case study

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Case Study: Prescribed Drugs with CAMs

Mr. X, a 42-year-old male presents to your primary care practice today complaining of low back pain.

History – Mr. X states that he has had chronic low back pain since he had a skiing accident about 10 years ago. Three days ago, he felt a pulling sensation in his lower back after moving some boxes. The pain intensity increased over the subsequent 24 hours and is now steady, aching in nature, at 3-4 out of 10. Mr. X also has Type2 diabetes, which is well controlled on metformin with a HGA1c of 5.6. He has a history of DVT 4 months ago for which he takes Coumadin, INR is WNL. He is followed by a specialist for this problem. He recently started taking two OTC products; kava kava for what he describes as “anxiety” and CoEnzyme Q10 on the advice of a friend.

Social – Mr. X is a smoker, 1 pack per week for 15 years. No alcohol or drug use. He is employed as an accountant and has medical insurance. He is divorced.
PE/ROS – Complains of low back stiffness and pain on movement with occasional spasms related to moving in certain directions. You note he has mild difficulty getting onto the exam table but gait is normal. He denies weakness/numbness/tingling of legs, no radiation, no change in bowel or bladder habits. BMI 27. All range of motion of the back is decreased by 25%. Straight leg lift is negative bilaterally, DTR intact. All other systems WNL.

Medications:

Metformin 1000mg ER one tab daily – Type II Diabetes controlled

Coumadin 5 mg. daily – Hx of DVT – Controlled

Kava Kava 50 mg. tid – Self-medication for anxiety

CoQ10 – 200 mg. daily. – Self-medication for unknown reason

1. Provide a diagnosis for the patient and your rationale for the diagnosis

2. Provide a treatment plan specifically for this patient, pharmacologic and non-pharmacologic.

3. Comment on the use of OTC products in relation to Mr. X’s current chronic and acute disease diagnoses and medications. Include drug-drug interactions and side effect profiles.

4. Provide an education plan for Mr. X

5. Present this Assignment as a PowerPoint presentation with between 12 and 16 slides (not including opening slide and resource slide).

6. You will use the Narrative notes section of the presentation to include the majority of your evidentiary support of your treatment choices and education of family complete with in-text citations using APA formatting,

Due by the last day of Unit 9 at 11:59 p.m.

Assignment Requirements:

Before finalizing your work, you should:

· be sure to read the Assignment description carefully (as displayed above);

· consult the Grading Rubric (under Course Resources) to make sure you have included everything necessary; and

· utilize spelling and grammar check to minimize errors.

· Submit to and review results of Turnitin. Purdue University Global Student Conduct policy as it relates to plagiarism will be adhered to in this course.

Your writing Assignment should:

· follow the conventions of Standard English (correct grammar, punctuation, etc.);

· be well ordered, logical, and unified, as well as original and insightful;

· display superior content, organization, style, and mechanics; and

· utilize APA 7th edition formatting.

Rubric Title: MN553 Unit 9 Assignment Rubric

Assignment Criteria

Level III

Level II

Level I

Not Present

Criteria 1

Level III Max Points

Points: 8

Level II Max Points

Points: 6.4

Level I Max Points

Points: 4.8

Not Present

0 Points

Correctly diagnosing the patient

· A correct diagnosis is provided with supportive rationale from literature

· A correct diagnosis is provided without rationale

· Does not meet the Criteria

· Does not meet the criteria

Criteria 2

Level III Max Points

Points: 12

Level II Max Points

Points: 9.6

Level I Max Points

Points: 7.2

Not Present

0 Points

Prescribing a treatment plan

· An appropriate and specific treatment plan for the case study patient is provided with rationale from literature for treatment choices.

