Poster Presentation 19403757
All the instructions are on the Word document attached. There is an example and a template
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Post Walter Dq
I decided to return to school for my BSN at this time due to the increased need for further education. As the hospitals and the medical field advances so should our education. I have always wanted to teach and after many years of floor nursing this is a good time for me. I watch the new nurses coming in and often help them getting started in their careers. It is exciting seeing them starting out and remembering how I felt. Maybe I can help in some way make ths transition for others easier. And it would be a great learning experience for me.
I love learning and school. Classroom is my perferred way of learning but at this time that will not work. I work full time nights and am helping raise two of my grandchildren. My life is full, but I still have plenty of time to do what is needed to be a sucess in this career choice. I have my own office and all the things needed to complete my assignments and research. Sleep is my biggest problem, what with working nights. So I need to plan my time off well. I try to make my schedule to allow me several days off at a time. This allows for my rest and getting things done.
I am looking forward to this exciting advancement in my career and learning experience. I will need to use all of my resources and available help to make it but I think it will be a lot of fun. My famiy is very excited and more then willing to help me.
Regina DQ
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Post Traumatic Stress Disorder
Following the
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Post Tiffany Ni
Respond to the post bellow offering additional/alternative ideas regarding opportunities and risks related to the observations shared.
Main Post
iPhone technology, secure texting, and telehealth
The hospital that I currently work for piloted the use of iPhones in addition to our work station on wheels (WoW). We can use this iPhone technology for charting simple nursing interventions, receive STAT orders and discharge orders, and communicate with our colleagues through texting. Our WoWs enable us to do “secure texting” to a physician, some physicians prefer the secure texting technology some don’t, but surely there are times that the answering service may fail to page them in a timely manner and the secure texting technology becomes very useful. As nurses, we can see through our WoWs as soon as the physician reads the text message, that way we know they are aware. This technology saves us some precious time we spend on the phone waiting on hold just to page a physician for orders, condition and/or results. Our hospital also offers telehealth services especially for those who are likely to be readmitted due to chronic diseases. We mostly see a telehealth order for a patient with cardiac issues.
Risks and benefits
The biggest threat that I believe healthcare technology is at risk for is privacy. According to Chaet, Clearfield, Sabin and Skimming (2017), privacy and confidentiality are just “as important in the context of telehealth and telemedicine as in hospital and office settings” (p. 1138). I surmise, organizations providing this type of technology in healthcare have an incredible security system in place. The secure texting technology, we are instructed not to use full names, instead, we use room numbers of the patients.
The biggest benefit of the use of telehealth and mobile devices for healthcare is accessibility. Use of the iPhone technology in our hospital is quick and easy to navigate, we can get in touch with virtually anybody logged in for that shift in the whole hospital. From a distance, telehealth helps those patients who are unable to manage their chronic illnesses very well.
Trends in healthcare technology
The most promising healthcare technology to me is virtual visits, mobile health, telehealth, and telemedicine technology. One can get in touch with a healthcare provider as long as one has a smartphone and internet access. It could provide access to so many more patients in need of healthcare that resides in rural areas or have no means to transport themselves to the physician’s office. It could save time and money for patients as we all know healthcare can get expensive very easily and very fast. According to Abuhaimidd, Meetoo and Rylance (2018), technology in healthcare with the use of mobile devices can “truly offer the potential to promote healthcare management and health behaviour change outside formal clinical settings” (p. 1176). This does not take away the significance of having a physical visit with a physician, those visits are intended for more complicated health issues, but I believe this technology has potential to truly help those with chronic illnesses to be able to manage their health on their own, make them accountable for their own wellbeing, patients can share data, interact with clinicians over a mobile device instead of having to go to the doctor’s office.
Telehealth rules
According to Mastrian and McGonigle (2017), nurses who participate in telehealth must be “licensed to practice in all of the states in which they provide telehealth services by directly interacting with patients” (p. 381). This can be challenging as states have different rules and regulations regarding licensure, continuing education requirements are different as well as fees and renewal process.
References
Abuhaimid, H. A., Meetoo, D., & Rylance, R. (2018). Health care in a technological world. British Journal of Nursing, 27(20). 1172-1177.
Barreto, E. A., Cohen, A. B., Donelan, K., Estrada, J. J., Michael, C., Schwamm, L. H., … Wozniak, J. (2019). Patient and clinician experiences with telehealth for patient follow-up care. American Journal of Managed Care, 25(1), 40-44.
