In the media introduction to this module, it was suggested that you as a nurse have an important role in the Systems Development Life Cycle (SDLC). With a focus on patient care and outcomes, nurses may not always see themselves as contributors to the development of new systems. However, as you may have observed in your own experience, exclusion of nurse contributions when implementing systems can have dire consequences.


Report Issue

In the media introduction to this module, it was suggested that you as a nurse have an important role in the Systems Development Life Cycle (SDLC). With a focus on patient care and outcomes, nurses may not always see themselves as contributors to the development of new systems. However, as you may have observed in your own experience, exclusion of nurse contributions when implementing systems can have dire consequences.

In this Discussion, you will consider the role you might play in systems development and the ramifications of not being an active participant in systems development.

To Prepare:

  • Review the steps of the Systems Development Life Cycle (SDLC) as presented in the Resources.
  • Reflect on your own healthcare organization and consider any steps your healthcare organization goes through when purchasing and implementing a new health information technology system.
  • Consider what a nurse might contribute to decisions made at each stage of the SDLC when planning for new health information technology.

By Day 3 of Week 9

Post a description of what you believe to be the consequences of a healthcare organization not involving nurses in each stage of the SDLC when purchasing and implementing a new health information technology system. Provide specific examples of potential issues at each stage of the SDLC and explain how the inclusion of nurses may help address these issues. Then, explain whether you had any input in the selection and planning of new health information technology systems in your nursing practice or healthcare organization and explain potential impacts of being included or not in the decision-making process. Be specific and provide examples.

The post In the media introduction to this module, it was suggested that you as a nurse have an important role in the Systems Development Life Cycle (SDLC). With a focus on patient care and outcomes, nurses may not always see themselves as contributors to the development of new systems. However, as you may have observed in your own experience, exclusion of nurse contributions when implementing systems can have dire consequences. appeared first on Shine Essay.


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In the Module 4 Discussion, you considered how professional nurses can become involved in policy-making. A critical component of any policy design is evaluation of the results. How comfortable are you with the thought of becoming involved with such matters?

In the Module 4 Discussion, you considered how professional nurses can become involved in policy-making. A critical component of any policy design is evaluation of the results. How comfortable are you with the thought of becoming involved with such matters?

Some nurses may be hesitant to get involved with policy evaluation. The preference may be to focus on the care and well-being of their patients; some nurses may feel ill-equipped to enter the realm of policy and political activities. However, as you have examined previously, who better to advocate for patients and effective programs and polices than nurses? Already patient advocates in interactions with doctors and leadership, why not with government and regulatory agencies?

In this Discussion, you will reflect on the role of professional nurses in policy evaluation.

To Prepare:

  • In the Module 4 Discussion, you considered how professional nurses can become involved in policy-making.
  • Review the Resources and reflect on the role of professional nurses in policy evaluation.
By Day 3 of Week 9

Post an explanation of at least two opportunities that currently exist for RNs and APRNs to actively participate in policy review. Explain some of the challenges that these opportunities may present and describe how you might overcome these challenges. Finally, recommend two strategies you might make to better advocate for or communicate the existence of these opportunities. Be specific and provide examples.

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Examine Case Study: An Elderly Iranian Man With Alzheimer’s Disease( Click media link above to open case study)You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

Examine Case Study: An Elderly Iranian Man With Alzheimer’s DiseaseClick media link above to open case study)You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

Assignment: Assessing and Treating Clients With Dementia

Learning Objectives

Students will:

· Assess client factors and history to develop personalized therapy plans for clients with dementia

· Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring therapy for dementia

· Evaluate efficacy of treatment plans

· Analyze ethical and legal implications related to prescribing therapy for clients with dementia.

Required Readings

Note: All Stahl resources can be accessed through this link provided.

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

To access the following chapter, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

  • Chapter 13, “Dementia and Its Treatment”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

To access information on the following medications, click on The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.

Review the following medications:

For insomnia

  • donepezil
  • galantamine
  • memantine
  • rivastigmine

Bui, Q. (2012). Antidepressants for agitation and psychosis in patients with dementia. American Family Physician, 85(1), 20–22. Retrieved from http://www.aafp.org/journals/afp.html

Meltzer, H. Y., Mills, R., Revell, S., Williams, H., Johnson, A., Bahr, D., & Friedman, J. H. (2010). Pimavanserin, a serotonin receptor inverse agonist for the treatment of Parkinson’s disease psychosis. Neuropsychopharmacology, 35, 881–891. Retrieved from http://www.nature.com/npp/journal/v35/n4/pdf/npp2009176a.pdf

Required Media( Click on Case study Below)

Laureate Education. (2016h). Case study: An elderly Iranian man with Alzheimer’s disease [Interactive media file]. Baltimore, MD: Author.

