Queen Essays

1 Assignment: Assessing and Treating Pediatric Patients with Mood Disorders

Assignment: Assessing and Treating Pediatric Patients with Mood Disorders

Name:

Walden U

NURS 6630: Psychopharmalogical Approaches to Treat Psychopathology

Instructor:

December 28, 2021

2 Assignment: Assessing and Treating Pediatric Patients with Mood Disorders

Assignment: Assessing and Treating Pediatric Patients with Mood Disorders

In the given scenario, the client is an 8-year-old African American male who

arrives at the ER with his mother. He is exhibiting signs of depression. The patient complained of

feeling "sad", the mother reports that the teacher said the child is withdrawn from peers in class,

decreased appetite, and occasional irritation periods. The client reached all developmental

landmarks at appropriate ages. Laboratory studies are within the normal range. The child was

referred to psychiatry for evaluation.

The patient is alert, oriented x 3, clear, coherent, goal-directed, spontaneous. The self-

reported mood was "sad." Affect was somewhat blunted but smiled appropriately at various

points throughout the clinical interview. He denies visual and auditory hallucinations. No

delusional or paranoid thought processes were noted. Judgment and insight appear to be age-

appropriate. He is not endorsing active suicidal ideation but does admit that he often thinks about

himself being dead and what it would be like to be dead.

Which decision did you select?

The first selected treatment option is Zoloft 25 mg orally daily for depression.

Why did you select this decision? Be specific and support your response with clinically

relevant and patient-specific resources, including the primary literature

Major depressive disorder occurs in adults and children and adolescents (Gershon et al.,

1987). According to researchers, it is appropriate for clinicians to prescribe an SSRI for children

and adolescents experiencing persistent moderate to severe depression or anxiety symptoms with

clear evidence of functional impairment in addition to supportive treatment or a course of

psychotherapy (Garland et al., 2016). In the given scenario, the patient is exhibiting functional

Health Promotion Plan Scoring Guide

CRITERIA NON- PERFORMANCE BASIC PROFICIENT DISTINGUISHED

Analyze a community health concern or need that is the focus of a health promotion plan.

Does not identify a community health concern or need that is the focus of a health promotion plan.

Identifies a community health concern or need that is the focus of a health promotion plan.

Analyzes a community health concern or need that is the focus of a health promotion plan.

Provides an in-depth analysis of a community health concern or need that is the focus of the health promotion plan, and articulates underlying assumptions and points of uncertainty in the analysis.

Explain why a health concern or need is important for health promotion within a specific population.

Does not describe a health concern or need that is important for health promotion within a specific population.

Describes a health concern or need that is important for health promotion within a specific population.

Explains why a health concern or need is important for health promotion within a specific population. Conclusions are not supported by relevant or current health data.

Explains why a health concern or need is important for health promotion within a specific population. Conclusions are well supported by current and relevant population health and demographic data and based on a perceptive analysis of the factors that contribute to health, health disparities, and access to services.

Establish agreed- upon health goals in collaboration with hypothetical participants.

Does not establish agreed-upon health goals in collaboration with hypothetical participants.

Establishes health goals without hypothetical participant collaboration.

Establishes agreed- upon health goals in collaboration with hypothetical participants.

Establishes agreed- upon health goals in collaboration with hypothetical participants. Goals are realistic, measurable, and attainable.

Organize content so ideas flow logically with smooth transitions; contains few errors in grammar/punctuation, word choice, and spelling.

Does not organize content for ideas. Lacks logical flow and smooth transitions.

Organizes content with some logical flow and smooth transitions. Contains errors in grammar/punctuation, word choice, and spelling.

Organizes content so ideas flow logically with smooth transitions; contains few errors in grammar/punctuation, word choice, and spelling.

Organizes content with a clear purpose. Content flows logically with smooth transitions using coherent paragraphs, correct grammar/punctuation, word choice, and free of spelling errors.

Apply APA formatting to in-text citations

Does not apply APA

Applies APA formatting to in-text

Applies APA formatting to in-text

Exhibits strict and flawless adherence to

5/20/23, 4:07 PM Page 1 of 2

and references exhibiting nearly flawless adherence to APA format.

formatting to headings, in- text citations, and references. Does not use quotes or paraphrase correctly.

citations, headings and references incorrectly and/or inconsistently, detracting noticeably from the content. Inconsistently uses headings, quotes, and/or paraphrasing.

citations and references exhibiting nearly flawless adherence to APA format.

