Category: Nursing

The purpose of this assignment is to provide an opportunity for students to apply the nursing process while planning education to meet the needs of patients. APA STYLE
Instructions:
Develop a teaching plan based on an assigned scenario, case, or client interview. Determine what elements you would include in your assessment of the learner. Identify anticipated or expected learner needs. Select and prioritize evidence based teaching strategies that would best meet the needs of the learner. Describe the resources you would provide to enhance learning. Explain methods that would be used to evaluate learning outcomes. Provide rationales for elements of your teaching plan supported by references from the required course reading assignments. Use the teaching plan format assigned. The competencies contained in the Teaching Plan Rubric will be assessed through this assignment
.Scenario
Mr. Green is a 45 y/o male client who was involved in a MVA (motor vehicle accident), sustaining
bilateral compound fractures. The patient was transferred via fire rescue to the trauma hospital. The
client was evaluated and taken to surgery for an open reduction and internal fixation (ORIF). During
surgery the patient had an estimated blood loss of 850 mL. Postoperatively the client was transferred to
the surgical intensive care unit (SICU). Mr. Green is now 2 days post-op. At 0800 the UAP takes the
client’s vital signs T: 98.5 F, P: 97 bpm, RR: 22 bpm, BP:132/77 mmHg, O2: 97% on room air. The nurse’s
assessment findings note: client is alert and oriented, the client reports pain 7/10.
At 1325 Mr. Green rings the call bell to report chest pain. The nurse delegates to the UAP to check the
vitals while the nurse assess the client. The nurse notes the client is experiencing labored breathing,
dyspnea, cyanosis, and is diaphoretic. Upon lung auscultation the nurse notes decreased breath sounds
and coarse crackles in the right lung. The vital signs are: T: 97.8 F, P: 125 bpm, RR: 28 bpm, BP: 90/70
mmHg, 02: 82% on room air. The client report worsening chest pain when breathing, dizziness, and back
pain.
Mr. Green experienced an acute pulmonary embolism. It has been 3 weeks since Mr. Green’s pulmonary
embolism diagnosis. He is now on a respiratory medical -surgical unit, preparing to be discharged in a
few days.

please let me know if you can do this presentation. i had mistakes with my last writer.
ALL templets are included for this.
i have attached part 1 which is what the part 2 presentation is to be about.

Respond with a minimum of two (2) paragraphs of 4-5 sentences each.
You should address each bullet point in the exercise you select.
Exercise 1.5 The relationship between obesity and cancer is described and discussed in this chapter. Conduct a search to answer the following questions. The incidence rates for six cancers associated with obesity are increasing in young Americans. Identify them. What is the prevalence rate of obesity in people younger than 18 in your state? Which children are at highest risk for obesity in your state? Are there any prevention programs in your state that address this issue? Are they effective? Has your state passed and enacted any laws designed to decrease obesity? Are they effective? If they are not effective, explain why you believe they are not working.
   Your work should have in-text citations integrating at a minimum one scholarly article from this week’s readings and course textbook.
APA format should be utilized to include a reference list.
Correct grammar, spelling, and APA should be adhered to when writing, work should be scholarly without personalization or first person use.

Describe three techniques, methods, or recommendations you can use to promote retention in a study. Are there some additional personal examples you can lend that might not already be in the course materials? Please share. 3 apa citations

