpating the joints and surrounding structures. By noting carefully the consistency of the enlargement and its boundaries, one can decide whether this is due to bony widening, thickening of the synovial lining of the joint, soft tissue swelling of the structure surrounding the joint, an effusion into the joint capsule, or nodule formation, which might be located in a tendon sheath, subcutaneous tissue, or other structures about the joint.

While palpating the joints, note areas of increased warmth (heat). A method for doing this that will help even the most inexperienced to perceive subtle increases in heat is to choose the most heat-sensitive portion of the hand (usually the dorsum of the fingers) and, beginning proximally, lightly pass this part of your hand over all portions of the patient’s extremity several times. As you proceed from proximal to distal, the skin temperature gradually cools. If you find an area becoming slightly warmer, this represents increased heat.

Have the patient perform active movements through an entire range of motion for each joint. Defects in function can be most rapidly perceived by having the patient perform active functions with each region of the musculoskeletal system. This reduces examination time and helps the examiner to identify areas in which there is poor function for more careful evaluation.

Manipulate the joint through a passive range of motion only if the patient is unable actively to perform a full range of motion, or if there is obvious pain on active motion. In passively manipulating a joint, note whether there is a reduction in the range of motion, whether there is a pain on motion, and whether crepitus is produced when the joint is moved. Note also whether the joint is stable or whether abnormal movements may be produced.

Upper Extremity

Observe and palpate both hands and wrists, noting areas of color change, enlargement, and temperature change (described elsewhere). Also note deformities if present (contractures, subluxations, abnormal angulations). Look carefully for nail and cuticle abnormalities, atropy of the thenar or hypothenar eminences, and triggering. Triggering in a finger is caused by an inflammatory nodule within a tendon sheath. It is characterized by an inability to extend a finger until a larger than usual force is applied along the flexor tendon sheath and the finger snaps into extension. Ask the patient to make a tight fist with both hands. Ask the patient to grasp a small object such as a finger. If the patient is capable of making a tight fist and grasping a small object with no observable abnormality, then a passive manipulation of the metacarpophalangeal joints and proximal and distal interphalangeal joints need not be made; however, should an abnormality be detected, passive examination of the range of motion of each of the joints should be performed.

Normal range of motion for the fingers:

  • Distal interphalangeal joints (digits 2–5): 0 to 80 degrees of flexion
  • Proximal interphalangeal joints (digits 2–5): 9 to 120 degrees of flexion
  • Interphalangeal joint of the thumb: 35 degrees hyperextension, 90 degrees flexion
  • Metacarpophalangeal joints (digits 3–5): 30 degrees hyperextension, 90 degrees flexion
  • Metacarpophalangeal joint of the thumb: 0 to 70 degrees of flexion

To examine range of motion of the wrist, ask the patient to assume an attitude with the elbows flexed and the forearms parallel to the floor, and then press the palms of the hands and the dorsum of the hands as closely together as possible, producing angulation of the wrist. The wrist can normally be dorsiflexed to 70 degrees and palmar flexions should be possible to approximately 80 or 90 degrees. Ask the patient to deviate the hand ulnarward; this should be possible to 50 to 60 degrees. Finally, ask the patient to deviate both hands radialward; this should be possible to approximately 20 degrees.

Observe and palpate both elbows and over the olecranon process, again noting areas of color change and enlargement. Be careful to observe for synovial thickening or effusion both in the joint itself and in the area of the olecranon bursa. Observe for subcutaneous nodules over the olecranon process. Ask the patient to extend both elbows fully and to flex them fully. The position of full extension is designated as 0 degrees, and flexion should be performed well to 160 degrees in the normal state.

The range of motion in the radiohumeral joints is then tested by asking the patient to pronate and supinate both hands fully. In the normal state the palm of the hand should be able to be placed flat on a table in pronation and the dorsum of the hand flat on the table in supination.

The examination of the shoulder is best performed with the patient sitting or standing in such a position that the examiner can move freely about the patient’s body. Range of motion of the shoulder should be examined with and without manual fixation of the shoulder.

The shoulder mechanism is a complicated system where several joints act in concert. The physician should be familiar with the anatomy of the shoulder and of the contiguous structures that act together. These include the glenohumeral joint, the acromioclavicular joint, the sternoclavicular joint, the gliding tissue space between the scapula and thorax, the shoulder capsule or rotator cuff, and the subacromial bursa.

NURS 4465 Population and Community Nursing

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NURS 4465 Population and Community Nursing

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NURS 4465 Population and Community Nursing

Each person has his or her own personal history; that is, his or her collected experiences. Everything you have ever seen, heard, felt, learned, or experienced has lead to the development of this personal history. Factors that affect this history include your gender, race, age, ethnicity, culture, education, native language, and religion, to name a few. Collectively, these factors create the sum total of who you are as a person. Bias occurs when a person has a tendency towards a particular perspective or ideology (i.e. your personal history); after all, you see the world through your own eyes. To some extent, every person has a natural bias. However, if or when your personal bias interferes with your ability to be unprejudiced or objective – especially in your nursing practice – your biases can become problematic. In this discussion, you will have the opportunity to determine how strong your biases are.You should post your original message by 23:59 PM Wednesday. You should also reply to posts by two of your peers by 23:59 PM, Saturday of Module 3.

NURS 4465 Module 3 Discussion Population and Community Nursing

In the professional nursing practice, nurses must provide unbiased care, even in situations where the person/s being treated have different backgrounds (language, religion, culture, ethnicity, etc.) than you. The first step in overcoming and minimizing personal biases is to recognize them. In this discussion, you will assess your personal biases. Answer the questions honestly and to the best of your ability, noting that there are no right or wrong answers.