APA formatting of headings, in-text citations, and references. Quotes and paraphrases correctly.

5/20/23, 4:07 PM Page 2 of 2

© 2016. Grand Canyon University. All Rights Reserved.

Translational Research Graphic Organizer Template

<Type

Translational

Research Type

Here>

<Type Traditional

(Qualitative or

Quantitative)

Research Type

Here>

Observations

(Similarities/Differences)

Methodology

Goals

Data Collection

© 2016. Grand Canyon University. All Rights Reserved.

Translational Research Graphic Organizer Template

<Type

Translational

Research Type

Here>

<Type Traditional

(Qualitative or

Quantitative)

Research Type

Here>

Observations

(Similarities/Differences)

Methodology

Goals

Data Collection

Evidence-Based Practice in Nursing

Examine the importance of incorporating current research evidence into clinical decision-making

and discuss the steps involved in implementing evidence-based practice in nursing care.

Evidence-based practice (EBP) in nursing is a systematic approach that integrates the best

available research evidence, clinical expertise, and patient preferences to guide clinical decision-

making and improve patient outcomes. It involves critically appraising and applying research

findings to inform nursing practice, ensuring that interventions and care are based on the most up-

to-date and reliable evidence. Here is a detailed explanation of evidence-based practice in nursing:

1. Importance of Evidence-Based Practice:

• Enhancing Patient Outcomes: By incorporating current research evidence into

clinical decision-making, nurses can provide care that is more effective, safe, and

aligned with best practices, leading to improved patient outcomes.

• Ensuring Quality and Safety: Evidence-based practice promotes the use of

interventions and procedures that have been shown to be safe and effective through

rigorous research. This reduces the risk of harm to patients and enhances the overall

quality and safety of nursing care.

• Advancing Professional Development: Engaging in evidence-based practice

encourages nurses to stay updated with the latest research findings, enhancing their

knowledge and professional growth. It also fosters a culture of lifelong learning

within the nursing profession.

2. Steps in Implementing Evidence-Based Practice:

• Formulating a Clinical Question: The first step in evidence-based practice is

formulating a clear and focused clinical question based on the patient's problem or

the nursing intervention under consideration. The question should be structured

using the PICO framework (Population, Intervention, Comparison, Outcome) to

guide the search for relevant evidence.

• Conducting a Literature Search: Once the clinical question is identified, nurses

conduct a systematic search of the literature using databases and other reliable

sources to find relevant research evidence. This includes peer-reviewed journals,

systematic reviews, meta-analyses, and clinical practice guidelines.

• Appraising the Evidence: After identifying relevant research articles, nurses

critically appraise the evidence to evaluate its validity, relevance, and applicability

to the clinical question. This involves assessing the study design, sample size,

methodology, and statistical analysis to determine the quality and strength of the

evidence.

• Synthesizing the Evidence: Nurses analyze and synthesize the findings from

multiple research studies to develop a comprehensive understanding of the

evidence. This includes comparing and contrasting the results, identifying patterns

or consistencies, and determining the overall strength of the evidence.

• Integrating the Evidence: Based on the synthesis of the evidence, nurses integrate

the findings into their clinical decision-making process. They consider the patient's

unique circumstances, preferences, and values, along with their own clinical

expertise, to develop an individualized care plan.

• Evaluating Outcomes: Nurses implement the evidence-based intervention and

closely monitor the patient's response. They collect data on outcomes, evaluate the

effectiveness of the intervention, and make adjustments as necessary. This step

contributes to the ongoing cycle of evidence-based practice, as outcomes are

assessed and used to inform future practice decisions.

3. Barriers and Facilitators of Evidence-Based Practice:

• Barriers: Some common barriers to implementing evidence-based practice in

nursing include time constraints, lack of access to research literature, limited skills

in critically appraising research, resistance to change, and organizational culture

that does not prioritize evidence-based practice.

• Facilitators: Organizations can support evidence-based practice by providing

resources, promoting a culture of inquiry, and offering training and mentorship to

nurses. Collaboration between nurses, researchers, and educators can also facilitate

the integration of research evidence into practice.

