Assignment:
Analyze the possible conditions from your colleagues’ differential diagnoses.
Determine which of the conditions you would reject and why.
Identify the most likely condition, and justify your reasoning.
42-year-old White Male
S.
Chief Complaint: “low back pain for the past month that sometimes radiates to my left leg.”
HPI: The patient is a 42-year-old white male who is complaining of low back pain that began one month ago. He explains that the pain will intermittently radiate to his left leg as well. He reports that the pain is constant and is also “sharp” at times. He describes the pain that radiates to his left leg as a “tingling” sensation and can sometimes even feel it “all the way down to his toes.” He rates the pain at an “8” when he is standing or walking but describes that the intensity decreases to a “4” when he is sitting or lying down. The patient complains of intermittent numbness and tingling in his left leg that seems to have gotten worse “in the past week.” He explains that the numbness and tingling is always worse first thing in the morning. He also describes the pain as almost “unbearable” after working a 12-hour shift and that he even has experienced a loss of appetite on those days after working long hours. He explains that the pain does wake him up sometimes at night. The patient explains that Aleve has been his “lifesaver,” as he does not feel that he could have worked at all if it wasn’t for taking it routinely before work. He proceeded to verbalize that the Aleve only “took the edge off,” but that he is worried about the effect it may be having on his stomach.
Current Medications: Centrum Vitamin for Men, one PO daily; Aleve capsule, one PO every 8 hours; over-the-counter Zantac 150 mg PO, “occasionally” at bedtime for heartburn.
Allergies: PCN- experienced hives after taking as a teenager; Denies food or environmental allergies.
PMH: Occasional acid reflux, history of childhood asthma, hospitalized last year with pneumonia. Reports only surgery being tonsillectomy at age 5. Reports that he is current with immunizations and received a tetanus injection two years ago when he cut his finger at work.
FH: Father died at age 60 with a heart attack, mother is living and has HTN. Maternal grandparents are living with no history of heart disease or cancer. Maternal grandmother-type 2 diabetes; Maternal grandfather- HTN, controlled with medication. Paternal grandmother- living and in excellent health, with no history of heart disease or cancer. Paternal grandfather died at age 72 with a heart attack. Reports that both children are in excellent health. Denies a history of back pain or scoliosis with maternal or paternal relatives.
SH: Works as a nurse in the ICU at a local hospital and has been married for 15 years; they have two school-aged children. He reports that he and his family love to spend time outdoors and that they usually hike on the weekends together. He explains that he is very active in his local church and teaches a class there on Wednesday nights. He denies any past tobacco use, including smokeless tobacco. He also denies any history of illicit drug use. The patient explains that he drank beer on the weekends in college but denies alcohol use at this time. He reports that his family lives in the country, but states that he and his wife’s family only live one hour away and are all very supportive. The patient reports regular use of a seat belt and was reminded of the danger of texting and driving, as he admitted that this is something that he is in the habit of doing.
ROS:
- General: Reports 7 lb. weight loss in the past month; Denies fevers or chills. Reports increased fatigue due to pain waking him up at night. Reports increased anxiety that he relates to the constant pain.
- Skin: Negative for rash, lesions, cysts, or wounds.
- Cardiovascular: Negative for chest pain, tightness, or chest pressure. Negative for palpitations. Denies any issues with swelling in extremities.
- Respiratory: Negative for shortness of breath, cough, or sputum. Denies shortness of breath even after long hikes.
- Gastrointestinal: Negative for abdominal pain. Reports some nausea when back pain is intensified but denies vomiting. Reports normal bowel movements with no issues of diarrhea, constipation, or blood in stools. Positive for heartburn for at least the past couple of years, especially at night. Negative for bowel incontinence.
- Genitourinary: Negative for burning upon urination or frequency. Negative for urinary incontinence.
- Neurological: Negative for headaches, dizziness, or fainting. Denies head trauma. Positive for intermittent numbness and tingling in left leg, foot, and toes. Denies numbness or tingling in any other extremities. Denies any problems with balance or coordination.
- Musculoskeletal: Denies muscle weakness. Positive for constant low back pain. Positive for back and left leg stiffness upon getting up in the mornings. Denies any other joint pain or issues.
- Hematologic: Negative for a history of bleeding problems. Denies any back trauma, wounds, or lesions. Denies any unusual bruising.