Note: This case study will serve as the foundation for this week’s Assignment.

To prepare for this Assignment:

· Review this week’s Learning Resources. Consider how to assess and treat clients requiring therapy for dementia.

The Assignment

Examine Case Study: An Elderly Iranian Man With Alzheimer’s DiseaseClick media link above to open case study)You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

· At each decision point stop to complete the following:

Decision #1

§ Which decision did you select?

§ Why did you select this decision? Support your response with evidence and references to the Learning Resources.

§ What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

§ Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?

Decision #2

§ Why did you select this decision? Support your response with evidence and references to the Learning Resources.

§ What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

§ Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?

Decision #3

§ Why did you select this decision? Support your response with evidence and references to the Learning Resources.

§ What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

§ Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

· Also include how ethical considerations might impact your treatment plan and communication with clients.

Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.

The post Examine Case Study: An Elderly Iranian Man With Alzheimer’s Disease( Click media link above to open case study)You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes. appeared first on Shine Essay.


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Community Needs And Health Screening Initiative

Community Needs And Health Screening Initiative

1) Minimum 3 full pages 

             Cover or reference page not included) 

2)¨**********APA norms, 

            Use headers 

            All paragraphs must be narrative and cited in the text- each paragraphs

            Bulleted responses are not accepted

            Dont write in the first person.

            Left-justified text indented in the first line. 

            Times New R 12 font

            Citations in text and references according to APA form

3) It will be verified by Turnitin and SafeAssign 

4) Minimum 3 references not older than 5 years per document

5) Each answer must be identified according to the question number. 

             Use headers 

            Check the list of questions. 

            Your answer should start objectively answering the question

______________________________________________________________

Purpose:

An initiative is a project, an event, so something in the community is ideal. Workplace location for employees is fine too. This Assignment is focused on preventive screening applications in the community, workplace or school settings. You should be able to apply this knowledge to their specialty focus as it relates to health promotion and epidemiology.

Mandatory: 1) pick one recommended screening from United States Preventive Task Force A and B Recommendations.  

Please include the following suggested level one headings so content is clear and easily identified.

2) Theory or Conceptual Model

a) Choose a theory or conceptual model that you think might work for your initiative and explain the theory or model.  

3) Screening Purpose

a) Discuss why it is important to screen for this condition. 

b) Address your community assessment and the reason for this need in your community/ population choice. 

c) Support your stance with statistics and information, ideally related to the location and population.

4) Population

a) Clearly address the demographics that are being screened; where they live, state (Florida), county, ages, races included etc. 

b) Provide a brief general community assessment as it related to the condition and the population.

5) Location/ Setting

a) Briefly explain where you are doing this. It should be very specific (e.g., Senior Citizen Center in Monroe Co on Saturday). 

b) Think about what kind of facility or area you will need. Include comments explaining how this location meets the needs of your target population and screening choice.

6) Screening Activity

a) This section is what you are doing at the screening and should completely align with the screening guideline for the condition. 

b) Include some brief prevention education component.

7) Outcome Goals

Bullet specific goals here. 

a) What do you hope to accomplish with your screening?

8) Cost

This is the cost for you to develop and conduct the initiative.

a) Make a brief Word table showing what it costs you to conduct the screening; paper, equipment, rentals etc. Volunteers are fine, but everything is not free. Students must demonstrate they can develop a cost estimate for a community screening intervention that is realistic and takes into account financials. If there is a cost for the attendees that should go here as well.

9) Summary

a) Provide a summary of your screening, general benefit to the community and why it is important. Master’s-prepared nurse educators, leaders, nurse practitioners and all specialty nursing fields are contributors to health promotion in populations across the life span. 

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You are a lobbyist for an issue that you find important. For example, you would like to see the banning of smoking in federal buildings (Note: This policy has already been enacted.) You are going to make an informational pamphlet to highlight your points to prominent members of Congress. Research members of Congress that you will target in your lobbying. Explain why these members are critical to your goal. Make a plan of action and produce a pamphlet supporting your cause. Who will you be reaching out to? Why? Write a cover letter to a Congressional member and include your reasoning for reaching out to them in particular in the letter. Remember a lobbyist is only as good as the information they provide. A lobbyist who provides incomplete or unreliable information will soon be unemployed, or lose access to officials.

You are a lobbyist for an issue that you find important. For example, you would like to see the banning of smoking in federal buildings (Note: This policy has already been enacted.) You are going to make an informational pamphlet to highlight your points to prominent members of Congress. Research members of Congress that you will target in your lobbying. Explain why these members are critical to your goal. Make a plan of action and produce a pamphlet supporting your cause. Who will you be reaching out to? Why? Write a cover letter to a Congressional member and include your reasoning for reaching out to them in particular in the letter. Remember a lobbyist is only as good as the information they provide. A lobbyist who provides incomplete or unreliable information will soon be unemployed, or lose access to officials.