4. Ethical Considerations: Nurses must consider ethical principles when implementing

evidence-based practice. This includes obtaining informed consent from patients, ensuring

patient confidentiality, respecting patient autonomy, and considering the potential risks and

benefits of interventions based on the available evidence.

Evidence-based practice is a continuous process that requires ongoing learning, critical thinking,

and integration of research findings into nursing practice. By incorporating

Nursing Care Plan for Pain with Diagnosis and Nursing

Intervention

Nursing Care Plan for Pain with Diagnosis and Nursing Intervention

Pain classifications Acute pain:

Mild to severe pain lasting less than six months; associated with a sympathetic nervous system

response; resulting in increased pulse rate and volume, increased respiratory rate and depth,

increased blood pressure, and increased glucose levels; decreased urine production and

peristalsis.

The protective function of acute pain is to alert the patient of injury or infection. The onset of

sudden severe pain prompts the patient to seek solace. The physiological manifestations of acute

pain result from the body's tension response to the pain. Acute pain may be exacerbated by the

patient's cultural context, emotions, and psychological or spiritual distress. The assessment of

pain can be challenging, particularly in elderly patients with cognitive impairment and sensory

perception deficits.

Chronic ache:

Mild to severe pain lasting longer than six months; associated with the parasympathetic nervous

system; the patient may not exhibit acute pain-related signs and symptoms. may result in

despondency and diminished function

Terms for suffering

Pain threshold is the minimum quantity of stimulus required to produce a painful sensation.

The maximum quantity of pain that a patient is willing or able to tolerate.

Pain felt in a location other than the origin of a tissue injury

Pain that cannot be relieved by conventional treatments is untreatable.

Neuropathic pain: agony caused by a neurological disorder and unrelated to tissue damage

Phantom pain: pain felt in an absent body part Radiating pain: pain felt at the source that spreads

to other locations.

Nursing Intervention

Plan of nursing care for pain that includes intervention and pain

Affiliated with suffering

medical concerns

Diagnostic techniques and medical care

emotionally and mentally traumatic

Aspirational Cultural distress.

Desired Results

On a scale from 0 to 10, the patient reports adequate

pain control with a score of less than 3 to 4.

The patient is capable of utilizing both

pharmacologic and nonpharmacologic pain relief

strategies.

Patient feels more at ease, as demonstrated by a

regulated pulse, blood pressure, respiration, and calm

muscle tension and posture.

May be exemplified by.

Protective behavior, body protection, egocentric,

narrowed focus

Relief or diversion methods

Pain masking the face

Consideration of muscular tone

Nursing care plan for pain with intervention and rationale

Nursing intervention Rationale

Assessment of pain characteristics. ex.

Quality, severity, location, onset, duration,

precipitating and relieving factors

Assessment of the pain experience is the first step in

planning pain management strategies. The patient is

the most reliable source of information about his or

her pain.

Screening for signs and symptoms related

to pain.

Some people deny the sensation of pain even though

it is present. Paying attention to signs associated

with pain can help the nurse assess pain.

A patient with acute pain may have elevated blood

pressure, heart rate, temperature, be agitated, and

have difficulty concentrating.

For scientific findings and symptoms

associated with chronic pain, such as

fatigue, decreased appetite, weight loss,

change in posture, disruption of sleep

patterns, anxiety, agitation, or depression.

Patients with chronic pain may not exhibit the

physical changes and behaviors associated with

acute pain. Pulse and blood pressure are usually

within the normal range.

Evaluate the patient’s response to pain and

pain management strategies.

It is important to assist the patient in presenting the

effect of pain-relieving measures as factually as

possible. Discrepancies between the patient’s

behavior or demeanor and what he or she says about

pain relief.

Assess patient’s expectations for pain

relief.

Some patients are satisfied with pain relief, while

others expect complete elimination of pain, which

affects their perception of the effectiveness of the

treatment method and their willingness to participate

in further treatment.

Anticipate the need for pain relief.

The most effective way to address pain is to prevent

it. Early intervention can reduce the total amount of

analgesics needed.

Eliminate additional stressors or

discomfort whenever possible.

Patients may experience exaggeration of pain or

diminished ability to tolerate painful stimuli if they

experience additional stress from environmental,

intrapersonal, or intrapsychic factors.

