Please write a comment on this post. APA, citation  and reference. prefer CDC, healthy people 2020. 

 Mr. Barley is a 58-year-old well-developed male with a chief complaint of “a bad cough, mainly in the morning, last winter and this winter.” Cough produces “whitish phlegm”.  The history of present illness includes no complaint of chest pain, weight loss, or fever. There is also no noted nausea, vomiting or diarrhea. Also, of note, the coughing is not precipitated by choking, trembling/shaking, palpitations, sweating or chills.  Mr. Barley notes that he does have contact with chemicals on his farm, however, is cautious to use protective equipment.  He also notes that he has a long (26 year) history of smoking up to two packs of cigarettes per day though recently he has cut back to a half a pack per day. Mr. Barley also notes that he has no known allergies, has not traveled or been exposed to tuberculosis.  He also does not have leg swelling, orthopnea, or proximal nocturnal dyspnea (PND). Mr. Barley has no chronic illness noted in his past, only being seen for minor injuries, and has never been admitted to the hospital and only surgical history is a tonsillectomy at age 12. Mr. Barley takes no medications at this time. Mr. Barley’s social history includes being married for thirty-five years and has two adult daughters. He currently resides with his wife on their farm. Both of his daughters have families of their own. His past family history includes his mother whom he thinks has hypertension, and father who died of a stroke when he was seventy. His sisters and daughters have no known medical history.
            To complete a focused physical exam a differential diagnosis must first be established. There are several potential causes of acute dyspnea with a cough including asthma, acute bronchitis, and new onset chronic obstructive pulmonary disease (COPD), lung cancer, and congestive heart failure (CHF).  (Buttaro, Trybulski, Polgar-Bailey, and Sandberg-Cook, 2017). It is unlikely that Mr. Barley has an active infection due to the lack of fever (current temp 98.9), chills, or change in color and consistency of the phlegm. At this time CHF may be set aside due to the lack of chest pain, edema in lower extremities, the absence of PND, and a blood pressure of 128/78. Therefore, a focused assessment relating to the respiratory system is warranted at this visit.  According to Petty (2001), the National Lung Health Education Program (NLHEP) began a campaign to introduce early assessment, intervention, and diagnosis of chronic lung disease in individuals who smoke.  It was recommended that individuals older than forty-five complete an in-office spirometry exam to indicate risk for chronic lung diseases such as asthma, chronic bronchitis, COPD, and lung cancers. 

A general physical exam will assess Mr. Barley’s general appearance, vital signs, head, eyes, ears, nose, throat, neck, lungs, heart, abdomen, and extremities. The focused assessment for COPD will include auscultation of breath sounds specifically looking for wheezing/end expiratory wheezing, assessment of anterior-posterior (AP) diameter of the chest, and prolonged expiratory phase and evidence of a change in the suprasternal notch.  Mr. Barley is noted to have a laryngeal height of 2cm from the sternal notch, increased AP diameter, and diffuse end-expiratory wheezes in addition to self-admittance of long-term smoking.  These findings are indicative of a COPD diagnosis.

The GOLD standard for assessment of COPD is the use of spirometry to assess for airway obstruction. (Global Initiative for Chronic Obstructive Lung Disease (GOLD), 2016). Buttaro, Trybulski, Polgar-Bailey, and Sandberg-Cook (2017) state that additional tests should include pulse oximetry, laboratory studies of complete blood count (CBC) with differential, arterial blood gas (ABG), and alpha 1 antitrypsin, and that imaging including a chest x-ray is suggested. Within the case study, pulmonary function testing (spirometry) is completed indicating that the diagnosis of COPD was accurate.  At this time, I would also have completed baseline blood work including the suggested CBC, ABG, alpha 1 antitrypsin, and imaging of chest x-ray. Though the spirometry exam is the gold standard and indicative of COPD, identifying baseline images and laboratory information will provide information when an exacerbation occurs or the disease progresses.

This diagnosis may be a shock for Mr. Barley and written information will need to be provided about COPD, what changes in symptoms will mean, and the addition of maintenance medications. Studies have shown that patient education and nonpharmacologic interventions are factors which decrease the incidence of COPD emergencies. (Lloyd and Garside, 2017).  It is also necessary to discuss with Mr. Barley the need to quit smoking, assessment of his readiness to quit because smoking is the primary cause of chronic lung disease. (Lloyd and Garside, 2017). Mr. Barley should also be aware that smoking cessation will also decrease his current risk of premature morbidity related to COPD related illnesses. (Petty, 2001).

At this point, it is necessary to support Mr. Barley emotionally as well.  Information about support groups both in person and online should be provided. Resources for additional information about COPD should be supplied as well. 