- Lymphatics: Negative for any swollen lymph nodes.
- Psychiatric: Reports no history of depression or mental disorders. Admits to current anxiety that he relates to constant back pain.
O.
Vital signs: B/P 135/72; Pulse 83; RR 18; O2 Sat 98%; Temp. 98.3; Wt. 205 lbs.; Ht. 72”
General: Patient sitting on edge of the exam table, appears restless and anxious. He is alert and oriented x3 and responds appropriately to all questions.
Skin: Warm, dry, and intact. No evidence of rashes, lesions, wounds, or cysts. Adequate turgor.
Respiratory: Breath sounds clear and equal upon auscultation in all 4 lobes anteriorly and posteriorly. No adventitious sounds heard. Symmetrical chest wall expansion noted. No difficulty in breathing patterns noted.
CV: Heart RRR, no audible murmurs or gallops. No peripheral edema noted. Tibial and dorsalis pedal pulses present, 2+ bilaterally. Capillary refill less than 3 seconds in fingers and toes bilaterally, with no cyanosis noted.
Abdomen: Soft and nontender. No distention; no palpable masses. Bowel sounds normoactive in all 4 quadrants. No evidence of guarding. No flank tenderness noted bilaterally.
Rectal: No prostate tenderness or enlargement noted upon palpation.
Back: Spine straight with no obvious curvature. Full ROM of the spine, but tenderness reported upon palpation of the sacroiliac region.
Musculoskeletal: full weight-bearing. No evidence of gait disturbances. Full ROM noted in all 4 extremities. Leg measurements are equal. Positive FABER test upon placing the left leg on right knee, pain reported in the sacroiliac region. Straight leg raises performed bilaterally, with complaints of pain verbalized upon 45 degrees of elevation. Pain in the sacroiliac region also voiced upon left ankle dorsiflexion (Dains, Baumann, & Scheibel, 2019, Chapter 24).
Neurological: Alert and oriented x 3; appropriate mood and affect in the present circumstance of constant pain. No foot drop noted when examined bilaterally (Dains et al., 2019). Reflexes are 2+ and equal bilaterally, including deep tendon (Dains et al., 2019). Strength is 5/5 in all extremities except for left leg, which is assessed at 4/5 (Sullivan, 2019, Chapter 2). No evidence of limping with ambulation.
Diagnostic Results:
CBC: WBC 14, 500; HgB 12.3; Hct 46%. While this patient’s WBC is only slightly elevated, it is important to consider the presence of an infection in the back or spinous processes. While he has not reported any fever or chills, clinicians can never be too certain that there is not a hidden bacterium that would be the causative agent for the reported symptoms (Dains et al., 2019). Additionally, as the thought of a malignant condition is always in the minds of patients and clinicians, alike, it is essential to assess the H & H of the individual (Dains et al., 2019). While anemia is commonly present amongst cancer diagnoses, ranging anywhere from 30% to 90% of diagnosed patients, the extent of such a condition will vary according to the type of tumor (Krasteva, Harari, & Kalsi, 2019).
UA: negative for blood, nitrites, or bacteria. As the advanced practice nurse, it is equally important to ensure that there is no specific visceral involvement, such as what can occur with the kidneys when there is infection present (Dains et al., 2019). The U/A results would be helpful information to rule out a condition known as pyelonephritis (Dains et al., 2019).
ESR: 25 mm/hr. A hematologic test, known as an erythrocyte sedimentation rate, is very useful when trying to conclude if infection, inflammation, trauma, or even malignant disease is present (Patil, Muduthan, & Kunder, 2019). While the ESR can be initially elevated in the acute stages of an illness, it is a significant enough diagnostic test to perform when trying to rule out infection as the underlying cause of the condition (Patil et al., 2019).
PSA: 9.2. The elevated PSA level in this gentleman does warrant enough suspicion for the advanced practice nurse, as there is always a potential for prostate cancer with bony metastasis in the spinal region (Bakhsh et al., n.d.). The bony lesions that are found in metastatic prostate cancer are typically osteoblastic in nature (Bakhsh et al., n.d.).
MRI: awaiting the radiologist report. The condition of the soft tissue in the spinal region is best visualized with magnetic resonance imaging (Dains et al., 2019). There are medical conditions that need to be ruled out as a source of the back pain, such as disc herniations, tumors, and various diagnoses that originate from the spinal cord (Dains et al., 2019).