Provide rest periods to promote comfort,

sleep, and relaxation.

The patient’s perception of pain may be exaggerated

by fatigue. In a cycle, pain can lead to fatigue, which

in turn can lead to exaggerated pain and fatigue. A

quiet environment, a darkened room, and a phone

turned off are measures that facilitate recovery.

Determine the appropriate method for pain

relief.

Unless contraindicated, all patients with acute pain

should receive a nonopioid analgesic around the

clock.

Hot or cold compress

Heat reduces pain by improving blood flow to the

area and reducing pain reflexes. Cold reduces pain,

inflammation, and spastic massage by decreasing the

release of pain-inducing chemicals and slowing the

transmission of pain impulses.

Massage of the painful area

Increases endorphin levels and decreases tissue

edema. This intervention may require another person

to perform the massage.

Administer analgesics as ordered by a

physician, evaluate their effectiveness,

and observe signs and symptoms of side

effects.

Analgesics are absorbed and metabolized differently

by patients, so their effectiveness must be assessed

by the patient individually. Analgesics usually have

side effects that range from mild to life-threatening.

Notify the physician if interventions are

unsuccessful or if current symptoms

represent a marked change from the

patient’s previous pain experience.

Patients who request pain medications at shorter

intervals than prescribed may actually require a

higher dose or stronger analgesics.

Anticipatory education about the causes of

pain and appropriate measures for

prevention and relief.

Knowing what to expect can help patients develop

effective coping strategies for pain management.

Patients need to learn the importance of reporting

pain early to achieve more effective pain relief.

The patient should learn how to

effectively discontinue the medication

Patients must learn to use pain relief strategies to

minimize the pain experience.

dose in relation to potentially unpleasant

activities and avoidance of pain spikes.

Assist the patient and family in identifying

lifestyle changes that can contribute to

effective pain management. Guide the

patient to plan activities during the times

when pain is at its greatest relief.

Changes in work routine, household responsibilities,

and home environment may be necessary to promote

more effective pain management. Ongoing support

and guidance for the patient and family will increase

the success of these strategies.

Evidence-Based Practice in Nursing

Examine the importance of incorporating current research evidence into clinical decision-making

and discuss the steps involved in implementing evidence-based practice in nursing care.

Evidence-based practice (EBP) in nursing is a systematic approach that integrates the best

available research evidence, clinical expertise, and patient preferences to guide clinical decision-

making and improve patient outcomes. It involves critically appraising and applying research

findings to inform nursing practice, ensuring that interventions and care are based on the most up-

to-date and reliable evidence. Here is a detailed explanation of evidence-based practice in nursing:

1. Importance of Evidence-Based Practice:

• Enhancing Patient Outcomes: By incorporating current research evidence into

clinical decision-making, nurses can provide care that is more effective, safe, and

aligned with best practices, leading to improved patient outcomes.

• Ensuring Quality and Safety: Evidence-based practice promotes the use of

interventions and procedures that have been shown to be safe and effective through

rigorous research. This reduces the risk of harm to patients and enhances the overall

quality and safety of nursing care.

• Advancing Professional Development: Engaging in evidence-based practice

encourages nurses to stay updated with the latest research findings, enhancing their

knowledge and professional growth. It also fosters a culture of lifelong learning

within the nursing profession.

2. Steps in Implementing Evidence-Based Practice:

• Formulating a Clinical Question: The first step in evidence-based practice is

formulating a clear and focused clinical question based on the patient's problem or

the nursing intervention under consideration. The question should be structured

using the PICO framework (Population, Intervention, Comparison, Outcome) to

guide the search for relevant evidence.

• Conducting a Literature Search: Once the clinical question is identified, nurses

conduct a systematic search of the literature using databases and other reliable

sources to find relevant research evidence. This includes peer-reviewed journals,

systematic reviews, meta-analyses, and clinical practice guidelines.

• Appraising the Evidence: After identifying relevant research articles, nurses

critically appraise the evidence to evaluate its validity, relevance, and applicability

to the clinical question. This involves assessing the study design, sample size,

methodology, and statistical analysis to determine the quality and strength of the

evidence.