Chaet, D., Clearfield, R., Sabin, J. E., & Skimming, K. (2017). Ethical practice in telehealth and telemedicine. Journal of General Internal Medicine, 32(10), 1136-1140.
Mastrian, K. G., & McGonigle, D. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.
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Post Tami Pharmacology
Respond to at least two of your colleagues on two different days by suggesting additional patient factors that might have interfered with the pharmacokinetic and pharmacodynamic processes of the patients they described.
In addition, suggest how the personalized plan of care might change if the age of the patient were different and/or if the patient had a comorbid condition, such as renal failure, heart failure, or liver failure.
Main Post
Clinical Scenario
The patient is a tall, lanky 67-year-old male with end-stage renal failure and cirrhosis of the liver. He presents to the Emergency Department (ED) with an inguinal hernia that he cannot reduce. He rates his pain 10/10 on a scale of 1-10, with 0 being no pain and 10 being extreme pain. The patient appears uncomfortable, complains of dizziness, and constipation. Social history consists of smoking a pack a day or cigarettes for 25 years, moderate alcohol consumption, daily marijuana use, poor diet, and decreased mood. His medications are centered around pain control and include the use of narcotics every 4 hours. The patient is given a dose of Toradol 30mg, intravenously (IV). After ten minutes, the patient is asking for more pain medication. Fentanyl 50 mcg, IV is given with no pain relief reported by the patient. Finally, Hydromorphone 1mg, IV is administered. After an hour, the patient still reports pain 10/10.
Pharmacokinetics and Pharmacodynamics
Pharmacokinetics studies the absorption, distribution, metabolism, and excretion of drugs within the body system (Ball, Dains, Flynn, Solomon, & Stewart, 2019). The use of pharmacokinetics enables providers to determine the appropriate drug for a patient’s diagnosis. Pharmacodynamics refers to how the body is affected by the use of certain medications (Fox, Hawney, & Kaye, 2011). Due to the individualized nature of the human body, finding a drug that responds with minimal side effects are desired.Pharmacokinetics, as it relates to this patient’s pathophysiology, creates difficulty for the patient due to the diagnosis of kidney failure and cirrhosis. Cirrhosis of the liver prevents the body from absorbing, distributing, and metabolizing the drug. With significant disease process in effect, it is difficult for the body to absorb the drug at a rate that provides effective pain control. The first-pass metabolism with hydromorphone is decreased in liver cirrhosis and has a likelihood of high hepatic extraction (Wehrer, 2015). Whereas, fentanyl, is a protein-bound medication is reportedly unaffected by cirrhosis (Wehrer, 2015). Though the patient tolerated the fentanyl in our case, no specific relief is found due to the chronic nature of the pain. Decreased kidney function reduces the excretion of drugs from the body creating an accumulation of medication in the entire body (Ball et al., 2019). Frequent use of medications creates a tolerance to that medication and accelerates metabolism of the drug. Tolerance and increased metabolism results in ineffective pain management outcomes (Ball et al., 2019). The use of opioids for pain management, in this case, may create an antagonist effect causing unwanted consequences such as constipation, the potential for abuse, and withdrawal (Walter, Knothe, & Lotsch, 2016). Due to the patient’s continued alcohol consumption and disease processes, the use of acetaminophen or ibuprofen is not encouraged (Wehrer, 2015).
Contributing Factors
For the patient above, behavioral and pathophysiological changes are contributing factors for the choice of medications given. Alcohol use is the highest contributing factor to cirrhosis (Askgaard, Gronbaek, Kjaer, Tjonneland, & Tolstrup, 2015). This behavior, as well as smoking, will need to be eliminated to be on the transplant list. The pathophysiological changes created altered renal excretion and inability of the liver to metabolize medications given for pain control.
Personalized Plan of Care
The plan of care for this patient is to control the pain from the inguinal hernia until it can either be repaired or reduced. The ability to control pain at a level of 5/10 is the first goal. A discussion with the patient is necessary to establish realistic goals in light of the chronic conditions. Focusing on the pain from the hernia is our primary focus. Initiation of other medications for pain such as Ketamine, Benadryl, or Reglan can decrease pain by 50 percent. Lastly, non-medication alternatives such as positioning, distraction, and ice-therapy can provide temporary relief.