Cover letter should:

  • Follow a standard business format
  • Correctly address your Congressperson
  • Use the correct postal address
  • Explain your choice to write to this representative in particular, and provide your pamphlet. For example, maybe your research showed that this representative sponsored legislation on this issue in the past.

Pamphlet should:

  • Define the problem. Tells us exactly what the problem is. Detail its urgency and provide data. Be objective.
  • Analyze the problem. Provide relevant data. Tell us how to make sense of the data. Provide any findings
  • Offer a recommendation. Do not generalize. Be specific.
  • Must be persuasive.
  • Cite four scholarly sources

Submit your cover letter and pamphlet for grading.

Writing Requirements (APA format). 

  • Length: Cover letter to Congressman should be only 1 page
  • Pamphlet should be 5 pages in length
  • 1-inch margins
  • 12-point Times New Roman font
  • Reference page (minimum of 4 scholarly sources)

Grading
This activity will be graded based on the Assignment Grading Rubric.

The post You are a lobbyist for an issue that you find important. For example, you would like to see the banning of smoking in federal buildings (Note: This policy has already been enacted.) You are going to make an informational pamphlet to highlight your points to prominent members of Congress. Research members of Congress that you will target in your lobbying. Explain why these members are critical to your goal. Make a plan of action and produce a pamphlet supporting your cause. Who will you be reaching out to? Why? Write a cover letter to a Congressional member and include your reasoning for reaching out to them in particular in the letter. Remember a lobbyist is only as good as the information they provide. A lobbyist who provides incomplete or unreliable information will soon be unemployed, or lose access to officials. appeared first on Shine Essay.


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Patient Information: CC : A 46-year-old female reports pain in both of her ankles, but she is more concerned about her right ankle. She was playing soccer over the weekend and heard a “pop.” She can bear weight, but it is uncomfortable. In determining the cause of the ankle pain, based on your knowledge of anatomy, what foot structures are likely involved? What other symptoms need to be explored? What are your differential diagnoses for ankle pain? What physical examination will you perform? What special maneuvers will you perform? Should you apply the Ottowa ankle rules to determine if you need additional testing?

Patient Information: CC : A 46-year-old female reports pain in both of her ankles, but she is more concerned about her right ankle. She was playing soccer over the weekend and heard a “pop.” She can bear weight, but it is uncomfortable. In determining the cause of the ankle pain, based on your knowledge of anatomy, what foot structures are likely involved? What other symptoms need to be explored? What are your differential diagnoses for ankle pain? What physical examination will you perform? What special maneuvers will you perform? Should you apply the Ottowa ankle rules to determine if you need additional testing?

Initials, N/A Age, 46 Sex, Female Race, not indicated

CC: Bilateral Ankle pain 

HPI: Pt c/o bilateral ankle pain, worse on R s/p hearing a “pop” while playing soccer this past weekend. Pt is able to bear weight, with some discomfort and was more concern about her R ankle.

Location: Bilateral ankle

Onset: Over the weekend

Character: Bilateral ankle pain, worse on the right. She was playing soccer over the weekend and heard a “pop.”

Associated signs and symptoms: She can bear weight, but it is uncomfortable

Timing: over the weekend and heard a “pop. “while playing soccer

Exacerbating/ relieving factors: She can bear weight, but it is uncomfortable

Severity: She can bear weight, but it is uncomfortable

Current Medications: Not indicated

Allergies: None indicated

PMHx: None indicated

Soc Hx: played Soccer over the weekend

Fam Hx: None Indicated.

GENERAL:  No weight loss, fever, chills, weakness or fatigue indicated 

HEENT:  Eyes: PERRLA, no visual impairment blurred vision, double vision or yellow sclerae indicated. Ears, Nose, Throat:  No hearing loss, sneezing, congestion, runny nose or sore throat indicated 

SKIN:  No rash or itching nor discoloration indicated

CARDIOVASCULAR:  No chest pain, chest pressure or SOB. No palpitations or edema indicated 

RESPIRATORY:  No shortness of breath, cough or difficulty breathing indicated

GASTROINTESTINAL:  No anorexia, nausea, vomiting or diarrhea. No abdominal pain or blood indicated 

GENITOURINARY:  No Burning on urination. No indication of Pregnancy. Last menstrual period not indicated.