A.
1.) Sciatica: While it is vital that other medical conditions that originate from the spine are reviewed, sciatica is a presumptive diagnosis for this male patient that is experiencing low back pain. The long-standing nursing career of this male patient often involves a great deal of twisting, bending, and lifting that has become repetitive (Dains et al., 2019). The bowel and bladder functions are not usually compromised, but the patient will experience a significant amount of pain, burning, and even numb sensations in the buttock and leg of the affected side (Dains et al., 2019). The straight leg raises test (SLR) will usually reveal positive results, which was the case of this male patient (Dains et al., 2019).
2.) Primary or metastatic tumor: The advanced practice nurse must rule out the presence of a tumor type, first and foremost, before proceeding on to other differential diagnoses. While this patient may not have all the “classic” indicators of malignancy, it is vital that clinicians understand that no one patient will present with a malignant condition in the same exact fashion. The elevated PSA in this young 42-year-old male is enough indication to ensure that a malignant condition is not the underlying cause for his symptomology. The weight loss that the patient has reported is a symptom that does require further exploration.
3.) Disc Herniation: Although numbness and tingling are not as common with a disc herniation, patients with such a condition will usually complain of pain that radiates throughout the leg of the affected side (Dains et al., 2019). The patient with a herniated disc will quite frequently have positive straight leg tests, and an MRI is undoubtedly warranted if the patient has experienced back pain for at least one month (Dains et al., 2019).
4.) Infection: A condition known as osteomyelitis can often occur in the spine, especially if the patient has experienced recent infection in a neighboring anatomical region or if they have undergone a type of invasive procedure where various instrumentation was utilized (Dains et al., 2019). Sadly enough, infection ranks high in the medical community as one of the most overlooked conditions by well-intended clinicians (Mohamed, Finucane, & Selfe, 2019). The cause for many of these errors that pertain to spinal infections is because of the extended period between the time of initial onset to the time of full development of the condition (Mohamed et al., 2019). The consideration of infection is very prudent with this male patient, as his slight WBC elevation and ESR level do require further exploration.
5.) Spinal Stenosis: While this condition is typically diagnosed in those patients over 50 years of age, the advanced practice nurse must take into consideration the length of time that this male patient has endured long hours on his feet in his nursing career. Spinal stenosis of the lumbar region is a common location and is usually associated with degenerative changes of the three-joint complex (Abbas, Peled, Hershkovitz, & Hamoud, 2019). The presence of neurogenic claudication is an anticipated clinical symptom, with pain levels increasing upon long periods of standing (Abbas et al., 2019). The pain will normally radiate to one or both buttocks, legs, and feet (Abbas et al., 2019).
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Response 1 19485791
/in Uncategorized /by developerAssignment:
Analyze the possible conditions from your colleagues’ differential diagnoses.
Determine which of the conditions you would reject and why.
Identify the most likely condition, and justify your reasoning.
42-year-old White Male
S.
Chief Complaint: “low back pain for the past month that sometimes radiates to my left leg.”
HPI: The patient is a 42-year-old white male who is complaining of low back pain that began one month ago. He explains that the pain will intermittently radiate to his left leg as well. He reports that the pain is constant and is also “sharp” at times. He describes the pain that radiates to his left leg as a “tingling” sensation and can sometimes even feel it “all the way down to his toes.” He rates the pain at an “8” when he is standing or walking but describes that the intensity decreases to a “4” when he is sitting or lying down. The patient complains of intermittent numbness and tingling in his left leg that seems to have gotten worse “in the past week.” He explains that the numbness and tingling is always worse first thing in the morning. He also describes the pain as almost “unbearable” after working a 12-hour shift and that he even has experienced a loss of appetite on those days after working long hours. He explains that the pain does wake him up sometimes at night. The patient explains that Aleve has been his “lifesaver,” as he does not feel that he could have worked at all if it wasn’t for taking it routinely before work. He proceeded to verbalize that the Aleve only “took the edge off,” but that he is worried about the effect it may be having on his stomach.
Current Medications: Centrum Vitamin for Men, one PO daily; Aleve capsule, one PO every 8 hours; over-the-counter Zantac 150 mg PO, “occasionally” at bedtime for heartburn.