Hi! It’s a 3 page paper -reference page included. Prepare a paper, based on an ethical scenario provided by the faculty. Relate a course of action to the scenario that is based on ethical principles. All ethical principles learned in class that apply to the scenario should be included. APA 7 style and you could choose one of the many scenarios provided. Just one! I’ll also attach the prompts and guides to help write the paper.
Scenario 1:
Mrs. Duncan is a 75-year-old woman with a diagnosis of Stage IV breast cancer with metastasis to the
lungs. Although Mrs. Duncan spoke with the nurse and conveyed her wishes for no life-saving measures,
she does not have an Advanced Directive in place. Mrs. Duncan has experienced a significant decline in
cognitive function and is presently unable to make decisions for her care. Her children cannot agree on
what treatment or life-saving measures are appropriate.
Scenario 2:
Mr. Jameson is in end-stage renal failure. Despite efforts to help manage the disease, including dialysis
three times weekly, his condition has worsened. Mr. Jameson’s physician has noted the decline in his
status and has informed the family that Mr. Jameson may have only a few weeks to live. Mr. Jameson’s
children and family are skeptical about telling Mr. Morris how bad his condition is, and the physician has
made no effort to talk to the patient about it. After his family left the hospital for the evening, Mr.
Jameson called for the nurse and asked her to tell him what the doctor said, stating he felt like he was
not getting the whole story.
Scenario 3:
A 7-year old male patient K. Gomez, was involved in a motor vehicle accident, resulting in a traumatic
brain injury. Diagnostic test revealed that the K. Gomez was brain dead. A second battery of test was
performed days later, which also concluded the lack of brain stem activity. The parents were informed
that there was nothing more medically that could be done for K. Gomez and that advanced life support
would be withdrawn. The parents adamantly opposed the medical decision as they believed that their
son was still alive.
Scenario 4:
During a first trimester ultrasound and checkup, the provider noted chromosomal abnormalities. They
were informed that a second trimester follow-up blood work would be necessary to confirm any
chromosomal abnormalities. Test revealed the fetus had Trisomy 18. Parents were informed that 90% of
infants do not survive their first year of life. The newborn was delivered at 39 weeks. Trisomy 18 was
again confirmed once the newborn was born. As expected with a child diagnosed with Trisomy 18, the
newborn had diagnosed cardiac anomalies in addition to skeletal deformities and an omphalocele. The
parents are requesting cardiac surgery to improve the newborn quality of life. However, the medical
team decided against the cardiac surgery as the newborn has other medical condition impacting quality
of life for the newborn
Here are the topics the professor provided that we should hit:
These are just prompts to help guide your paper.
How do the ethical principles apply to the scenario?
Ethical principles
-Justice
-Beneficence
-Nonmaleficence
-Autonomy
Why are ethics important in nursing.
Code of Ethics for Nurses (can be found online)
What is the responsibility of the nurse regarding clients involved in ethical dilemmas?
How can ethical awareness be applies to the scenario?

1. Nurses can have various important roles in response to disaster emergencies. During disaster emergencies, the need for healthcare services may increase, depending on the nature and severity of the disaster. According to Northeastern University (2023), nurses are key during disaster emergencies as they can fill many diverse roles such as triage and assessment, infection control and disease prevention, direct medical treatment, mental health support, etc. The specific legal requirements for nurses or health care practitioners to respond to disaster can differ from state to state. Some states may legally require nurses to report for duty during disaster emergencies, while others may take volunteers. While most states have set aside plans to be activated during emergencies, most rely on other local health related departments to deploy personnel. In the state of California, public workers and emergency responders such as police officers and firefighters may be required to report for duty. According to the Emergency Management Department of LA County (n.d.), all public employees in the State of California are considered disaster service workers, meaning they are required to work as a disaster service worker during times of emergency. Public workers take an oath or affirmation prior to resuming employment duties acknowledging their duty and willingness to upholding and protecting the constitution of the United States and the constitution of the state of California (n.d.). References
A nurse’s responsibility in a disaster. Northeastern. (2023, January 20). https://absn.northeastern.edu/blog/nurses-responsi…
Disaster Service Worker Program for Public Employees. Disaster Service Worker Program for Public Employees | Emergency Management Department. (n.d.). https://emergency.lacity.gov/dsw/disaster-service-…
2. In California, “A licensed nurse who, in good faith, provides emergency care at the scene of an emergency which occurs outside the nurse’s employment will not be held legally responsible for acting or failing to act. They can be held legally responsible if acting with extreme carelessness”(ELI, para. 1, 2022). The law does not require nurses to respond in disaster situations. In terms of contractual responsibility, “However, nurses not only have an ethical obligation to care for others but also to care for themselves. Provision 5 of the Code states that the nurse owes the same duty to self as to others. This conflict of obligation is especially prominent during times of disaster when nurses are put in the position to provide care to critically ill or wounded patients for extended periods of time”(ANA, para. 1, 2023). Nurses must care for others, but must also care for themselves and their well-being during times of emergency. It is a complicated situation, but a nurse must use their best judgment and decide how to act, whether it’s helping others or helping themselves and their family. Before, I was not very familiar with the nursing laws in California, but I have been going through several articles and will put these laws into memory. I need to know these laws because if I work in California, I need to know what actions to take during a disaster and if I’m making the right choice according to the laws of California. Overall, it’s important to know the nursing laws of your state, what laws apply during a disaster, and understand the legal and ethical choices a nurse must make at the time. EmergencyLawInventroy. Displaying information for Nurse located in California for State of Emergency. (n.d.). https://legalinventory.pitt.edu/display-laws?role=Nurse&state=CA&scenario=State+of+Emergency&exportpdf#:~:text=Enforcement%2C%20EMT%2C%20or%20RN&text=A%20firefighter%2C%20law%20enforcement%20officer,acting%20or%20failing%20to%20acLinks to an external site.. Nurses’ roles and responsibilities in – ana enterprise. Who will be there? (n.d.). https://www.nursingworld.org/~4af078/globalassets/docs/ana/ethics/endoflife-positionstatement.pdf