NEUROLOGICAL:  No headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control indicated 

MUSCULOSKELETAL:  bilateral ankle pain, worse on R. Positive pulses on both dorsalis and pedis bilaterally. Right ankle with 1+edema, erythema; and tenderness on palpation noted. No edema or erythema noted on the left ankle.

HEMATOLOGIC:  No anemia, bleeding or bruising indicated 

LYMPHATICS:  No enlarged nodes. No history of splenectomy.

PSYCHIATRIC:  None indicated

ENDOCRINOLOGIC:  No reported 

ALLERGIES:  NkDA

Peripheral Vascular: Right ankle with 1+edema, erythema; and tenderness on palpation noted. No edema or erythema noted on the left ankle Positive pulses on both dorsalis and pedis bilaterally.

Assessment:

Additional questions

More needed questions may include

Point exactly where your pain is?

What’s your pain scale on 0-10, o no pain and 10 being the worst? 

Have you taken anything for the pain?

What makes it better or worse?

Diagnostic results: This will include X-Ray, Ct scan and MRI According to Ball, Dains, Flynn, Solomon, and Stewart (2015) an x-ray of the ankle should be done when pain is present in the malleolar area with one of the following locations: Bony tenderness to the distal 6cm of the posterior edge or tip of the lateral malleolus, bony tenderness on the distal 6cm of the posterior edge or tip of the medial malleolus, or the inability for the patient to be weight bearing.  According to Ball, Dains, Baumann, & Scheibel 2016, Ottawa Ankle Rules are used to identify the need for diagnostic testing in the patient with ankle pain.  This tool determines that if a patient has ankle pain the malleolar area of the ankle in addition to bone tenderness near the posterior fibula, bone tenderness near the posterior tibia, or the inability to bear weight for four steps, he or she should be sent for an ankle radiography series. Also, Ottawa have 98.5%sensitivity level in identifying fracture.

Differential Diagnoses

1.  Ankle Sprain is an injury that occurs to one or more of the ligaments in the ankle that produces symptoms like pain, swelling, bruising, soreness, joint stiffness, and difficulty walking Sports injuries are very common when running, landing a jump, or any direct contact that can create pain, swelling, and even an audible tearing or popping, yet ecchymosis can be delayed by a few days (American Orthopedic Foot & Ankle Society, 2015).

  1. Achilles tendon injury: Occurs from a sudden snap in the lower calf with the inability to stand on the toes of the affected side (Saglimbeni, 2016). 
  2. Post-exercise muscle soreness: Appears as a discomfort or pain to the distal portion of skeletal muscles after physical activity that one is not used to, as well as decreased strength and flexibility (Kedlaya, 2016).
  3. Achilles tendon injury presents through a sudden snap in the lower calf with the inability to stand on the toes of the affected side (Saglimbeni, 2016). 

5.  Ankle Fracture: Stress fractures in the foot are most often seen in the calcaneus, navicular, and metatarsal bones, and less often in the cuboid bone.  An ankle fracture usually manifest with swelling, bruising, and an inability to bear weight (Unnithan & Thomas, 2018).

 References

American Orthopedic Foot & Ankle Society. (2015, June). Ankle Sprain. Retrieved from http://www.aofas.org/PRC/conditions/Pages/Conditions/Ankle-Sprain.aspx

American College of Foot and Ankle Surgeons. (2018). Ankle Sprain. Retrieved from https://www.foothealthfacts.org/conditions/ankle-sprain

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s 

guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Kedlaya, D. (2016). Post-Exercise Muscle Soreness. Retrieved from http://emedicine.medscape.com/article/313267-overview#a4

Kelly, J. (2015). Ankle Fracture in Sports Medicine. Retrieved from http://emedicine.medscape.com/article/85224-clinical#b4

Luke, A. (2011). Ankle Physical Examination. Orthopedic Trauma Institute. Retrieved from http://orthosurg.ucsf.edu/oti/patient-care/divisions/sports-medicine/physical-examination-info/ankle-physical-examination/

The post Patient Information: CC : A 46-year-old female reports pain in both of her ankles, but she is more concerned about her right ankle. She was playing soccer over the weekend and heard a “pop.” She can bear weight, but it is uncomfortable. In determining the cause of the ankle pain, based on your knowledge of anatomy, what foot structures are likely involved? What other symptoms need to be explored? What are your differential diagnoses for ankle pain? What physical examination will you perform? What special maneuvers will you perform? Should you apply the Ottowa ankle rules to determine if you need additional testing? appeared first on Shine Essay.


