Category: Nursing

Think about your learning on end-of-life (lecture, readings) and answer the following prompts:
How would you describe the differences between Palliative care and Hospice care to a patient or their family?
Describe the medication philosophy at end-of-life. What is the purpose of these interventions? Do you agree with this approach? What are your thoughts on “Death with Dignity?”
What are strategies/resources we can use to support the grieving family?.
maximum words is 500
.
Week Eight – End of Life
Washington State blank forms
Resource for creating Advanced Directive
State law and consumer tips for Living Wills
POLST v. Advanced Directive
End of Life WA- supporting end of life choices
Books you might find helpful:
Let me die before I wake by Derek Humphrey
The Peaceful Pill (Hemlock Society)
The Art of Dying Well: A Practical Guide
Being Mortal: Medicine and What Matters in the End
Finding Your Way to Say Goodbye

Scenario
As a nurse on a general medical floor, the RN has received a new admit. Review the client data provided.
Richard Henderson
58 years old
Male
Admit diagnosis: GI bleed
History: no surgical history
Medical history: Gastritis & GERD
Medications: Prilosec 40 mg PO daily, Atenolol 25 mg PO BID, Fiber daily, Alka Seltzer PO – states he takes this at least daily.
Report from physician’s office: Mr. Henderson arrived to the physician’s office today for a complaint of increasing abdominal pain. He states that he is now throwing up coffee-ground emesis. He states that he didn’t take his BP medication this morning because he was dizzy. The physician is admitting him with a diagnosis of GI bleed with an EGD scheduled for tomorrow. He is NPO, and has a 22G IV lock in the left forearm. Last set of vital signs BP 106/60 mm Hg, HR 98 beats/min, RR 20 breaths/min, Temp. 98.8 degrees F, P.O. 90% on room air. He last vomited about 45 minutes ago with a small amount of dark coffee-ground emesis. His pain is 4/10 at present. No pain medication is ordered at this time.
Lab assessments ordered: CBC and chemistry panel
CT of the abdomen shows no signs of free air (no perforation)
When he arrives to the floor, he is pale, nauseous, and his skin is cool and clammy. When he is transferred to the bed from the stretcher, he vomits a large amount of coffee-ground emesis and loses consciousness.
Instructions
In the discussion post, address the following:
While receiving report, what concerns do you have regarding the client report?
What type of shock is occurring?
What stage of shock is the client experiencing?
What is your next intervention and why?
What additional lab assessments would you anticipate?
Provide additional thoughts and insights.

Meeting the 8 objectives of the course- patient centered care of the older adult population, international learning in caring for the older adult client, evidence based gerontology nursing concepts, assessment of the older adult clients and leadership in order adult client assessments and interventions