• Synthesizing the Evidence: Nurses analyze and synthesize the findings from

multiple research studies to develop a comprehensive understanding of the

evidence. This includes comparing and contrasting the results, identifying patterns

or consistencies, and determining the overall strength of the evidence.

• Integrating the Evidence: Based on the synthesis of the evidence, nurses integrate

the findings into their clinical decision-making process. They consider the patient's

unique circumstances, preferences, and values, along with their own clinical

expertise, to develop an individualized care plan.

• Evaluating Outcomes: Nurses implement the evidence-based intervention and

closely monitor the patient's response. They collect data on outcomes, evaluate the

effectiveness of the intervention, and make adjustments as necessary. This step

contributes to the ongoing cycle of evidence-based practice, as outcomes are

assessed and used to inform future practice decisions.

3. Barriers and Facilitators of Evidence-Based Practice:

• Barriers: Some common barriers to implementing evidence-based practice in

nursing include time constraints, lack of access to research literature, limited skills

in critically appraising research, resistance to change, and organizational culture

that does not prioritize evidence-based practice.

• Facilitators: Organizations can support evidence-based practice by providing

resources, promoting a culture of inquiry, and offering training and mentorship to

nurses. Collaboration between nurses, researchers, and educators can also facilitate

the integration of research evidence into practice.

4. Ethical Considerations: Nurses must consider ethical principles when implementing

evidence-based practice. This includes obtaining informed consent from patients, ensuring

patient confidentiality, respecting patient autonomy, and considering the potential risks and

benefits of interventions based on the available evidence.

Evidence-based practice is a continuous process that requires ongoing learning, critical thinking,

and integration of research findings into nursing practice. By incorporating

NR 546 Week 3 Case Study

Powered by TCPDF (www.tcpdf.org)

1 / 1

1 Assignment: Assessing and Treating Pediatric Patients with Mood Disorders

Assignment: Assessing and Treating Pediatric Patients with Mood Disorders

Name:

Walden U

NURS 6630: Psychopharmalogical Approaches to Treat Psychopathology

Instructor:

December 28, 2021

2 Assignment: Assessing and Treating Pediatric Patients with Mood Disorders

Assignment: Assessing and Treating Pediatric Patients with Mood Disorders

In the given scenario, the client is an 8-year-old African American male who

arrives at the ER with his mother. He is exhibiting signs of depression. The patient complained of

feeling "sad", the mother reports that the teacher said the child is withdrawn from peers in class,

decreased appetite, and occasional irritation periods. The client reached all developmental

landmarks at appropriate ages. Laboratory studies are within the normal range. The child was

referred to psychiatry for evaluation.

The patient is alert, oriented x 3, clear, coherent, goal-directed, spontaneous. The self-

reported mood was "sad." Affect was somewhat blunted but smiled appropriately at various

points throughout the clinical interview. He denies visual and auditory hallucinations. No

delusional or paranoid thought processes were noted. Judgment and insight appear to be age-

appropriate. He is not endorsing active suicidal ideation but does admit that he often thinks about

himself being dead and what it would be like to be dead.

Which decision did you select?

The first selected treatment option is Zoloft 25 mg orally daily for depression.

Why did you select this decision? Be specific and support your response with clinically

relevant and patient-specific resources, including the primary literature

Major depressive disorder occurs in adults and children and adolescents (Gershon et al.,

1987). According to researchers, it is appropriate for clinicians to prescribe an SSRI for children

and adolescents experiencing persistent moderate to severe depression or anxiety symptoms with

clear evidence of functional impairment in addition to supportive treatment or a course of

psychotherapy (Garland et al., 2016). In the given scenario, the patient is exhibiting functional

P r e p a r i n g t h e A s s i g n m e n t

1. Review the elements included in PICOT questions to guide evidence-based

nursing practice.

2. Respond to the questions below using the PICOT Question Worksheet

TemplateLinks to an external site. Download PICOT Question Worksheet

Template.

3. Using a minimum of 3 scholarly nursing sources, current within 5 years:

• Identify and describe one practice-related issue or concern. You may choose to

build on the practice issue you identified in NR500NP/NR501NP.

• Explain why the issue/concern is important to nurse practitioner practice and its

impact on health outcomes.