· A specific treatment plan is provided for the case study patient but is missing less than 50% of pharmacologic and non-pharmacologic treatment with rationale from literature for treatment choices

· A specific treatment plan is provided for the case study patient but is missing more than 50% of pharmacologic and non-pharmacologic treatment with rationale from literature for treatment choices; Or

· Rationale for treatment choices from literature are not provided

· Does not meet the criteria

Criteria 3

Level III Max Points

Points: 11

Level II Max Points

Points: 8.8

Level I Max Points

Points: 6.6

Not Present

0 Points

Over-the-counter medication use discussion

A thorough discussion of the kinetics and dynamics of OTC products is provided and a rationale for including or excluding them from the treatment plan is provided.

· Kinetics and dynamics of OTC products are discussed and are related to the patient's current meds/conditions but specific direction regarding continued use is not included

· Kinetics and dynamics of OTC products are discussed but not related to the patient's current meds/conditions.

· Does not meet the criteria

Criteria 4

Level III Max Points

Points: 8

Level II Max Points

Points: 6.4

Level I Max Points

Points: 4.8

Not Present

0 Points

Education plan

· A thorough education plan for the treatment plan is provided which includes principles of therapeutic communication.

· An education plan is provided which provides more than 50% of necessary information for the treatment plan and includes principles of therapeutic communication

· An education plan is provided but contains less than 50% of necessary information and includes principles or therapeutic communication OR

· Principles of therapeutic communication are not included

· Does not meet the criteria

Criteria 5

Level III Max Points

Points: 8

Level II Max Points

Points: 6.4

Level I Max Points

Points: 4.8

Not Present

0 Points

College-level academic writing

· Professional, peer-reviewed, advanced practice references are used

· Grammar and mechanics of writing demonstrate graduate level work

· Adheres to page number requirements

· The majority of references used are professional, peer-reviewed and advanced practice

· Errors in grammar or mechanics of writing are present but do not interfere with readability

· Adheres to page number requirements

· The minority of references used are professional, peer-reviewed and advanced practice

· Errors in grammar or mechanics of writing are present Which interferes with readability

· Does not adhere to page number

· Does not meet the criteria

Criteria 6

Level III Max Points

Points: 8

Level II Max Points

Points: 6.4

Level I Max Points

Points: 4.8

Not Present

0 Points

Citations and Formatting

· There is a strong attempt to cite all sources using APA style.

· Minor paper formatting errors may occur.

· Minor in-text citation errors may occur.

· All authorship is clear and retrievable.

· There is an overall attempt at APA formatting and citation style.

· Errors in formatting of citation or sources are present.

· All sources have some form of citation and all citations have a matching source.

· Citations generally make authorship clear.

· Major errors in citations or source formatting are present.

· Citation or source information may be missing or incorrect.

· Authorship may be unclear.

· Does not meet the criteria

Maximum Total Points

55

44

33

0

Minimum Total Points

45 points minimum

34 points minimum

1 point minimum

0

Discussion

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Purpose

The purpose of this assignment is to discuss the healthcare policy of the APN profession and how Transformational Leadership can help to influence policy changes. This week’s assignment focuses on the APN as a Health Policy Leader, one of the nine NONPF NP competencies.  Students will analyze how health policy may affect NP practice and how Transformational Leadership can help to influence policy changes.

Preparing the Discussion

Criteria for Content 

· Explanation of how healthcare policy can impact the advanced practice nurse profession 

· Explanation of why advocacy is considered an essential component of the advance practice nurse's role

· Discuss the four pillars of Transformational leadership and the effect they may have on influencing policy change

· A scholarly resource must be used for EACH discussion question each week.

LEARNING CONTRACT

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Please see attached document.

Nursing

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Clinical Case Report

Part 2: Case Description and Conceptualization

Part 2 of the clinical case report assignment should be in APA style (title page,

references, etc. but does not require an abstract). This part of the case report will likely

be 6-7 pages, without references. It should include:

(1) The case, with provisional diagnoses (already completed for the paper proposal but

likely modified based on my feedback and any other client information you find helpful in

conceptualization below). See above for guidelines about an effective case. (around 2

pages)

(2) A case conceptualization, to include risk and maintenance factors in the client's

diagnosis(es): (around 4-5 pages)

(2a) Should include a range of etiological factors, based on class readings and

discussions (i.e., cognitive model, memory, emotion, neurobiology,

social/contextual factors),

(2b) These etiological factors should be tied specifically to the case description

(that is, don't speak only generally of risk factors, but how this manifests for the

particular client). In some places (e.g., neurobiology), you may need to use some

conjecture, based on the literature. That is OK. However, your case should

include sufficient detail to be able to relate several risk factors to the

conceptualization.