Instructions:
Please respond to two peers’ post regarding their differential diagnosis list and/or plan.
What did you find interesting about their response?
How did their differential diagnosis list or plan compare to yours?
Responses need to address all components of the question, demonstrate critical thinking and analysis, and include peer reviewed journal evidence to support the student’s position.
Please be sure to validate your opinions and ideas with citations and references in APA format.
Please review the rubric to ensure that your response meets the criteria.
please use updated references for both peer response
i will provide both below
Peer#1
Dezirae Berry
Mar 5, 2023Mar 5 at 5:53pm
Unit 10 Discussion: Anemia, Infectious Disease
Pertinent Positives: female, fatigue x 3 months, increasing SOB walking up steps, increased need for sleep, memory issues, omeprazole daily use, vegetarian diet
Pertinent Negatives: Denies CP, weight gain/loss, poor appetite or swelling, abdominal pain, n/v/d, vaginal bleeding, bloody or dark tarry stools, weakness; denies NSAID or ETOH use, normal colonoscopy 5 years ago
Missing Information: How long have you been taking omeprazole? Do you take OTC supplements? How long have you been a vegetarian? What does your typical diet consist of? Are you able to afford fresh foods? Do you drink caffeine? What is your activity like day to day? How do you feel your mood has been? Do you go to counseling? Do you have new life stressors? Have you been sick recently?
Differential Diagnosis List:
Fatigue – there are many common causes of fatigue, such as recent life changes, mood disorders, medication side effects, substance overuse, infection, thyroid dysfunction, and chronic medical disease (Domino et al., 2023).
Iron deficiency anemia – Symptoms of iron deficiency anemia can include fatigue, exertional dyspnea, and inability to concentrate, and a risk factor for iron deficiency anemia is a strict vegan diet (Domino et al., 2023).
Depression – Reports hx of depression. Depression can cause symptoms such as fatigue, difficulty with concentration, and changes in sleep (Warshaw et al., 2022).
Plan: Fatigue
Diagnostics: CBC, CMP, iron studies, TSH, ESR/CRP, UA; PHQ-9/GAD-7
Therapeutic: Therapeutics would depend on further evaluation.
Educational: Omeprazole is not meant to be a long-term medication, especially in older adults, due to the increased risk of C. diff infection, bone loss/fractures, and iron deficiency anemia (Lexicomp, 2023). Recommend tapering off omeprazole. For reflux prevention, recommend elevating the head of the bed, avoid eating at least 2 hours before bedtime, and avoid foods that trigger symptoms (Domino et al., 2023). Recommend keeping a diary of symptoms. Encourage increased activity/exercise. Would discuss that vegetarians are at an increased risk for iron and vitamin B12 deficiency (Hargreaves et al., 2021). Therefore, would discuss the importance of having a well-balanced diet to ensure she is getting the vitamins and nutrients she needs. Consider OTC multivitamin with iron.
Consultation/Collaboration: Consider a dietician and gastroenterology referral.
References
Domino, F. J., Baldor, R. A., Barry, K. A., Golding, J., & Stephens, M. B. (2023). The 5-minute clinical consult: Premium 2023 (31st ed.). Wolters Kluwer.
Hargreaves, S. M., Raposo, A., Saraiva, A., & Zandonadi, R. P. (2021). Vegetarian diet: An overview through the perspective of quality of life domains. International Journal of Environmental Research and Public Health, 18(8), 4067. https://doi.org/10.3390/ijerph18084067Links to an external site.
Lexicomp. (2023). Omeprazole: Drug information. UpToDate. https://www.uptodate.com/contents/omeprazole-drug-information?source=auto_suggest&selectedTitle=1~4—1~4—omepra&search=omeprazole#F203615Links to an external site.
Warshaw, G., Potter, J. F., Flaherty, E., Heflin, M., McNabney, M., & Ham, R. J. (2022). Ham’s primary care geriatrics: A case-based approach (Seventh ed.). Elsevier.
peer#2
Haiying (Helen) Zhang
Mar 11, 2023Mar 11 at 6:33pm
NU 627 Week 10 Case Study
Pertinent positives
Subjective
CC: “I am always tired.” JL 71 y.o. F reports feeling tired for the last three months but recently has noticed shortness of breath when walking up the steps and sleeping more. She has noticed some issues with her memory as well. Follow a healthy vegetarian diet. Paternal grandmother was diagnosed with hypertension, while paternal grandfather suffered from heart disease.
PMH: GERD 2016. Depression 2000. Surgical history: R Lumpectomy 1999. Cscope/EGD 5 years ago.
Medications: Omeprazole 20mg PO daily Sertraline 50 mg PO daily
ROS
NS: Does notice some numbness and tingling at times. Has noticed more forgetfulness at times.
Skin: Wife reports pale appearance.
Objective
Constitutional: pale appearance.
HEENT: Conjunctiva pale. Angular cheilitis. Tongue beefy appearance
CVS: slight murmur is noted.
Neuro: Decrease vibratory sensation noted to hands/feet.
Skin: pale
Pertinent negatives
Subjective
She denies CP, weight gain/loss, poor appetite, or swelling. She denies abdominal pain, N/V/D. She denies vaginal bleeding and bloody or dark tarry stools. She denies taking NSAIDs, or ETOH use. She had a normal colonoscopy 5 years ago. She is retired and lives with her wife and they live off their pensions and SSI. Denies alcohol, illicit drug use, and tobacco use. Family History Her brother, and 2 sisters are alive and well; not been diagnosed with any chronic condition. Her parents are deceased, and not been diagnosed with any chronic condition. Health Maintenance UTD on all immunizations and cancer screenings for age. Has had diabetes, HTN, and cholesterol screenings, all within normal limits. Allergies: No known drug allergy.