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The presenting low back pain symptoms indicate a sciatic nerve involvement since the pain is radiating down the posterior aspect of the left leg. The X-rays show lesions most likely at the L-5. Further tests that may be ordered include; Schober test. This test measures the ability of a patient to flex his lower back. The patient is asked to touch his toes while keeping the knees straight. A positive test will be less than 4 cm between the 2 marks indicating decreased lumbar mobility. A Straight Leg Raise (SLR) test can be used to determine if the patient has true sciatica. A positive SLR test usually indicates S1 or L5 root irritation.

The presenting low back pain symptoms indicate a sciatic nerve involvement since the pain is radiating down the posterior aspect of the left leg. The X-rays show lesions most likely at the L-5. Further tests that may be ordered include; Schober test. This test measures the ability of a patient to flex his lower back. The patient is asked to touch his toes while keeping the knees straight. A positive test will be less than 4 cm between the 2 marks indicating decreased lumbar mobility. A Straight Leg Raise (SLR) test can be used to determine if the patient has true sciatica. A positive SLR test usually indicates S1 or L5 root irritation.

I need a response to this assignment

zero plgiarism

three references

Initials: J.S    Age: 42     Sex: Male   Race: African American 

S.

CC:  “I am experiencing lower back pain that radiates to my left leg”

HPI:  Mr. Smith is a 42-year-old African American male who reports to the clinic complaining of lower back pain that periodically radiates to his left leg.  The pain started about one month ago.  The character of the pain is shooting and stabbing. It appears to get worse when sitting for an extended period of time, bending over and during strenuous physical activity. The severity of the pain is 8/10 without medications but relieves to about 3/10 after taking Tylenol and getting some rest.  

Location: Lower back

Onset: 1 month

Character: Shooting and Stabbing

Associated signs and symptoms: nausea, vomiting, photophobia.

Timing: Sitting for extended periods, bending over and strenuous physical activity. 

Exacerbating/ relieving factors: Tylenol and rest makes the pain tolerable, but not completely better.

Severity: 8/10 pain scale

Current Medications

Metoprolol 100 mg tablet, PO once daily. 

Acetaminophen 500 mg tabs, 1-2 PO q 6 hrs, PRN for pain. (not to exceed 3 g in 24 hr).

PMHx:

Diagnosis: Hypertension

Surgical Hx: Laparotomy, 02/2000

Immunizations: Childhood immunizations completed. Tetanus and Flu shots are up-to-date.

Soc Hx: Unemployed. Lives alone and never married. Has one brother and both parents are alive. Performs physical exercise regularly at the gym, and uses seat belts all the time when driving. Denies tobacco and alcohol use.

Fam Hx: Father has a stroke and heart disease, Mother has hypertension, Brother has diabetes. Maternal and Paternal grandparents died of a stroke 2 years ago.

ROS:  BP – 140/90 L arm,  P – 86, T – 98.1 oral,  RR – 18,  Ht. – 5’10”, Wt. – 200 lbs. BMI 28.7

GENERAL:   No weight loss, fever, chills, weakness or fatigue.

HEENT:  Eyes:  No visual loss, blurred vision, doubles vision or yellow sclerae. 

Ears, Nose, Throat:  No hearing loss, sneezing, congestion, runny nose or sore throat.

Skin: No rash or itching. No skin lesions or moles that are new or suspicious.  

CARDIOVASCULAR:  No chest pain, chest pressure or chest discomfort. No palpitations or edema. No pleurisy pain, no hx of a heart murmur. No EKG on record. No peripheral edema or claudication. BP controlled with medication. 

RESPIRATORY:  No cough, sputum or SOB. No DOE, hemoptysis. Chest X-rays – 3 years ago. 

GASTROINTESTINAL:  No anorexia, nausea, vomiting or diarrhea. No abdominal pain or blood. No unintentional weight loss or gain. No change in bowel habits.

GENITOURINARY:  No penile discharge or erectile dysfunction. No nocturia, dribbling, or incontinence.

NEUROLOGICAL:  No headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control. No reports of numbness or tingling to the left leg since the onset of lower back pain.

MUSCULOSKELETAL: Reports lower back pain that sometimes radiate to the left leg. No edema noted. 

HEMATOLOGIC:  No hx of Blood transfusions. No anemia, bleeding or bruising. 

LYMPHATICS:  No hx of splenectomy. No enlarged lymph nodes.

PSYCHIATRIC:  No hx of depression or anxiety.

ENDOCRINOLOGIC:  No reports of sweating, cold or heat intolerance. No polyuria or polydipsia. No heat or cold intolerance.

ALLERGIES:  NKFA, NKDA

O.

Physical exam

General: Alert & Oriented x3. Appears well-nourished but exhibits a slight limp due to left leg pain.

Cardiovascular: Regular heart rate and rhythm, normal heart sounds and intact pulses. No murmurs, gallops or pericardial friction rub.