Please Read the case and answer the questions. (Please be sure to answer ALL questions using at LEAST 3 to 5 sentences.)
Case
Barbara is a 66 years old grandma who has been smoking since she was 22 years old. Despite numerous attempts, she has been unable to break her pack-a-day habit. She has just undertaken the ‘smoking jacket’ concept because she lives with her daughter and three grandchildren, and her daughter has recently learned about second-hand smoke in the First 5 program that works for her son. During her annual examination at her PCP’s office, Barbara reports being “constantly out of breath” and tired. She is wheezing slightly and states this is because she has recently been fighting a cold.
On assessment, her provider notes several symptoms, including clubbing of the fingers. Barbara has a barrel-shaped chest, uses pursed-lip breathing, and is using accessory muscles to breath. She has difficulty catching her breath while speaking. Inspection reveals peripheral edema. Vital signs include a heart rate of 82 beats per minute and respiratory rate of 12 breaths per minute. Oxygen saturation is 87%. Spirometry results show reduced FEV1 (forced expiratory volume in one second) and reduced forced vital capacity. She has never had full Pulmonary Function Tests (PFTs) done.

Questions
Advanced Physical Assessment:
1. Is Barbara’s oxygen saturation value normal?
2. What is clubbing? What might explain the clubbing of Barbara’s fingers?
3. Where does the discovery of pursed-lip breathing belong in the SOAP note and why? And clubbing? Why?
4. How do we convey whether or not Barbara’s Health care Maintenance is up-to-date? What does that consist of and where does that belong in her note?
5. What are two “pertinent positives (or negatives)” in the physical findings? Where do they belong in the SOAP note?
Advanced Pharmacology:
1.What medications are indicated in this situation?
2. Are you looking for a curative treatment or symptom management?
3.Discuss the most common routes of administration for Barbara’s medication regimen. Are there advantages to using multiple routes? Disadvantages?
Advanced Pathophysiology:
1. Why has Barbara developed a barrel-shaped appearance to her chest?
2. Why is Barbara using pursed-lip breathing?
3.What is the significance of the spirometry test results?
4.Given Barbara’s pulmonary issues, why may she have developed peripheral edema?
5.Describe the course of disease (signs, symptoms, physical exam, lab and diagnostic studies) that you expect if she remains untreated.

This paper is a ethical reflective paper and will have to reflect. The rubric for this paper will be attached and there should be evidence from 1 evidenced based nursing article that identify the ethical provisions that were possibly being violated. This has to be from a evidenced based nursing article. On the rubric ANA stands for American Nurses Association. Please follow Rubric that is attached.