References
Askgaard, G., Gronbaek, M., Kjaer, M. S., Tjonneland, A., & Tolstrup, J. S. (2015). Alcohol drinking pattern and risk of alcoholic liver cirrhosis: a prospective cohort study. Journal of Hepatology, 62(5), 1061-1067. http://dx.doi.org/10.1016/j.jhep.2014.12.005Ball, 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.Fox, C. J., Hawney, H. A., & Kaye, A. D. (2011). Opioids: Pharmacokinetics and Pharmacodynamics. New York, NY: Springer.Walter, C., Knothe, C., & Lotsch, J. (2016). Abuse-deterrant opioid formulations:Pharmacokinetic and pharmacodynamic considerations. Clinical Pharmacokinetics, 55(7), 751-767. http://dx.doi.org/10.1007/s40262-015-0362-3Wehrer, M. (2015, December 14). Pain management considerations in cirrhosis. U.S. Pharmacist, 40(12), HS5-HS11. Retrieved from https://www.uspharmacist.com/article/pain-management-considerations-in-cirrhosis
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Post Tami 19446005
Respond to two colleagues in one of the following ways:
If your colleagues’ posts influenced your understanding of these concepts, be sure to share how and why. Include additional insights you gained.
If you think your colleagues might have misunderstood these concepts, offer your alternative perspective and be sure to provide an explanation for them. Include resources to support your perspective.
Main Post
Agonist-to-Antagonist Spectrum
The agonist-to-antagonist spectrum of action refers to the action that is taken by a neurotransmitter to produces a conformational change (Stahl, 2013). The spectrum starts with the agonist action, which, with the help of a second-messenger, can turn on the full potential of change (Stahl, 2013). Full agonists can be natural transmitters used to produce change. An antagonist blocks the conformational change of the potential of the transmitter for binding with the intended agonist (Stahl, 2013). The role of the antagonist is to keep the receptors in a baseline state in order to reverse what the agonist has done (Stahl, 2013). This is the opposite end of the spectrum and seeks to block agonists. In the middle, some partial agonists mimic its agonist partner to a lesser degree, and inverse agonists stop all activity from occurring on the receptor (Stahl, 2013). The conformational change is needed for a receptor to open to the action of drugs, particularly, psychopharmaceutical medications in this case.
G couple proteins and Ion gated channels
G couple proteins are used at the binding site of a neurotransmitter to act as a conduit for enzymes (Stahl, 2013). Whereas, ion gated channels exist as targets to regulate chemical neurotransmitters (Stahl, 2013). Ion gated channels consist of channels and receptors that can only be opened by the neurotransmitters. Conversely, G couple proteins attach to neurotransmitters and conform to enzymes to serve as a channel for a second messenger (Stahl, 2013). Most psychotropic medications aim for the ion gated channels, which open through chemical neurotransmission and initiate the signal transduction cascade (Stahl, 2013). The cascade results in faster uptake of psychotropic medications into the system.
The Role of Epigenetics
According to DeSocio (2016), epigenetics is the study of how genomes that undergo changes with certain molecular compounds and environmental changes can leave the essential DNA unchanged. It is a modification of gene expression that is independent of the DNA (DeSocio, 2016). DNA is the code that determines much of who we are. Changes in that code can be seen as a result of heredity, the environment, or neurotransmission (Stahl, 2013). These alterations affect individuals at a physical, emotional, and psychological level. Stress and adversity play a significant role in epigenetics by changing the genomes, which in turn leads to changes in a person’s DNA (Park et al., 2019). These alterations influence psychological issues related to many individuals. It is essential to know how to combat these changes when determining a plan of care for clients.
Implications of Findings to Prescribing
As nurse practitioners, it is essential to have an extensive understanding of how the above processes affect the way we prescribe medications to clients. It is also essential to take into consideration how the environment impacts maintaining optimal health and healing (DeSocio, 2016). Knowing the mechanisms of action for medications that we are prescribing is vital to providing competent care. For example, a patient with a generalized anxiety disorder (GAD) is prescribed Venlafaxine. The PMHNP needs to understand that the Venlafaxine works by boosting the serotonin, norepinephrine, and dopamine neurotransmitters (Stahl, 2014). This action blocks serotonin reuptake, norepinephrine reuptake, and the dopamine reuptake (Stahl, 2014). Each of these actions then increases these neurotransmissions in the brain providing therapeutic results.