(2c) Should include discussion of risk factors for, AND maintenance of, PTSD

and/or related symptoms

(2d) Should be integrative, as all risk and maintenance factors intersect (e.g.,

environment affects biology, social context influences both; don't just list

etiological factors)

(2e) Should consider culture and intersectionality of client.

(2f) Should include references to literature (in APA style). NOTE: Please avoid

excessive use of quoted text, instead summarizing/paraphrasing when possible.

Quoted text should be limited to points in which you think the initial wording is

absolutely necessary to convey the author's point, and, in many papers, does not

need to be used at all.

Grading Rubric for Clinical Case Report Part 2: Case Description and

Conceptualization (75 points)

____/22 Case description. Student provides detail on client's background, traumatic

experience(s), symptoms and presenting problems, impairment/distress, and within this

description, sufficient detail to support the case conceptualization.

____/35 Case conceptualization. Student describes risk AND maintenance factors

in the client's diagnosis(es), including a range of etiological factors (i.e., cognitive

model, memory, emotion, neurobiology, social/contextual factors and culture and

identity). These factors are tied specifically to the case description, when possible

and are integrative (i.e., intersections among etiological factors are discussed).

____/9 Incorporation of empirical research. Empirical research and course materials

are incorporated effectively to advance arguments and are cited appropriately in-text.

____/9 Grammar, style, mechanics. Paper is in APA style, includes references, is

proofread, and contains proper grammar, flow, transitions, and headings as appropriate.

NURSING

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Student Instructions for i-Human Virtual Simulation

NR325/NR330 Eva Smith


PURPOSE:

The following information is to be used in guiding your preparation and participation in the virtual simulation scenario for this course. This document will provide applicable course outcomes in preparation for your simulation.

SCENARIO OVERVIEW:

78-year-old female is being admitted to the neurology unit for observation and pain management.

LEARNER OBJECTIVES:

1. Define the components of a comprehensive nursing assessment. (CO1, 2)

2. Explain the approach for a comprehensive nursing assessment for an older adult admitted to the neurology unit for observation and pain management of worsening headache. (CO1, 2)

3. Demonstrate an appropriate assessment for an older adult admitted to the neurology unit for observation and pain management of worsening headache. (CO1, 2)

4. Distinguish between the treatment/interventions options for an older adult admitted to the neurology unit for observation and pain management of worsening headache. (CO1, 2, 4, 6)

5. Recommend appropriate treatment/interventions for an older adult admitted to the neurology unit for observation and pain management of worsening headache. (CO1, 2, 3, 4, )

6. Design an appropriate care plan for an older adult admitted to the neurology unit for observation and pain management of worsening headache. (CO1, 2, 3, 4, 6)

STUDENT ROLES DURING SIMULATION:

You are the staff nurse at the hospital who will be conducting a comprehensive assessment. After completing your assessment, you are expected to document your findings as a nurses note in SBAR format.

KEY FEATURES OF i-HUMAN:

· As the nurse, you are expected to complete the case scenario using the following tabs: EHR, History, Physical, Nursing Notes, Summary

· There are required questions and/or additional information provided related to this case. The questions, information, and videos must be completed/reviewed prior to progressing to the next tab.

· Nursing Notes: At the end of the simulation, you will document your assessment findings using ISBAR.