• Describe each element of your PICOT question in one or two sentences, being

sure to address all of the following:

o P-Population and problem– What is the nursing practice concern or

problem and whom does it affect?

o I–Intervention– What evidence-based solution for the problem would

you like to apply?

o C–Comparison– What is another solution for the problem? Note that

this is typically the current practice, no intervention at all, or alternative

solutions.

o O–Outcome– Very specifically, how will you know that the intervention

worked? Think about how you will measure the outcome.

o T–Time frame– What is the Timeframe involved for the EBP initiative or

the target date of completion?

• Construct your PICOT question in the standard PICOT question format (narrative)

and define each letter separately, such as:

o P =

o I =

o C =

o O =

o T =

o PICOT question written in full =

1. Abide by the Chamberlain College of Nursing Academic Integrity Policy.

2. At the graduate level, we like to see you synthesizing your ideas into your own

words. No direct quotes may be used in this worksheet.

3. Use APA formatting guidelines for references and citations.

4. Submit your worksheet using the PICOT Worksheet Template as a Word

document to the Week 2 Dropbox

ASSIGNMENT CONTENT

Category Points % Description

Practice-

related Issue

20 20% This section of the worksheet includes:

• Identification of one practice-related issue or concern

• Description of the issue or concern

• Rationale for addressing this issue or concern

• Sufficient support from current, scholarly nursing sources

Significance

of the Issue

20 20% This section of the worksheet includes:

• Explanation of why the issue/concern is important to the

profession of nursing and to NP practice

• Explanation of the impact of the issue or concern health

outcomes

• Sufficient support from current, scholarly nursing sources

ASSIGNMENT CONTENT

Discussion of

PICOT

Elements

20 20% This section of the worksheet includes:

• Accurate and clear discussion of the following elements,

including 1-2 sentences to address each:

• P-Population and problem – What is the nursing practice

concern or problem and whom does it affect?

• I–Intervention – What evidence-based solution for the

problem would you like to apply?

• C–Comparison – what is another solution for the

problem? Note that this is typically the current practice,

no intervention at all, or alternative solutions.

• O–Outcome – Very specifically, how will you know that the

intervention worked? Think about how you will measure

the outcome.

• T–Time frame – What is the Timeframe involved for the

EBP initiative and the target date of completion?

PICOT

Question

20 20% This section of the worksheet includes:

• Construction of the above described PICOT question in the

standard PICOT question format (narrative) and define

each letter separately, such as:

o P =

o I =

o C =

o O =

o T =

o PICOT question =

80 80% Total CONTENT Points= [100 pts]

ASSIGNMENT CONTENT

ASSIGNMENT FORMAT

Category Points % Description

Graduate-

Writing Style

10 10% For full credit in this section, the following criteria must be met:

• Correct use of spelling and sentence structure

• Clarity, organization, and logical flow of ideas within

writing

• Reference and citation formatting follow APA guidelines

• No direct quotes are used in the worksheet

Scholarly

Support

10 10% • Minimum of 3 scholarly nursing sources, current within 5

years, are integrated

20 20% Total FORMAT Points = [20pts]

ASSIGNMENT TOTAL = 100 points

1

Benchmark – Capstone Project Change Proposal

Amanda James

Professor Letisha Hardy

Grand Canyon University

NRS-493

May 17, 2023

2

Introduction

In the modern healthcare system, which is constantly evolving, practitioners must address

the difficulties of delivering exceptional patient care while simultaneously satisfying the wants of

laws and regulations and displaying mastery of processes supported by evidence. Suppose

scientific professionals want to acquire the highest level of success in their practice. In that case,

it is fundamental that they remain current on scientific research and the most effective methods for

treating patients. The problem or issue that will serve as the focal factor of this final project will

have a medical orientation and require a change proposal. We are going to address the problem or

worry by the use of research approaches that are backed with the aid of evidence.

Background

One of the greatest threats to public health these days is sepsis, a medical emergency that

is tough and complicated to treat. It places a heavy load on healthcare systems, especially in places

where such establishments are already stretched thin due to other reasons for mortality. A delay in

treatment and an improved risk of death are the consequences of a missed or incorrect analysis of

sepsis (Meulenbroeks et al., 2021). Although sepsis is more common among people who have

previously been ill or had surgery, healthy humans can also get the illness. Antibiotics and other

supportive care must be given to sepsis patients very away to prevent worsening their condition

into septic shock, which may be deadly due to irreparable organ damage.