Allergies: PCN- experienced hives after taking as a teenager; Denies food or environmental allergies.
PMH: Occasional acid reflux, history of childhood asthma, hospitalized last year with pneumonia. Reports only surgery being tonsillectomy at age 5. Reports that he is current with immunizations and received a tetanus injection two years ago when he cut his finger at work.
FH: Father died at age 60 with a heart attack, mother is living and has HTN. Maternal grandparents are living with no history of heart disease or cancer. Maternal grandmother-type 2 diabetes; Maternal grandfather- HTN, controlled with medication. Paternal grandmother- living and in excellent health, with no history of heart disease or cancer. Paternal grandfather died at age 72 with a heart attack. Reports that both children are in excellent health. Denies a history of back pain or scoliosis with maternal or paternal relatives.
SH: Works as a nurse in the ICU at a local hospital and has been married for 15 years; they have two school-aged children. He reports that he and his family love to spend time outdoors and that they usually hike on the weekends together. He explains that he is very active in his local church and teaches a class there on Wednesday nights. He denies any past tobacco use, including smokeless tobacco. He also denies any history of illicit drug use. The patient explains that he drank beer on the weekends in college but denies alcohol use at this time. He reports that his family lives in the country, but states that he and his wife’s family only live one hour away and are all very supportive. The patient reports regular use of a seat belt and was reminded of the danger of texting and driving, as he admitted that this is something that he is in the habit of doing.
ROS:
O.
Vital signs: B/P 135/72; Pulse 83; RR 18; O2 Sat 98%; Temp. 98.3; Wt. 205 lbs.; Ht. 72”
General: Patient sitting on edge of the exam table, appears restless and anxious. He is alert and oriented x3 and responds appropriately to all questions.
Skin: Warm, dry, and intact. No evidence of rashes, lesions, wounds, or cysts. Adequate turgor.
Respiratory: Breath sounds clear and equal upon auscultation in all 4 lobes anteriorly and posteriorly. No adventitious sounds heard. Symmetrical chest wall expansion noted. No difficulty in breathing patterns noted.
CV: Heart RRR, no audible murmurs or gallops. No peripheral edema noted. Tibial and dorsalis pedal pulses present, 2+ bilaterally. Capillary refill less than 3 seconds in fingers and toes bilaterally, with no cyanosis noted.
Abdomen: Soft and nontender. No distention; no palpable masses. Bowel sounds normoactive in all 4 quadrants. No evidence of guarding. No flank tenderness noted bilaterally.
Rectal: No prostate tenderness or enlargement noted upon palpation.
Back: Spine straight with no obvious curvature. Full ROM of the spine, but tenderness reported upon palpation of the sacroiliac region.
Musculoskeletal: full weight-bearing. No evidence of gait disturbances. Full ROM noted in all 4 extremities. Leg measurements are equal. Positive FABER test upon placing the left leg on right knee, pain reported in the sacroiliac region. Straight leg raises performed bilaterally, with complaints of pain verbalized upon 45 degrees of elevation. Pain in the sacroiliac region also voiced upon left ankle dorsiflexion (Dains, Baumann, & Scheibel, 2019, Chapter 24).
Neurological: Alert and oriented x 3; appropriate mood and affect in the present circumstance of constant pain. No foot drop noted when examined bilaterally (Dains et al., 2019). Reflexes are 2+ and equal bilaterally, including deep tendon (Dains et al., 2019). Strength is 5/5 in all extremities except for left leg, which is assessed at 4/5 (Sullivan, 2019, Chapter 2). No evidence of limping with ambulation.
Diagnostic Results:
CBC: WBC 14, 500; HgB 12.3; Hct 46%. While this patient’s WBC is only slightly elevated, it is important to consider the presence of an infection in the back or spinous processes. While he has not reported any fever or chills, clinicians can never be too certain that there is not a hidden bacterium that would be the causative agent for the reported symptoms (Dains et al., 2019). Additionally, as the thought of a malignant condition is always in the minds of patients and clinicians, alike, it is essential to assess the H & H of the individual (Dains et al., 2019). While anemia is commonly present amongst cancer diagnoses, ranging anywhere from 30% to 90% of diagnosed patients, the extent of such a condition will vary according to the type of tumor (Krasteva, Harari, & Kalsi, 2019).