Pulm/chest: No respiratory distress. Lung Sounds clear to auscultation in all fields.

Abdomen: Soft, non-tender, Bowel sounds present x4 quadrants.

Musculoskeletal: Decreased mobility with lower back pain. Limited ROM with lumbar flexion. Gait disturbances, leaning to the right side on examination. Muscle spasms noted.

Hip flexion/ extension and strength against resistance indicates weakness to left gluteus maximus and L5 nerve root involvement. No hip or joint instability, knees equal in height

Neurological:  Bilateral L3-S1 dermatomes reactive to touch, no decrease in sensation. Deep tendon reflexes are symmetrical.  Knee jerk reflex positive and symmetrical bilaterally. 

Diagnostic results

Urinalysis: Negative, Light-yellow urine.

A.

Differential Diagnoses: 

  1. Low back pain & sciatica – Shooting pain in the lower back, that radiates down to one leg.
  2. Degenerative disc – The gradual deterioration of the disc between the vertebrae. 
  3. Lumbar radiculopathy – Nerve irritation caused by damage to the discs b/w the vertebrae. 
  4. Herniated disk -Signs and symptoms include arm/leg pain, numbness/tingling, and weakness. 

The presenting low back pain symptoms indicate a sciatic nerve involvement since the pain is radiating down the posterior aspect of the left leg. The X-rays show lesions most likely at the L-5. Further tests that may be ordered include; Schober test. This test measures the ability of a patient to flex his lower back. The patient is asked to touch his toes while keeping the knees straight. A positive test will be less than 4 cm between the 2 marks indicating decreased lumbar mobility. A Straight Leg Raise (SLR) test can be used to determine if the patient has true sciatica. A positive SLR test usually indicates S1 or L5 root irritation.

A FABER test can be used to rule out Sacroiliac (SI) Joint Pain and sacroiliitis. It is considered positive if movements reproduce pain or cannot be completed due to limited range-of-motion. Nerve testing of the lower extremities can be used to detect nerve irritation, while disc herniation can be detected with radiology testing, such as CT scan or MRI scan (McCance et al., 2014).

According to El Barzouhi et al., (2013), patients with sciatica frequently experience disabling back pain. Sciatica or lumbar spine pain with nerve root involvement results in low back pain and leg pain. The condition generally resolves within a period of 8 weeks. If the low back pain does not resolve within 8 weeks, then consider using imaging techniques such as; CT scan or MRI (El Barzouhi et al., 2014).                         

Diagnostic testing is not usually recommended within the first four weeks of the onset of low back pain, with no neurological symptoms, according to national practice guidelines (Dains, Baumann, & Scheibel, 2012). Evidence shows that unnecessary or routine imaging (X-ray, MRI, CT scans) for low back pain is not associated with improved outcomes. Patients who have early imaging had much greater health care use and costs, but they did not have better outcomes (AHRQ, 2015). 

References

Agency for Healthcare Research and Quality (2015). Back pain? Hold the MRI, new research says. Retrieved from https://www.ahrq.gov/news/newsletter/e-newsletter/464.html

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.

Dains, J. E., Baumann, L. C., & Scheibel, P. (2012). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St.Louis, Missouri: Elsevier.

El Barzouhi, A., Vleggeert-Lankamp, C. L. A. M., van der Kallen, B. F., Lycklama à Nijeholt, G. J., van den Hout, W. B., Koes, B. W., & Peul, W. C. (2014). Back pain’s association with vertebral end-plate signal changes in sciatica. The Spine Journal, 14(2), 225–233. https://doi-org.ezp.waldenulibrary.org/10.1016/j.spinee.2013.08.058

McCance , K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2014). Pathophysiology: The biologic basis for disease in adults and children (7th ed.). St. Louis, MS: Elsevier.

The post The presenting low back pain symptoms indicate a sciatic nerve involvement since the pain is radiating down the posterior aspect of the left leg. The X-rays show lesions most likely at the L-5. Further tests that may be ordered include; Schober test. This test measures the ability of a patient to flex his lower back. The patient is asked to touch his toes while keeping the knees straight. A positive test will be less than 4 cm between the 2 marks indicating decreased lumbar mobility. A Straight Leg Raise (SLR) test can be used to determine if the patient has true sciatica. A positive SLR test usually indicates S1 or L5 root irritation. appeared first on Shine Essay.


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The healthcare industry is the Americans’ top concern, and priority as millions of Americans are dying because they can’t afford medical care, as the majority of the population delaying seeking medical help because of skyrocketing cost.