Education on medications including the use of metered dose inhalers (MDI)/inhaled bronchodilators and corticosteroids should also be discussed. It is important to reinforce that no medication will reverse the disease process however, these medications will reduce the severity of the symptoms felt by Mr. Barley. (Buttaro, Trybulski, Polgar-Bailey, and Sandberg-Cook, 2017). An assessment of Mr. Barley’s current knowledge on how to use MDI’s and preferred learning style is necessary to determine the type of education utilized.  The use of demonstration/ return demonstration was utilized within the case study and is a measurable way to assess assimilated knowledge from teaching. It is also important to discuss with Mr. Barley when to seek medical attention in the future relating to his COPD which includes changes in breathing quality (i.e. increased dyspnea) and productive cough with changes in phlegm amount, color or thickness. (Bostock-Cox, 2017). A preventative measure that Mr. Barley can take is to be sure to stay current on his immunizations including pertussis (DTaP), influenza, and pneumococcus. Seo, Hong, Kim, Choi, Baek, Lee, Song, Lee, Cheong, and Kim (2013) indicate that the influenza vaccine does decrease the risk of COPD exacerbations requiring hospitalization by 27 %. Follow up appointments should be set up to ascertain the effectiveness of the medications and further understanding of Mr. Barley’s diagnosis, perhaps to include his wife and or daughters. Follow up appointments also yield information about depression related to changes in health status as well as an opportunity to assess for weight gain related to corticosteroid use and assessment of smoking cessation.

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Answer to this post. APA, citation and reference . I need an answer that support the text below . 

Discuss the differences between non-parametric and parametric tests.

Parametric and nonparametric tests are terms used by statistics shins frequently when doing analysis. Parametric and nonparametric tests referred to hypothesis test of the mean and median. The mean being the parametric and the median being a non-parametric. Parametric test assumes that your date of follows a specific distribution whereas non-parametric test also known as distribution free test do not.

Provide an example of each and discuss when it is appropriate to use the test. Next, discuss the assumptions that must be met by the investigator to run the test.

An example of a parametric test is a 1-2 sample T Test. It is appropriate to use this type of analysis when the sample size is greater than 20. In order to run a parametric test a researcher must know and assume that the test can perform well with skewed and non normal distributions. Another assumption a researcher must have in order to run a parametric test is the knowledge of knowing that the parametric test can perform well when the spread of each group is different.

An example of a non-parametric test is a 1 sample sign. One reason to perform a study using a non-parametric test is because you can perform a parametric test with non normal data. Another reason to use a non-parametric test in a study is when you have a very small sample size,  original data, rank data or outliers which are not removable.  An assumption that must be met any nonparametric test is that the data for all groups must have the same dispersion.

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Informed Consent Form

By the due date assigned, submit the Informed Consent Letter to the Submissions Area (please note that this is only an example and no data may be collected).

    Informed Consent Letter   

• Procedure section is clear, described in detail, specific, and all inclusive. Written in lay language (as documented by reading level score). Includes risks and benefits relevant to study. Address assent (if applicable).

This is something that the professor posted separate. Hopefully can help to answer this work…..

• Informed Consent: Informed consent is usually documented by a form that will vary from agency to agency. However, the three important aspects of informed consent are that the individual has been given sufficient information about the research to make an informed choice; the information has been given in a way that the individual can understand; and the consent is voluntary.

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Please write at least 2 paragraph to support this post. APA, citation and reference.. 

Notably, the learning objectives for the term have been based on nursing research methods with a focus on the ways of carrying out research that is evidence-based and beneficial to the nursing profession. As such, it is vital to review and reflect on what has been covered because through this one can draw on their strengths and realize their weaknesses. Through reflection, any concepts that were not addressed appropriately can be given more emphasis by setting goals to achieve them shortly. My topic has been based on oncology, and all the learning outcomes were met through discussions centered on the subject.

Discussion

The learning objective of ethics in research was met by reviewing the article on protecting human research participants outlined in the National Institute of Health (NIH). I learned about the requirements for carrying out qualitative research and how participants in a study on oncology should be treated with dignity and respect. In an oncology unit, patients often suffer psychological problems just as much as physical pain is experienced as well. Treating the patient with utmost dignity while alleviating their suffering is critical in ensuring the nurse and patient build a trusting relationship (Ford, 2014). The learning outcome of the problem statement was met by developing a PICOT question with a focus on my population, which was patients with oncology needs. The patient characteristics were explained with two interventions being compared to determine which was best for the care of the patient. I came up with a statement of the problem for my topic on oncology with an emphasis on facts that depict the existence of a problem that needs to be addressed to ensure patients with cancer are cared for using standard practice. The research purpose was indicated by highlighting the vitality of the subject in the society because oncology is fast becoming an area that should be addressed by all, making awareness crucial.

A theoretical and conceptual framework based on the subject was achieved by reviewing previously documented theories on the subject of oncology. In the recent years, there has been a surge of information on cancers and their proposed forms of management because it has become a public health concern. Through the analysis of the theories cited by various authors, I was able to construct a conceptual map narrowing precisely on the subject. I learned many aspects of oncology since it is a widely researched topic with many angles of patient management and treatment options as well. Research design learning outcome was met by identifying a design that was most appropriate with chosen research questions. I was able to identify various strengths and weaknesses of the design and relate to my topic. A research outcome is dependent on the design was chosen because quantitative and qualitative research designs are different and often provide results that could be significantly different. Through reading on the research designs and selecting an appropriate one for my topic, I was able to identify the most suitable design to use on the subject of oncology.

Through the problem statement, I came up with a method to select the sample size and sample characteristics based on the topic. A sampling technique is crucial in determining if, at the end of the research process, the results will be generalized to the entire population. I came up with a research question to help in addressing the research topic with the information on the existing instrument that would be used to address the research question. All the learning outcomes were successfully met through a proper literature review on the topic of oncology and the research of the appropriate research design.

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