ROS
General: Denies fever, chills, sleeping difficulties, and weight loss/gain. Denies poor appetite lightheadedness or dizziness. HEENT, Respiratory, CV, GI, GYN, GU, MSS, and psychiatric are all negative.
NS: Patient denies weakness in strength, headache, or headache. Skin: No rashes or lesions.
Objective Data
125/95mmHg. – 88 bpm. -17RR. -98.5 degrees Fahrenheit, Oxygen saturation – 100%. – Height – 5 feet 4 in. – Weight – 130 pounds. BMI=22.3
Constitutional: Alert, oriented, dressed appropriately
HEENT: Normocephalic. Lids/lashes/orbit unremarkable. No discharge. PERRL, EOMI. ENT, neck, Respiratory system, Abdominal examination, MSS, and psychiatric are all negative. CVS: Heart rate is regular, and its rhythm is normal, Pulses are symmetrical and regular. No evidence of a collapsing pulse.
Neuro: PERRLA +6mm. The cerebellar exam is intact. Skin is warm and dry. No rashes nor erythema were noted.
Missing information
I want to ask this patient how long has she been following the vegetarian diet. Does she eat eggs? Does she eat dairy products such as cheese, milk, and yogurt? How severe is her symptom? Does anything seem to improve her symptoms? Is there anything that worsens her symptoms? How many servings of fruits and vegetables does she usually eat in a day? Does she take any supplements?
Then create a differential diagnosis list with at least 3 possible actual diagnoses based on your findings.
Differential diagnosis:
D51.9 -Vitamin B12 deficiency anemia, unspecified (pernicious anemia)– reports feeling tired for the last three months but recently has noticed shortness of breath when walking up the steps and sleeping more. pale appearance. Conjunctiva pale. Tongue beefy appearance. Has been sleeping more and fatigued.
D52.9 – Folate deficiency anemia, unspecified- feeling tired for the last three months but recently has noticed shortness of breath when walking up the steps and sleeping more. Pale appearance.
G60.9 – Unspecified Neuropathy- Does notice some numbness and tingling at times.
G31.84 – Mild cognitive impairment of uncertain/unknown etiology- She has noticed some issues with her memory as well. Has noticed more forgetfulness at times.
The second part is to create a plan utilizing clinical practice guidelines for the priority diagnosis.
Plan for priority diagnosis
D51.9 – Vitamin B 12 deficiency
Plan
Order diagnostic test
Blood tests: CBC, serum vitamin B-12, folate, vitamin C, antibody test for intrinsic factor, CMP, TSH.
Study shows patients with risk factors for vitamin B12 deficiency should be screened with a complete blood count and serum vitamin B12 level (Langan & Goodbred, 2017).
Therapeutic
Recommend to take multivitamin, 1 tablet, daily.
Other pharmacological agent will be prescribed based on the diagnostic test result.
Evidence-based clinical guidelines recommend that parenteral B12 replacement is indicated if urgent treatment is required, if gastrointestinal malabsorption is suspected, and in elderly people (Sukumar & Saravanan, 2019). Oral B12 replacement may be a suitable alternative in asymptomatic individuals with dietary B12 deficiency (Sukumar & Saravanan, 2019).
Education
Teach the patient that Vitamin B-12 deficiency anemia (pernicious anemia) can result from a diet lacking in vitamin B-12, which is found mainly in meat, eggs, and milk. Vitamin B-12 deficiency anemia can also occur if your small intestine can’t absorb vitamin B-12 due to surgery to the stomach or small intestine.
Teach this patient that vegetarians who don’t eat dairy products and vegans who don’t eat any foods from animals are at risk for vitamin B-12 deficiency anemia. Study shows that elderly people, pregnant women, and vegans are more susceptible to B12 deficiency (Sukumar & Saravanan, 2019).
Teach this patient that certain medications such as the antiacid medication may interfere with the absorption of vitamin B-12. Study shows that the long-term usage of PPIs is linked to an increased risk of vitamin B12 insufficiency (Mumtaz et al., 2022).
Teach this patient that foods rich in vitamin B-12 include eggs, fortified foods, such as breakfast cereals, milk, cheese, and yogurt, and red and white meats and shellfish.
Collaboration/Referral
No referral is needed at this time. Consider specialist referral if it is refractory to treatment, or if neurological features or persistent macrocytic anemia is present.
Follow up
Return to clinic in 1 week for lab result review and treatment plan.
References
Langan, R.C. & Goodbred, A.J. (2017). Vitamin B12 deficiency: Recognition and management. Am Fam Physician, 96(6), 384-389. https://pubmed.ncbi.nlm.nih.gov/28925645Links to an external site.
Mumtaz, H., Ghafoor, B., Saghir, H., Tariq, M., Dahar, K., Ali, S. H., Waheed, S. T., & Syed, A. A. (2022). Association of Vitamin B12 deficiency with long-term PPIs use a cohort study. Annals of Medicine & Surgery, 82. https://doi.org/10.1016/j.amsu.2022.104762
Sukumar, N., & Saravanan, P. (2019). Investigating vitamin B12 deficiency. BMJ, l1865. https://doi.org/10.1136/bmj.l1865