Week 4 you are learning many concepts, the one we will be focusing on with this discussion board is appropriate prescribing of medication to the older adult. As Nurse Practitioner, we have the responsibility of deciding if a medication is warranted, which drug is the best to prescribe and how much/often. It is also our responsibility to educate on the side effects of the medication and when to seek medical attention if it should occur. Finally, it is our responsibility to determine the effectiveness of our treatment that was prescribed, for example, is the patient’s glucose stable on Glucophage 500 mg BID PO or do we need to titrate up or down.
Initial Post Instructions:
Please critically evaluate the subjective and objective information provided to you in the attached file below.
The first part of the discussion board is to identify all pertinent positive and, negative information and list missing information.
Then create a differential diagnosis list with at least 3 possibly actual diagnosis based on your findings.
Second part is to create a plan utilizing clinical practice guidelines for the priority diagnosis.
Be sure to utilize template, in-text citations and provide full reference citation at the end of the discussion.
Please use this document for your discussion response:
please use updated references
see below example please use in own words cover all aspect of assignment
Pertinent Positive
History of dizziness resolved by showering (yesterday)
Elevated BP of 189/112 during the feeling of dizziness yesterday
Elevated current BP: 129/86
Family history of Breast cancer, CAD, Diabetes with Hypertension
Has not been to the family doctor in 5 years, will seek urgent care if feeling ill.

Pertinent Negative
Significant medical history
Lightheadedness, dizziness, nausea, vomiting, headache, chest pain, shortness of breath and blurred vision
History of vertigo
History of elevated blood pressure
Increase stress
Use of Tobacco or ETOH
Use of NSAIDs or any recent medications
Use of herbal medicines
Feel like the room is spinning
Feel unsteady on her feet
Weakness, visual changes, ear pain / fullness
Numbness or tingling
Fatigue, Fever and chills
Night sweat
Unexplained weight loss or weight gain
Loss of appetite
Difficulty sleeping
Presence of rashes, itching, nail deformity, hair loss, moles, open areas or bruising
Nasal congestion, sinus pain, facial pressure or rhinorrhea
Sore throat
Difficulty swallowing
Cough and wheezing
Palpitations
Dyspnea
Orthopnea
Dysuria
Hematuria
Pain or swelling in the extremities
Bone pain
Muscle pain
Joint pain
Joint swelling, stiffness, weakness
Back pain
Behavioral changes
Difficulty concentrating
Fainting or motor sensory loss
Seizures
Increase thirst or urination
Thyroid enlargement or tenderness
Suicidal ideation
Depression
Mood swings
Hallucinations
Deformity on the chest
Murmur

See explanation.
Step-by-step explanation
Differential Diagnosis:
Primary hypertension
This means that there’s only present hypertension which is not caused by any other disease
The patient is not aware of the diseases that her parents because one died in MVA and she never knew the other. That is a big significant data that is missing because in maternal side, there’s a history of a cardiovascular disease that has a high percentage of getting passed down to different generations.
Hypertension’s signs & symptoms usually don’t show right away, a patient can be asymptomatic for years without ever knowing that her blood pressure has elevated. Patient might have experienced the first symptom yesterday which was dizziness.
Moreover, patient’s current blood pressure is still a bit elevated.
Secondary hypertension
This means that the hypertension is being caused by another disease that is reversible or manageable The only way to manage this is to manage first the other disease.
Age is a great risk factor for primary hypertension but also to a hundred of lists of other diseases such as renal failure, renal artery stenosis and more.
Since patient has not been to a doctor for 5 years, it’s also possible that she has developed another disease but still asymptomatic up until yesterday when she felt dizzy.
Patient reported that she relieved dizziness after taking a shower. There have been studies where taking a warm shower can lower blood pressure and is great for those with heart conditions. This may be the reason why her dizziness was relieved.
Malignant hypertension
This means an elevation in the blood pressure above 180 in systolic or above 120 in diastolic with an organ damage
This is a differential diagnosis since in the case study, no laboratory examination was done to the patient yet. So we have to rule out if the patient experienced a malignant hypertension yesterday since she also reported that she never had an elevated blood pressure.
Organ damages are mostly symptomatic but they can also be delayed.
It’s a medical emergency however, patient did not go to the hospital right after finding out what her blood pressure was.