UA: negative for blood, nitrites, or bacteria. As the advanced practice nurse, it is equally important to ensure that there is no specific visceral involvement, such as what can occur with the kidneys when there is infection present (Dains et al., 2019). The U/A results would be helpful information to rule out a condition known as pyelonephritis (Dains et al., 2019).
ESR: 25 mm/hr. A hematologic test, known as an erythrocyte sedimentation rate, is very useful when trying to conclude if infection, inflammation, trauma, or even malignant disease is present (Patil, Muduthan, & Kunder, 2019). While the ESR can be initially elevated in the acute stages of an illness, it is a significant enough diagnostic test to perform when trying to rule out infection as the underlying cause of the condition (Patil et al., 2019).
PSA: 9.2. The elevated PSA level in this gentleman does warrant enough suspicion for the advanced practice nurse, as there is always a potential for prostate cancer with bony metastasis in the spinal region (Bakhsh et al., n.d.). The bony lesions that are found in metastatic prostate cancer are typically osteoblastic in nature (Bakhsh et al., n.d.).
MRI: awaiting the radiologist report. The condition of the soft tissue in the spinal region is best visualized with magnetic resonance imaging (Dains et al., 2019). There are medical conditions that need to be ruled out as a source of the back pain, such as disc herniations, tumors, and various diagnoses that originate from the spinal cord (Dains et al., 2019).
A.
1.) Sciatica: While it is vital that other medical conditions that originate from the spine are reviewed, sciatica is a presumptive diagnosis for this male patient that is experiencing low back pain. The long-standing nursing career of this male patient often involves a great deal of twisting, bending, and lifting that has become repetitive (Dains et al., 2019). The bowel and bladder functions are not usually compromised, but the patient will experience a significant amount of pain, burning, and even numb sensations in the buttock and leg of the affected side (Dains et al., 2019). The straight leg raises test (SLR) will usually reveal positive results, which was the case of this male patient (Dains et al., 2019).
2.) Primary or metastatic tumor: The advanced practice nurse must rule out the presence of a tumor type, first and foremost, before proceeding on to other differential diagnoses. While this patient may not have all the “classic” indicators of malignancy, it is vital that clinicians understand that no one patient will present with a malignant condition in the same exact fashion. The elevated PSA in this young 42-year-old male is enough indication to ensure that a malignant condition is not the underlying cause for his symptomology. The weight loss that the patient has reported is a symptom that does require further exploration.
3.) Disc Herniation: Although numbness and tingling are not as common with a disc herniation, patients with such a condition will usually complain of pain that radiates throughout the leg of the affected side (Dains et al., 2019). The patient with a herniated disc will quite frequently have positive straight leg tests, and an MRI is undoubtedly warranted if the patient has experienced back pain for at least one month (Dains et al., 2019).
4.) Infection: A condition known as osteomyelitis can often occur in the spine, especially if the patient has experienced recent infection in a neighboring anatomical region or if they have undergone a type of invasive procedure where various instrumentation was utilized (Dains et al., 2019). Sadly enough, infection ranks high in the medical community as one of the most overlooked conditions by well-intended clinicians (Mohamed, Finucane, & Selfe, 2019). The cause for many of these errors that pertain to spinal infections is because of the extended period between the time of initial onset to the time of full development of the condition (Mohamed et al., 2019). The consideration of infection is very prudent with this male patient, as his slight WBC elevation and ESR level do require further exploration.
5.) Spinal Stenosis: While this condition is typically diagnosed in those patients over 50 years of age, the advanced practice nurse must take into consideration the length of time that this male patient has endured long hours on his feet in his nursing career. Spinal stenosis of the lumbar region is a common location and is usually associated with degenerative changes of the three-joint complex (Abbas, Peled, Hershkovitz, & Hamoud, 2019). The presence of neurogenic claudication is an anticipated clinical symptom, with pain levels increasing upon long periods of standing (Abbas et al., 2019). The pain will normally radiate to one or both buttocks, legs, and feet (Abbas et al., 2019).
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Response 1 19490183
/in Uncategorized /by developerRespond to your colleagues post by suggesting additional opportunities or recommendations for overcoming the challenges described by your colleagues.
at least 2 references in each peer responses!