Edited by Haiying (Helen) Zhang on Mar 12 at 9:09am
Reply

Explain what most excited and/or concerned you throughout your pediatric clinical experience.
Discuss how your personal definition of family and family roles has changed or stayed the same.
How has your understanding of family and family roles influenced your assessment of children and their families?
Explain how your understanding of culture (both the culture of the provider and that of the child and his or her family) has changed and how it may have influenced the assessments you conducted during your practicum.
Assess how you did with accomplishing the goals and objectives you developed in Week 1 for the practicum experience.
Based on your practicum experience, refine your existing goals and/or develop new goals for your continued education and professional practice. Be sure to consider the NAPNAP Position Statement on Age Parameters for Pediatric Nurse Practitioner Practice.
Use title page and references according to APA.

Informatics and technology has greatly changed the face of healthcare. What type of impact do you see genomics and personalized medicine having on healthcare delivery and patient outcomes? How will genomics and personalized medicine affect APRN practice and patient outcomes

Systems-based practice in nursing involves patient care from a wider perspective and requires practitioners to “demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care” (University of Maryland Medical Center, 2022). This approach includes special attention to cost awareness, risk benefit analysis, patient care quality advocacy, inter-professional teamwork, system error identification, and developing and implementing systems solutions.
Assignment Criteria:
Develop a scholarly paper that addresses the following criteria:
1. Cost Awareness
2. Risk benefit analysis
3. Patient care quality advocacy
4. Inter-professional teamwork
5. System error identification
6. Developing and implementing systems solutions
7. Questions to consider:
a. How can I improve the care for my patients?
b. How can I improve the system of care?
c. How would you identify and prioritize change?
8. The scholarly paper should
a. 4 to 6 pages, excluding the title and reference page.
b. Include an introductory paragraph, purpose statement, and a conclusion.
c. Include level 1 and 2 headings to organize the paper.
d. Write the paper in third person, not first person (meaning do not use ‘we’ or ‘I’) and in a scholarly manner. To
clarify: I, we, you, me, our is not used. In addition, describing yourself as the researcher or the author should not
be used.
e. Include a minimum of three (2) peer-reviewed scholarly journal references to support the paper (review in Ulrich
Periodical Directory) and be less than five (5) years old.