 The healthcare industry is the Americans’ top concern, and priority as millions of Americans are dying because they can’t afford medical care, as the majority of the population delaying seeking medical help because of skyrocketing cost. Rep. Frank Pallone Jr, Democratic Representative of NJ, introduced the H.R.1884 last March 26, 2019. “Protecting Pre-Existing Conditions and Making Health Care More Affordable Act of 2019.” (Congress, 2020) cosponsor by 160 Democratic Representatives. The primary focus is to reverse the Trump administrations’ harmful sabotage to repeal the Affordable Care Act (ACA) or Obamacare, which strengthens the protection for people with pre-existing conditions by stopping the insurance junk that discriminates against consumers and extending waiver to the States. This bill will make health care affordable to all Americans by lowering its insurance premiums by expanding affordability assistance. “Specifically, the bill expands eligibility for premium tax credits beyond 400 percent of the federal poverty line and increases the size of tax credits for all income brackets.” (Pallone, 2019)

The legislation offers to fund the states to establish their State- Base insurance marketplaces, which is usually lower compared to out of state insurance marketplaces. The opportunity to take advantage of the development of the national reinsurance program in helping to cover consumer high-cost medical conditions, thus making premium low and affordable to all the consumers. Thanks to Trump Administration by signing Section 1332: State Innovations Waivers, many States take the growing use to have the federal money fund their State reinsurance program. As an evidence-based practice, the following State, such as Alaska, Maine, Maryland, Minnesota, New Jersey, Oregon, and Wisconsin, had a lower insurance premium compared to the other State that did not utilize reinsurance programs. (Norris, 2020) As democrats taking this bold step and taking in all the credits while bashing the present administration. They need to realize with Trump ways of making changes in trying to mitigate Obamacare something good for the people came out of it, probably if both of our political parties and leaders will just do their job correctly in harmony and for the people. They will be able to deliver and fulfill their long promises to American people of great healthcare reform.

References

Congress. (2020). Retrieved from www.congress.gov: https://www.congress.gov/bill/116th-congress/house-bill/1884/text?q=%7B%22search%22%3A%5B%22HEALTH+POLICY+2020%22%5D%7D&r=46&s=3

Norris, L. &. (2020, March 24). What Is Reinsurance and Why Are States Pursuing It? very well health. Retrieved from https://www.verywellhealth.com/reinsurance-4174980

Pallone, F. (2019, March 26). House Democrats Unveil Legislation to Strengthens Protection for Pre-Existing Conditions and Lower Healthcare Cost. Retrieved from https://energycommerce.house.gov/newsroom/press-releases/house-democrats-unveil-legislation-to-strengthen-protections-for-pre

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Lawmakers are increasingly applying the principle of evidence-based legislation when developing laws that address various public health issues. Evidence-based legislation involves the formulation and writing of various laws based on scientific evidence that is available on the issue being legislated upon (Milstead & Short, 2019). A recent law that followed this principle is the Comprehensive Addiction and Recovery Act of 2016. Signed into law in July 2016, the law seeks to address the opioid crisis by authorizing multiple treatment and prevention programs for the condition.

Lawmakers are increasingly applying the principle of evidence-based legislation when developing laws that address various public health issues.  Evidence-based legislation involves the formulation and writing of various laws based on scientific evidence that is available on the issue being legislated upon (Milstead & Short, 2019). A recent law that followed this principle is the Comprehensive Addiction and Recovery Act of 2016. Signed into law in July 2016, the law seeks to address the opioid crisis by authorizing multiple treatment and prevention programs for the condition. 

The opioid pandemic, which the Comprehensive Addiction and Recovery Act seeks to address, has been a significant problem in the USA since the late 1990s. At the time of its passing, approximately fifty thousand Americans died each year from overdosing on opioid drugs acquired either illegally or through medical prescriptions (Bone et al., 2018). Without addressing the issue effectively, there was a risk of a continued increase in the number of deaths. 

In addressing the crisis, the Comprehensive Addiction and Recovery Act used the best available scientific evidence to support its recommendations. For instance, the legislation requires an increase in education programs that spread awareness of the dangers of using opioid drugs to senior populations, parents, caretakers, and teenagers. This requirement is supported by scientific evidence which has found that increasing awareness of the dangers of opioid drugs reduces their usage (Kahn et al., 2019). The legislation also requires criminal justice representatives to identify individuals in prisons who are addicted to opioid drugs and seek evidence-based treatment for them. This requirement is also backed by scientific evidence that shows that prisons are among the hardest hit institutions by the opioid crisis (Bone et al., 2018). 

The Comprehensive Addiction and Recovery Act is, therefore, legislation that is based on scientific evidence. Its requirements are simply implementations of findings from various scientific studies.