Much like in the nursing process, the step of evaluation is very important in implementing any change. Deciding how the policy will be evaluated should be done as the policy is being created (Laureate education). The Institute of Medicine wants nurses to be at the forefront of healthcare change. This also contributes to the fourth aim of the quadruple aim which is to fight healthcare worker fatigue (Milstead & Short, 2019). When nurses have a say in the changes, they will be more likely to help implement them.
Nursing input was asked for in evaluating the Affordable Care Act (ACA) (Milstead & Short, 2019). They were, “urged to engage in the evaluation process, advocate for cost transparency, campaign for patient education regarding enrollment in subsidized health insurance plans, and assist with the dissemination of accurate evaluation results” (Milstead & Short, 2019, pp. 121). With nurses being at the forefront of healthcare and the largest group of healthcare workers, their input is critical in evaluating how a new policy is working and they are also able to identify problems.
Nursing professional organizations, such as the American Nurses Association (ANA) and the American Association of Nurse Practitioners (AANP), among many others, were asked to provide formative data to lawmakers while the ACA was being evaluated (Milstead & Short, 2019). In addition to assisting with data collection, they were also asked to help disseminate evaluation data among peers, stakeholders, and patients (Milstead & Short, 2019). By being highly involved in a nursing organization, a nurse can have an excellent opportunity to review policies.
There are some challenges that exist in evaluating health policies. One factor is public opinion (Milstead & Short, 2019). This played a huge role in reviewing the ACA. Members of the public were constantly being manipulated by the press to think it was either bad or good and their opinions affected congress members’ decisions since they rely on votes to stay in office. A policy that might be overall beneficial to the public, could die by public opinion. To combat that, nurses need to make sure that they advocate for policies they believe in. This could make a difference since they are a trusted profession.
Another challenge is the rapid pace of policy changes (Milstead & Short, 2019). Some policies take time to truly see the effect they will have, but constituents and stakeholders want results overnight. This challenge might be met by establishing evaluation criteria from the start and asserting that time will be needed to fully know the impact.
Laureate Education (Producer). (2018). The Importance of Program Evaluation [Video file]. Baltimore, MD: Author.
Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Burlington, MA: Jones & Bartlett Learning.
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Response 1 6050
/in Uncategorized /by developerat least 2 references in each peer responses!
I noticed that there are many proposed policies on the agenda that are related to healthcare. Some of them are specific to the nursing practice. This creates the opportunity for the nurse to advocate for policies that impact nursing and healthcare directly by providing first-hand accounts and professional opinions supported by research. Nurses have insight on issues, such as patient safety and satisfaction, health disparities, access to care, and promoting positive outcomes (Abood, 2016).
The problem is that some nurses are unable to navigate through the politics of regulation and policy (Abood, 2016). This can create a challenge and become discouraging for nurses looking to make an impact or promote an agenda (Abood, 2016). Nurses can overcome this difficulty by participating in internships and workshops that provide the opportunity for a nurse to learn about the legislative process and the current issues being discussed (Abood, 2016). Understanding the political process is an essential method for effectively advocate for an issue. Nurses have to learn to play the game to promote change or obtain the scarcely rationed funding available.
According to Milstead and Short (2019), key opportunities to advocate for policy lies in knowledge and perception. Being knowledgeable on an issue can increase your influence as an advocate. Perception is a significant key in politics. Being perceived as a valuable collaborator or obtaining the support of a mentor that is respected can help push your agenda (Milstead & Short, 2019). Networking plays a significant role in politics. being introduced respected mentor or partner can help a nurse gain influence with rallying for support of a proposed agenda (Milstead & Short, 2019).
Probably the most significant opportunity for a nurse to advocate for a policy comes with becoming a member of a nursing association. Nurses associations like the American Nurses Association (ANA) are set up with the mission of influencing policy and advocating for the nurses and patients (ANA, 2019). The strength lies in numbers with the nursing association. Many of these organizations have built relationships with politicians and political parties to gain influence to support their agendas. For example, the ANA tends to favor and support democratic candidates (Milstead & Short, 2019). Nurses associations have enough members to get the attention of lawmakers. However, the nurse still has to task of advocating within the association to gain support from its members.