References:

Hecht, M. (2019, December 20). Types and Stages of Hypertension. Healthline. https://www.healthline.com/health/types-and-stages-of-hypertension#other-types

Verzwyvelt, M. (2017, September 28). 10 Reasons to Take a Hot Bath or Shower | An Electric Instant Water Heater May Be Good for Your Health. Heatworks. https://blog.myheatworks.com/blog/10-reasons-to-take-a-hot-bath-or-shower
another example:The first part of the discussion board is to identify all pertinent positive and, negative information and list missing information.
Pertinent (+)
65 year-old female – patient is of geriatric age, where cardiovascular and neurologic accidents such as CAD and stroke are more prone to happen
(+) hx of constant dizziness with resolution upon bathing – this is a pertinent positive because this is a symptom of ischemic heart disease, although chest pain should come with the said condition
(+) hypertension with BP 189/112 – blood pressure is at level where hypertensive urgency vs emergency is considered, although the blood pressure was only taken once
(+) family hx of obesity, diabetes, hypertension, breast cancer, CAD – increased risk for the patient to also have the same familial diseases
(+) normal vital signs – patient is apparently well and normal vital signs indicate that the patient is not in distress and this is not an urgent matter that requires urgent intake of medications or any other therapeutic interventions
(+) well-nourished and appears stated age – patient is apparently well
Pertinent (-)
(-) lightheadedness, dizziness, nausea, vomiting, headache, chest pain, shortness of breath or blurred vision – these are all symptoms that could point out to ischemic heart disease, which is an important differential diagnosis for the patient
(-) hx of hypertension – patient is less likely to have any atherosclerotic accidents
(-) medical, surgical or hospitalizations – cause of dizziness is unlikely due to any previous procedures that could have caused any embolisms or any structural abnormalities
(-) fatigue, fever, chills, malaise, night sweats, unexplained weight loss or weight gain, loss of appetite, difficulty sleeping – presumptively rules out infection, malignancies, thyroid abnormalities
(-) headaches or hx of vertigo, loss of vision or blurry vision, fainting, motor sensory loss, increased thirst or urination – presumptively rules out stroke, diabetes
(-) no JVD – presumptively rules out congestive heart failure
Peripheral pulses normal and equal in all extremities – presumptively rules out congestive heart failure
(-) edema noted on extremities – presumptively rules out congestive heart failure
Missing information
History of falls – Has she had any instances where her head hit the ground or something hard?
Dietary habits – Does she like fatty food? Is she eating enough protein?
Lifestyle – How many times a week does she exercise? What are her usual activities of daily living?
Diabetes history – Had she been told by a medical practitioner that she was diabetic?
On anticoagulant therapy? – Has she been taking any warfarin/heparin prescribed by her doctor?
How exactly was the blood pressure taken? Were proper steps followed? – Did she take a 15-minute rest prior to taking her blood pressure? Was the cuff positioned properly? Did she repeat blood pressure taking after 10-15 minutes?
List differential diagnosis list with at least 3 possibly actual diagnosis based on your findings.
Rule out Hypertensive crisis
Hypertensive crises refer to patients with severe blood pressure elevations (systolic blood pressure ≥ 180 mm Hg or diastolic blood pressure ≥ 120 mm Hg), and can be further classified as:
Hypertensive emergency – severe elevation in blood pressure is accompanied by end-organ damage
Hypertensive urgency – severe elevation in blood pressure occurs without end-organ damage
Benign Paroxysmal Positional Vertigo
BPPV is an inner ear disorder manifested by repeated episodes of spinning sensation triggered by changes in head position relative to gravity.
BPPV results from a small crystal of calcium carbonate (canalith, otoconia) entering a semicircular canal, usually affecting the posterior canal but it can also affect the horizontal or anterior (superior) semicircular canals.
Suspect BPPV in patients with a history and physical exam consistent with repeated brief (seconds) episodes of vertigo immediately following changes in head position and without signs or symptoms of hearing loss or an underlying neurological disorder.
Vestibular neuronitis
Vestibular neuronitis is inflammation of the vestibular nerve leading to acute, spontaneous peripheral vertigo.
The exact cause of vestibular nerve inflammation is unknown, but it is potentially due to precedent or concurrent viral infection.
It most commonly affects the superior division of the vestibular nerve (reported in 55%-100% of patients), and less commonly affects the total vestibular nerve (reported in 15%-30% of patients) or rarely, the inferior division of the vestibular nerve (reported in up to 15% of patients).
Patients often present with sudden spontaneous vertigo, nausea/vomiting, unsteadiness, and oscillopsia (visual disturbance in which items in the visual field appear to oscillate).
Step-by-step explanation
Second part is to make a plan utilizing clinical practice guidelines for the priority diagnosis.
Distinguishing hypertensive urgency from emergency requires tests to evaluate cerebral, cardiovascular, renal, and hematological function and damage, including:
blood tests including electrolytes, blood urea nitrogen, creatinine, and complete blood count
cardiac biomarkers
urinalysis (for proteinuria or hematuria consistent with glomerular damage)
toxicology screen
electrocardiogram
careful examination of optic nerve for signs of intracranial hypertension (with pupillary dilation if needed)
Imaging based on clinical suspicion for specific conditions, including:
chest x-ray (for signs of left ventricular failure)
chest computed tomography or Doppler echocardiography in patients with unequal pulses or widened mediastinum on chest x-ray – to look for dissecting aortic aneurysm
head computed tomography in patients with signs and symptoms of neurologic abnormalities to evaluate for ischemic or hemorrhagic stroke, and subarachnoid hemorrhage
Consider an evaluation for secondary causes of hypertension.
After obtaining the patient’s complete history, do the following:
Perform risk stratification and determine proper treatment setting for patient
Obtain vital signs with blood pressure taken in both upper extremities
Perform fundoscopic exam to assess for papilledema, which suggests hypertensive encephalopathy
Screen for noncompliance or abrupt discontinuation of medications that cause rebound hypertension (such as beta-blockers, clonidine, and minoxidil) or alcohol withdrawal
Assess for illicit drug use that could precipitate a hypertensive crisis (such as cocaine, amphetamines, and phencyclidine)
Consider the following laboratory tests depending on the clinical presentation of the patient:
Electrolytes
Blood urea nitrogen
Creatinine
Coagulation studies
Fibrinogen
Urine toxicology screen
Urine pregnancy test
Urinalysis for proteinuria, red blood cells, and cellular casts
Cardiac enzymes
Brain natriuretic peptide
Consider urine protein or 24-hour urine test for catecholamines in select patients where there is concern for secondary hypertension
Consider complete blood count and peripheral blood smear to check for microangiopathic hemolytic anemia
Order electrocardiogram to check for myocardial ischemia, infarction, and/or signs of left ventricular hypertrophy
Determine in-house availability of subspecialists and need for consultation as dictated by specific end-organ involvements
Ensure start of IV (hypertensive emergency) or oral (hypertensive urgency) antihypertensives prior to departure from the emergency department if indicated
please use in own word! examples are answers and format