References

Bone, C., Eysenbach, L., Bell, K., & Barry, D. T. (2018). Our Ethical Obligation to Treat Opioid Use Disorder in Prisons: A Patient and Physician’s Perspective. The Journal of Law, Medicine & Ethics46(2), 268-271.

Comprehensive Addiction and Recovery Act of 2016. Retrieved on 8th April 2020 from https://www.congress.gov/bill/114th-congress/senate-bill/524/text?overview=closed

Kahn, N., Chappell, K., Regnier, K., Travlos, D. V., & Auth, D. (2019). A Collaboration Between Government and the Continuing Education Community Tackles the Opioid Crisis: Lessons Learned and Future Opportunities. Journal of Continuing Education in the Health Professions39(1), 58-63.

Milstead, J. & Short, N. (2019). Health policy and politics: A nurse’s guide (6th edition). Burlington, MA: Jones & Bartlett Learning

The post Lawmakers are increasingly applying the principle of evidence-based legislation when developing laws that address various public health issues. Evidence-based legislation involves the formulation and writing of various laws based on scientific evidence that is available on the issue being legislated upon (Milstead & Short, 2019). A recent law that followed this principle is the Comprehensive Addiction and Recovery Act of 2016. Signed into law in July 2016, the law seeks to address the opioid crisis by authorizing multiple treatment and prevention programs for the condition. appeared first on Shine Essay.


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Nursing has become one of the largest professions in the world, and as such, nurses have the potential to influence policy and politics on a global scale (Milstead & Short, 2019). When nurses influence the politics that improve the delivery of healthcare, they are ultimately advocating for their patients. Hence, policy-making has become an increasingly popular term among nurses as they recognize a moral and professional obligation to be engaged in healthcare legislation (Burke, 2016). There exist opportunities for RNs and APRNs to actively participate in policy-making. However, with the opportunities can come.

Nursing has become one of the largest professions in the world, and as such, nurses have the potential to influence policy and politics on a global scale (Milstead & Short, 2019). When nurses influence the politics that improve the delivery of healthcare, they are ultimately advocating for their patients. Hence, policy-making has become an increasingly popular term among nurses as they recognize a moral and professional obligation to be engaged in healthcare legislation (Burke, 2016). There exist opportunities for RNs and APRNs to actively participate in policy-making. However, with the opportunities can come.

To be influential, nurses – particularly RNs and APRNs – must see themselves as professionals with the responsibility and capacity to influence healthcare policies delivery systems (Burke, 2016). Nurses can lean towards the nature of nursing, which is a “science of caring” or operate from a framework that values all people in a holistic way to advance people’s health. RNs and APRNs can influence practice standards and processes to assure quality of care.

How?

Considered as advanced and specialized professionals, RNs and APRNs can sit on committees or panels panel that give expert advice to policy makers (Tummers & Bekkers, 2014). Secondly, RNs and APRNs can become part of or conduct research that provided evidenced based support in policy making. Writing white papers, newspaper editorials, position statements, and other informative correspondence that educates the public and policymakers about the needs can support improvement of healthcare outcomes and overall improved nursing care (Milstead & Short, 2019).

With opportunities come challenges.

Policymakers may be unwilling to listen to expert advice or evidence-based research on particular policies to further either their political or personal agenda. In such as case resilience and advocacy can help make the policymakers change their mind (Burke, 2016).  Furthermore, sometimes some people (and/or policymakers) may question white papers, research, position statements, newspaper editorials or other correspondences that educate the public and policy makers (Burke, 2016). When that happens, you can seek the support of other stakeholders who support the evidence to help advance the policy agendas.

Finally, as an RN/APRN you may be required to advocate for or communicate these opportunities to participate in policymaking. You can do that in many ways. Two of the ways include;

  • Volunteering in policy-related activities including development meetings.
  • Participating in activities that advance health-policy driven agendas.
  • Seek appointments and serve on committees, boards, and leadership groups that have decision-making power.

References

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Burlington, MA: Jones & Bartlett Learning.

  • Chapter 5, “Public Policy Design” (pp. 87–95 only)

Tummers, L., & Bekkers, V. (2014). Policy implementation, street level bureaucracy, and the importance of discretion. Public Management Review, 16(4), 527–547. doi:10.1080/14719037.2013.841978.

The post Nursing has become one of the largest professions in the world, and as such, nurses have the potential to influence policy and politics on a global scale (Milstead & Short, 2019). When nurses influence the politics that improve the delivery of healthcare, they are ultimately advocating for their patients. Hence, policy-making has become an increasingly popular term among nurses as they recognize a moral and professional obligation to be engaged in healthcare legislation (Burke, 2016). There exist opportunities for RNs and APRNs to actively participate in policy-making. However, with the opportunities can come. appeared first on Shine Essay.


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