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Response 19197877
/in Uncategorized /by developerHello Irmia,
Yes, I think we can all agree that the genogram is a very useful tool. The literature is full of evidence that the genogram is a widely accepted and valuable tool in family assessment and treatment. Herth (1989) discusses that the genogram is most helpful with the elderly client. “The genogram is a tool that can be used by nurses to provide a comprehensive, holistic picture of the elderly client and his environment. A genogram can serve both as an assessment tool and as an intervention strategy” (p. 33).
Now let’s take this discussion one step further. You are the community health nurse, you have just completed a presentation to a group of people about genograms, the importance of them, how to create them. Everyone in the workshop has completed their genogram.
As the community health nurse what is the next step? How do you encourage the people to use this genogram to make better life style choices?
Dr. Diane Sokolowski
References
Herth, K, A. (1989). The root of it all genograms as a nursing assessment tool. Journal of Gerontological Nursing, 15(12), 32-37. Retrieved from https://search-proquest-com.cuw.ezproxy.switchinc.org/docview/1021723254?OpenUrlRefId=info:xri/sid:primo&accountid=10249
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Response 19241059
/in Uncategorized /by developerMilestones in Public Health
Class, there are many milestones in public health, but two that always come to my mind are vaccination and seat belts! The world’s first vaccine for smallpox was created by Edward Jenner in the late 1700s. Since then, vaccines have been developed for many other preventable diseases. According to Research America (n.d.), the CDC estimates that over the last 20 years, 700,000 children’s deaths have been prevented because of routine vaccination. That’s a large number!
Similarly, the number of motor vehicle deaths per year has largely decreased since the implementation of seat belts. I find this interesting! While developing a vaccine is complicated, as we see from the seatbelt example, an intervention does not need to be complicated to be successful. Hundreds of thousands of lives were saved by a simple invention to ensure people remained safe in their car!
What are some of your favorite public health milestones? Or milestones that you believe were important for public health?
References
Research America. (n.d.). Public Health Milestones. Retrieved from https://www.researchamerica.org/advocacy-action/public-health-thank-you-day/public-health-milestones
Please Use APA format, and include references below 5 years and 150 words
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Response 19297537
/in Uncategorized /by developerThe cross posts provide new or supplemental information to the original posting or raise additional areas for discussion. New or additional peer reviewed references should be cited in both cross posts.
Discussion cross posts should elaborate upon the ideas of others or content found in the readings/keynotes by adding details, examples, a different viewpoint, or other relevant information. The cross posts should provide original insights or responses which integrates multiple views. (Just saying ditto, I agree, or restating the original post is not considered elaboration.) There should be evaluation and feedback which assesses the accuracy, reasonableness, or quality of idea, and provides constructive feedback to classmates.
Be sure to use at least one reference. APA formatting, References should be timely, published within the previous 5 years.
Listed below is the discussion post you must respond to in 250-350 words max:
Background and Significance
Nursing informatics is a critical skill set that is incorporated in the nursing profession.
Information technology is being used to help the healthcare profession improve the standards of nursing. The improvements are allocated within the use of a software known as, “Cerner” that helps to ensure patient centered care is delivered. This also allows nurses to be more efficient and provide a detailed analysis of documentation. To be proficient it is vital to have this knowledge such as “ basic computer skills, information literacy and information management which are essential components of current nursing practice” (Foster, M., & Sethares,2017). Having an insight and competency in this expertise before starting a career as a new nurse is beneficial. Colleges are finding this to be essential and are incorporating it into the curriculum throughout nursing schools. In turn this will help to familiarize yourself with the software involved in patient documentations. However, there are still going to be challenges involved in informatics.
Benefits of EHR in the Healthcare Field
The electronic health record (EHR) has many benefits for patients and nurses. For patients, it allows them to have access to their own personal health record. This will allow patients to electronically view their health records and lab results. Additionally, this will help with future doctor appointments because the EHR will have all their patient history stored. For nurses “ the EHR allows for multiple members of the health care team to access, update, and share critical information to be used at the point of care without time delay” (Neumeier, 2016). This allows for flexibility for example, if a patient gets ill in another state while traveling they can still gain access to their information and show it to the physician.
Opportunities in Healthcare
There are various positions in informatics for healthcare professionals. For example, “ the career has many opportunities such as clinical transformation, leadership, entrepreneurship, consultant, researcher, and educator” (Harmon, C. S., & Parker, C. D, 2017). I like all the different variations available because if you do not like a certain area then you may try another. One certainty is job employment because technology is continuously growing and expanding. Most hospitals if not all have switched to electronic based records.