CONFIDENTIALITY:

To preserve the educational value, integrity, and safety of the learning environment, you agree to maintain strict confidentiality about the proceedings of the simulation session, details of the training scenarios, and the performance of all participants. You acknowledge that this expectation aligns with the guidelines related to the Health Insurance Portability and Accountability Act (HIPAA) as well as laws governing Protected Health Information (PHI) in client care environments.  You will not view, discuss, share, record, or disclose any confidential information pertaining to the session. You understand that lapses in confidentiality are considered academic misconduct and could result in dismissal from the academic program. 

 

FICTION AGREEMENT:

You will suspend judgment of realism for any given simulation in exchange for the promise of learning new knowledge and skills, treating the simulated patients with the same care due an actual patient, act with a genuine desire to learn even when it may be difficult to do so.  

DUE DATE:

The virtual simulation must be completed during

Week 2
.

SIMULATION TIMING:

· Pre-simulation preparation: 30-60 minutes

· Pre-brief: 15 minutes

· Run Time: 2.75 hours

· Debriefing: 60 minutes

ASSESSMENT & EVALUATION

Faculty will utilize your participation measurements in the i-Human case, and debriefing discussions to identify areas of opportunity for enhancement of your clinical growth. Your experiences in i-Human will contribute to your overall completion of clinical requirements for the course as documented on the Clinical Learning Evaluation tool.

i-Human Evaluation – What does my total score mean?

A screenshot of a computer Description automatically generated with medium confidence

REVIEW AND COMPLETE PRIOR TO THE START OF THE VIRTUAL SIMULATION:

To prepare for the simulation, you are
required to complete the pre-simulation questions below and submit this prework to the faculty via uploading your Word document in Canvas prior to the start of the virtual simulation. If you do not complete the pre-simulation questions and upload them, you will

not
be able to access or participate in the simulation.

1. Create a list of specific nursing interventions to perform when a patient is a fall risk.

2. Describe the components of a neurological assessment and the expected findings for a client with a subdural hematoma.

3. What clinical findings/cues would a nurse anticipate for a client with:

a. Worsening neurological cues

b. Improving neurological cues

**Immediately following the completion of the virtual simulation, you will complete the evaluation of the simulation using the link provided.

©2023 Chamberlain University LLC. All rights reserved.

Chamberlain University | National Management Offices | 500 W. Monroe St., Suite 1300 | Chicago, IL 60661

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nursing

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Topic:  Staffing needs and Scheduling policies

  • Title page (APA format) (3-4 pages, not including Titles and References)
  • Book: Leadership roles and management Functions in Nursing, Eleventh Edition, by Carol J. Huston

 

RESPONSE TO DISCUSSION QUESTION

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INSTRUCTIONS TO HOMEWORK

Please see attached document. Response to the question should have depth and include enriching posts with applicable nursing implication(practice, education, research, or advocacy), current events, personal thoughts. Please provide in text scientific citations.

musculoskeletal discussion

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see attached

COGNITIVE BEHAVIORAL THERAPY: COMPARING GROUP, FAMILY, AND INDIVIDUAL SETTINGS

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There are significant differences in the applications of cognitive behavior therapy (CBT) for families and individuals. The same is true for CBT in group settings and CBT in family settings. In your role, it is essential to understand these differences to appropriately apply this therapeutic approach across multiple settings. For this Discussion, as you compare the use of CBT in individual, group, and family settings, consider challenges of using this approach with groups you may lead, as well as strategies for overcoming those challenges.

Assignment

Post an explanation of how the use of CBT in groups compares to its use in family or individual settings. Explain at least two challenges PMHNPs might encounter when using CBT in one of these settings. Support your response with specific examples from this week’s media and at least three peer-reviewed, evidence-based sources. Explain why each of your supporting sources is considered scholarly and attach the PDFs of your sources.

Media

Advanced Nursing Inquiry and Evidence Based Practice

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Identify an article that is at least five years old. Summarize the statistical findings and discuss the significant it has on nursing.

Please post your initial post by Wednesday midnight with 400 words and one scholarly article. Please answer two peers by Saturday midnight.