Clinical area of practice is postpartum (mother-baby)
1. Review Table 2.2. Create 4 Research questions related to your nursing clinical practice area and/or role. One of each type: correlational, comparative, experimental, and phenomenology.
2. Review Table 2.3. Choose one of your research questions and map out the Independent, dependent variable, population, and testability.
Discussion Tip: This should be in paragraph format. You create four research questions. One research question will require you to expand on the components and related criteria. Read Chapter 2 for more information.
Discussion Submission Instructions:
The assignment must be fully completed for grading. You must have your original post and two responses to your peers. Discussions not including your original post and two responses will NOT be graded.
Your initial post must be at least 500 words, formatted, and cited in the current APA style with support from at least two academic sources. Your initial post is worth 8 points.
You must respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts and supporting your opinion with a reference. Response posts must be at least 150 words. Your response (reply) posts are worth 2 points (1 point per response). Your post will include a salutation, a response (150 words), and a reference.
Quotes “…” cannot be used at a higher learning level for your assignments, so sentences need to be paraphrased and referenced.
Acceptable references include scholarly journal articles or primary legal sources (statutes, court opinions), journal articles, and books published in the last five years—no websites or videos are to be referenced without prior approval. Discussions using websites as references will receive an automatic 0.
All submitted work must be the student’s original work which has never been submitted before for grading in another class. Faculty can access tools that detect work generated using artificial intelligence (AI). Submitting AI-generated work and not crediting the source for any assignment is considered academic dishonesty and will be subject to penalty.
Discussions must be posted in CANVAS to be graded. Uploaded documents will not be accepted.
Discussion and responses must be posted in APA format for Canvas to receive full grades—automatic deduction of 10% if not completed.

Interdiscpliary team (from diagnosing hospital and local hospital) ( Includes pediatricians, respiratory therapist, nurse and social workers) works together utlizing telemedicine and skype to improve patient outcomes and safety. Focus mostly on interdisciplinary, evidence based use of telemedicine ans skype to improve patient outcomes. Patient is 2 years old, at risk for impaired gas exchange, respiratory distress and anxiety.
-Proposes your evidence-based care plan to improve the safety and outcomes for thepatient with new content added. Notes areas in which further information or data could have been useful in developing the plan.
– Explains the ways in which you used the specific evidence-based practice model to help develop your care plan. Notes ideas for how to evaluate the positive benefits to patient outcomes.
-Reflects on which evidence you collected that was most relevant and useful when making decisions regarding the care plan. Discusses the rationale or criteria that was used to determine relevance and usefulness.
-Identifies benefits and proposes strategies to mitigate the challenges of interdisciplinary collaboration to plan care within the context of a remote team. Discusses how interdisciplinary collaboration could be better leveraged to improve outcomes in future care situations.
-The reference list is from relevant and evidence-based (published within five years) sources, exhibiting flawless adherence to APA format.

The purpose of this paper is to better understand gynecological health care for lesbian, bisexual and transgender individuals.
Define and describe for lesbian, bisexual and transgender individuals.
Gender and sexuality concepts.
Social and political context.
Social determinants of health affecting lesbian, bisexual and transgender individuals.
Barriers to health care.
Health care disparities.
Submission Instructions:
The paper is to be clear and concise and students will lose points for improper grammar, punctuation and misspelling.
The paper is to be no shorter than 3-4 pages in length, excluding the title and references page.
Your paper should be formatted per APA.
Incorporate current practice guidelines for diagnosis and treatment and a minimum of 4 current (published within the last five years) scholarly journal articles or primary legal sources (statutes, court opinions) within your work. Journal articles and books should be referenced according to APA style (the library has a copy of the APA Manual).