Challenges Faced
As in most careers there will be challenges to face. I personally think that one issue is that technology is always changing and advancing. With that said in informatics you will need to keep up to date with the software and training required. Another aspect is “nurses have many options to consider when contemplating formal education in informatics . Therefore, a nurse’s decision in selecting a formal education program can be challenging. ” However, having options to choose from can be a good situation to be in.
^PLEASE REMEMBER THIS IS AN RESPONSE TO THE DISCUSSION ABOVE^
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Response 19339897
/in Uncategorized /by developerFor your response posts, respond to two peers who analyzed a different way of knowing and comment on their analysis.
Peers document is attached below
My response is (1-1 Discussion) attached below
Respond to both peers individually.
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Response 19373463
/in Uncategorized /by developerIn response to two of your peers, identify the strengths and weaknesses of the discussed research design related to evidence-based practice.
Please respond individually to peers response attached below.
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Response 19398329
/in Uncategorized /by developer1 postsRe: Topic 5 DQ 1
Disaster usually involves causing great damage that often results in extensive loss of property and loss of life. These catastrophic events can be man-made or natural disaster. Nurses are always at the fore front and playing crucial role in responding to disasters. For nursing care to be holistic, the need for spiritual care is very important to be accomplished, particularly in the event of disaster. However, nurses are using not well equipped to be involved in spiritual work. This is due to the lack of training in the nursing curriculum and this has resulted in the lack of competent in implementing this very important part of care in promoting health and wellbeing. According to (Zehtab, & Adib-Hajbaghery, 2003), not proving spiritual support to patient is neglecting the opportunity to improve patient’s care.
Spiritual aspect of care is now more central throughout healthcare. A person’s health is looked at physical, mental social and spiritual wellbeing (Who Health Organization, 2007). Spiritual care has a positive effect on the wellbeing of the individual’s stress responses, and it is important for patients during illness and hospitalization (Cavendish et al., 2003).
Nurses serve as an essential resource and can play a wide range of responsibilities related disaster preparedness and response. One of the key roles is providing education to individuals, community, self and colleagues about how to keep self during a disaster. This knowledge shared will help in alleviating anxiety and fear. Nurses have also volunteer during disaster through various organizations such as American Red Cross, the Federal Emergency Management Agency and the United State Public Health Service (the Role of the Nurses in Providing Spiritual Care to Patients, n.d). They can be directly involved in assisting in disasters such as first aid and medication, assessing the state of victims and monitoring the mental health of victims. Nurses have family and themselves, preparing the family with emergency plan and emergency supplies can help ensure the nurse and family are safe in time of disaster.
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Response 19398335
/in Uncategorized /by developer3 postsRe: Topic 5 DQ 1
Whether natural or manmade, disasters take a toll on the communities they hit and those who are caring for them, physically, psychologically, and spiritually. However, natural and manmade disasters may have different impacts psychologically and spiritually. In the context of a natural disaster there are stresses from injury/loss of life, the potential damaging of a community, and a feeling of disbelief or stress related to coping with a loss. Depending on the cause of the manmade disaster, there could be slightly different stresses including loss of trust in people or anger if the disaster was intentional. Regardless they both have an impact on the individuals, community, and health care providers effected.
In order for health care providers to be able to care for people and communities affected by disaster, they must first ensure they care for themselves spiritually in order for them to focus on the needs of others. Once this is taken care of community health nurses can assist individuals in many ways including building rapport and relationship with them and having therapeutic conversations, they can also utilize the resources in the community such as chaplains and social work. Chaplains are trained and able to provide counseling and comfort to those impacted by the shock and grief of a disaster (Falkner, 2018). Another way in which community health nurses could assist would be with preparation of the community prior to the disaster occurring. By assessing and knowing the community’s spiritual needs and resources pre-disaster they will know who to turn to after an event even quicker. In working with colleagues during disaster response the community health nurse can monitor their mental and spiritual health and reach out if they see them slipping at all.
Resources
Falkner, A. (2018). Disaster management. In Grand Canyon University (Ed.), Community & public health: The future of health care. Retrieved from https://lc.gcumedia.com/nrs427vn/community-and-public-health-the-future-of-health-care/v1.1/#/chapter/5
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