References
DeSocio, J.E. (2016). Epigenetics: An emerging framework for advanced practice psychiatric nursing. Perspectives in Psychiatric Care, 52(3), 201-207. https://doi.org/10.1111/ppc.12118
Park, C., Rosenblat, J.D., Brietzke, E., Pan, Z., Lee, Y., Cao, B., Zuckerman, H., Kalantarova, A., McIntyre, R.S. (2019). Stress, epigenetics, and depression: A systematic review. Neuroscience and Biobehavioral Reviews, 102, 139-152. https://doi.org/10.1016/j.neubiorev.2019.04.010
Stahl, S.M. (2014). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.
Stahl, S.M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications. (4th ed.). New York, NY: Cambridge University Press.
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Power Point 18914353
The class will be placed by the instructor into groups. Each team member will personally interview one leader of his/her choice. Examples of leaders can include, but are not limited to, former or current managers or supervisors, educational leaders, civic/business leaders, and religious leaders. This interview can take place via phone, via e-mail, or in person.
To ensure that the interviews yield comparable results, the team must prepare a list of questions to ask the chosen leaders (interviewees). As a team, choose four questions from the list below:
- What are the most important qualities an effective leader should have?
- What is the importance of trust in leadership?
- What are the qualities you want most in an employee? Why?
- Who has had the most influence on how you lead? Why?
- In what areas would you like to improve your leadership?
- How do your employees react to your leadership?
- Have you engaged in 360-degree feedback? If so, what has been the result?
- What is the role of effective communication in leadership?
- How would you rate yourself at being able to communicate with all your important stakeholders?
In addition to the four interview questions your team will use from the above list, as a group, generate two more questions, for a total of six interview questions. Please note: Each team member is required to ask his/her chosen leaders the same interview questions so you must decide as a team which questions you will ask.
After conducting the interview, each team member will individually create a leadership profile of his/her chosen leader within a PowerPoint presentation (5-6 slides). Be sure to include the following in your individual leadership profile:
- A slide that introduces your chosen leader
- A summary of the answers to the interview questions
- A description of the leadership model with which the leader seems most closely aligned
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Power Point 18892519
Nursing Theory Presentation
Stress and Coping Process Theory
1. Describe the background of the theorist, description of the theory, assumptions of the theory, the application of the theory to nursing practice, and the compatibility of the theory to your personal philosophy of nursing.
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Power Point 10
Each student will select a topic that they feel presents an ethical dilemma. Certain topics may be of a sensitive nature and somewhat subjective; therefore, if you have any questions or are struggling to identify a topic, reach out to your instructor for guidance. Each student will create/submit a PowerPoint Presentation that addressed each element identified in the assignment guidelines.
Here is a list of some topics that have been used in the past for this assignment. You can also identify your own topic.
Topic Ideas
· Same-sex parenting/adoption/surrogates
· Organ donation and transplant issues
· Stem cell transplants and cord blood banking
· Sperm and/or Egg preservation in teens (usually those diagnosed with cancer)
· Circumcision and/or female genital alterations
· Parental refusal of medical treatments due to religious or cultural beliefs (e.g. blood transfusions, medications)
· Child refusing treatment (e.g. wants to stop chemotherapy for cancer)
· Gender-neutral parenting
· Munchausen Syndrome
· End-of-Life Care/Decision-Making
· Neglect and Abuse (physical abuse, sexual abuse, starving, over demanding, drug-addicted at birth)
· Health Insurance Issues (e.g. lack of coverage, coverage denials, access to care)
· Foster care for medically needy children
· Teen seeking birth control, pregnancy care, or abortion (without parental guidance)
· Separated or divorced parents fighting during hospitalization
· Parents with HIV/AIDS having children
· Social isolation due to homeschooling or other alternate schooling options
· Behavioral health patients boarding on Pediatric Medical-Surgical units
Assignment Guidelines
· Dilemma description (25 points)- Identify the chosen ethical dilemma and identify the key elements (who, what, when, how, why)
· Identify the resources at the clinical agency or in the community to assist dealing with the chosen ethical dilemmas (10 points)- Identify resources available for your chosen dilemma. Identify resources available through your clinical facility and in the community (including organizations for your specific topic).
· Writing Style, APA format, Grammar/Spelling/Mechanics (5points)- All references used should be scholarly/reputable and must be cited using current edition APA format. If you need assistance with APA formatting, refer to https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/general_format.html
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Poverty In Miami
All the concerned stakeholders should initiate proactive measures to ensure that the income disparities and poverty levels in Miami subside. Erwin (2008) contends that such measures should focus on empowerment, education and creating opportunities.
Nice work here! In regard to your statement here, we are stakeholders as this is your community, so what as nurses could you do to assist in addressing the issues you mention?
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