Assigned Readings
Masters, K. (2020). Role development in professional nursing practice (5th ed.). Jones & Bartlett.
Chapter 2: Frameworks for Professional Nursing pp. 59-68, 89 (WO 2)
Chapter 5: Education and Socialization to the Professional Nursing Role pp. 151-155 (WO 1)
Chapter 14: Ethics in Professional Nursing Practice pp. 378-387 (WO 2)
AACN Essentials of Baccalaureate Education: pp. 26-29. (Go to the Webliography Links to an external site.to find a link to this file.) (WO 2)
Integrity Matters at Chamberlain University (WO 1)
Professional Integrity ModuleLinks to an external site.
Academic Integrity ModuleLinks to an external site.
Massachusetts Nurse of the Future Nursing Core CompetThis week you will complete:
PrepareAssigned Readings
Explore
Interactive Lesson
Application to Practice
Week 2 Discussion: Maintaining Academic Integrity
Week 2 Assignment: Scavenger Hunt
ReflectWrap-Up and Reflect
Learning Success StrategiesPlan plenty of time in your week to be successful.
Reach out to your instructor early if you have any questions or concerns or if you are struggling to be successful.
Review the course outcomes and weekly objectives. This is what you will be expected to learn and what you will be assessed on.
Review all discussions and assignments for the week. Ask questions of your instructor as needed.
Weekly assigned readings and learning content contain the information required to help you meet your learning objectives and be successful in your assessments.