Complete the General Awareness and Attitudes Scale Preview the document

The General Awareness and Attitudes Scale is adapted from the Cultural Awareness Scale by Catterson, Cookston, Martinez, & Rew (1998). Answer the question as honestly as possible. There are no right or wrong answers.

Once you complete and score the General Awareness and Attitudes Scale, answer the following questions:

What does the scale say about you?

How strong are your biases?

NOTE: Do NOT post your individual scores. This discussion is not about how you score, but about personal discovery. In other words, the focus of this discussion is about what you learn about yourself. You also do NOT need to share your score with your academic coach.

How can you address these personal biases in your professional nursing practice?

Your original post should consist of complete sentences and should be at least two complete paragraphs but no more than three paragraphs.

NURS 680B

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NURS 680B

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NURS 680B

A 82-year-old diabetic male reports losing 12 lb

Select one of the following case studies to address. In the subject line of your post, please identify which prompt you are responding to, for example, choice #2 19-year old male.

A 82-year-old diabetic male reports losing 12 lbs. over the last month.

NURS 680B A 82-year-old diabetic male reports losing 12 lb

A mother brings in her pale and fatigued 16 month old son, who was changed to cow’s milk after his first birthday.

For the case you have chosen, post to the discussion:

Discuss what questions you would ask the patient, what physical exam elements you would include, and what further testing you would want to have performed.

In SOAP format, list:

Pertinent positive and negative information

Differential and working diagnosis

Treatment plan, including: pharmacotherapy with complementary and OTC therapy, diagnostics (labs and testing), health education and lifestyle changes, age-appropriate preventive care, and follow-up to this visit.

Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas.

In your peer replies, please reply to at least one peer who chose a different case study.

An 80-year-old woman with a past medical history of type 2 diabetes mellitus, asthma, and recurrent urinary tract infections presented to our clinic complaining of decreased appetite and weight loss. The patient lost 17 lb over the past 6 months. She also reported a poor appetite and nausea. She denied history of rectal bleeding and melena. A 2011 colonoscopy had previously revealed an adenomatous polyp.

Physical examination. The patient was in no distress and had no oral lesions. There was no abdominal tenderness or palpable masses.

Laboratory tests. An evaluation revealed hemoglobin 10 g/dL, hematocrit 33%, and mean corpuscular volume of 65 fL. Her white blood cell count was 7.4 mmol/L and platelets were 399 x 109/L. Urinalysis showed red blood cells, trace blood, and a few bacteria. The urine culture showed no growth. Her hemoglobin A1c count was at 6.5%.

Subsequent laboratory test results revealed an iron serum level of 22 mg/dL, total iron-building capacity 218 g/dL, ferritin 697.8 ng/mL, thyroid-stimulating hormone (TSH) 2.22 nIU/L, vitamin B12 311 pg/mL, and a folate level of 4.8 ng/mL.

Radiology. A CT scan of the abdomen and pelvis showed a mass in the upper pole of the left kidney (Figure).

Discussion. Weight loss is common in older adults. It occurs in 15% to 20% of older patients. It is associated with functional decline, frailty, and increased mortality.1-3 Clinicians should review weight trends at every office visit. Although it is not abnormal for the patient’s weight to steadily decline with age, the acceptable rate of weight loss is approximately 0.1 kg to 0.2 kg per year.4 Clinically, significant weight loss in the older adult is defined as a decrease of ≥5% of usual body weight over a 6- to 12-month period.4 If the healthcare provider observes such weight loss, further investigation is warranted.

It is difficult to determine the cause of weight loss in older patients who have multiple medical and psychosocial challenges. Malignancy, chronic disease, depression, cognitive impairment, poor oral health, low income, and medication side effects are a few of the common reasons older adults lose weight.

There are no guidelines available to assist clinicians in the workup of these complex patients. Evaluation usually consists of a through history, physical examination, and laboratory tests, including a complete blood count, comprehensive metabolic panel, urinalysis, sedimentation rate, and TSH.

The clinician’s knowledge of the patient and family is also useful in determining whether or not further studies are appropriate. In the above patient, her physician did not suspect depression or cognitive impairment. Her chronic medical problems were well-controlled. The patient had 2 daughters—both nurses—who provided close observation and care to the patient. In light of the patient’s history of adenomatous polyps, anemia, and microscopic hematuria, colonic or genitourinary malignancy were high in the differential. Therefore, a CT scan of the abdomen and pelvis seemed to be the best, first imaging test to pursue.

Outcome of the case. The patient was referred to urology for evaluation, and underwent hand assisted laparoscopic nephrectomy of her left kidney. Pathology revealed clear cell renal cell carcinoma confined to the capsule. The patient had an uneventful postoperatively course. One month later, the patient was doing very well and had gained 7 lb.

References:

1.Gaddey HL, Holder K. Unintentional weight loss in older adults.
Am Fam Physician. 2014;89(9):718-722.

2.Stajkovic S, Aitken EM, Holroyd-Leduc J. Unintentional weight loss in older adults. CMAJ. 2011;183(4):443-449.

3.Robertson RG, Montagnini M. Geriatric failure to thrive. Am Fam Physician. 2004; 70(2): 343-350.

4.Smith KL, Greenwood C, Payette H, et al. An approach to the nonpharmacologic and pharmacologic management of unintentional weight loss among older adults. Geriatrics Aging. 2007;10(2):91-98.