Since sepsis may negatively impact patient outcomes, healthcare providers must be extra

careful to spot the signs and symptoms and act quickly to treat them (Cardwell, 2020).

Improvements in patient outcomes and death costs may be achieved through promptly diagnosing

and remedying sepsis. More education and publicity regarding the warnings symptoms and

3

symptoms of sepsis, as well as the want for prompt medical attention, are urgently needed. In order

to higher manage sepsis and lower the morbidity and loss of life rates associated with it, higher

diagnostic technologies and treatment regimens are required.

Ultimately, sepsis is an important problem in public health that wants constant study. When

trying to avoid complications from sepsis, healthcare providers should be diligent in their attempts

to diagnose and treat the circumstance as soon as possible. Improving patient consequences and

lowering the cost of dealing with sepsis requires the development of better diagnostic equipment

and treatment methods.

Clinical Problem Statement

In order to avoid the improvement of severe sepsis or septic shock, both of which may

additionally result in substantial morbidity and death, a correct diagnosis of sepsis must be made

as quickly as possible. As a significant contributor to rising healthcare expenses, more extended

hospital stays, and extra deaths, sepsis diagnosis delays constitute a significant difficulty in

hospitals and other healthcare facilities. According to research, patient outcomes may be improved

and death costs reduced by up to 50% with early detection and care of sepsis (Rhodes et al., 2017).

However, in clinical practice, sepsis is tricky to diagnose on time, especially in patients

with comorbidities, the elderly, and those with impaired immune systems. Due to the absence of

well-defined symptoms, sepsis regularly goes undiagnosed and untreated for too long, with

potentially fatal results. Another issue is the incapacity or unwillingness of healthcare providers to

diagnose sepsis and institute suitable treatment promptly.

Therefore, enhancing healthcare facilities' capacity for early sepsis detection and diagnosis

is vital. Implementing sepsis detection techniques, healthcare issuer education programs, and

clinical selection support systems can also bring about this shift (Cardwell, 2020). Better patient

4

effects and lower healthcare costs might also be achieved by previous and more accurate analysis

of sepsis and subsequent fast implementation of suitable therapies.

Purpose of the Change Proposal

The want for prompt and accurate analysis of sepsis is one of the most significant

boundaries facing the healthcare industry today. By growing awareness among healthcare

specialists about the symptoms of sepsis, implementing a standardized screening tool, and creating

an evidence-based intervention plan for the timely administration of sepsis, the change that is being

proposed has the potential to enhance patient outcomes and reduce mortality rates.

Early sepsis diagnosis is critical to prevent the sickness from becoming extra severe.

Having a standardized screening method in place might also assist in this regard. An evidence-

based intervention plan may additionally be used to offer medical specialists with guidelines for

the treatment of sepsis. These suggestions include the administration of critical antibiotics, the

resuscitation of fluids, and the provision of additional supportive care measures.

If the endorsed alteration were carried out, medical professionals' capability to diagnose

and treat sepsis would be improved. Extended stays in the hospital and admissions to intensive

care gadgets are expensive for healthcare systems. However, they may also not be necessary if

sufferers have better outcomes due to their treatment.

Before agreeing to the alteration that has been suggested, it is critical to evaluate how

effective it will be. Healthcare practitioners can investigate the modification's effectiveness by

using indicators such as sepsis diagnosis rates, antibiotic administration timings, and affected

person outcomes. This allows them to identify areas the place improvements may be made.

PICOT Question

5

Improved identification and therapy of adult patients with sepsis in acute care settings is

the primary goal of the PICOT question posed in this proposal. Without speedy diagnosis and

treatment, sepsis is a significant fitness issue that may result in high fatality rates. One way to

better realize sepsis in its early stages is by using a standardized screening instrument.

Since grownup patients are more possibly to be diagnosed with sepsis in an intensive care

unit, our plan goals for this demographic. The intervention will introduce a standardized sepsis

screening instrument to detect sepsis in its earliest stages in patients. A standard therapy will be

provided to patients in the manipulated group without adding a screening device for comparison.

The critical result of interest is using a screening method to detect sepsis as quickly as

possible. Timely intervention and higher patient outcomes are possible thanks to early detection

of sepsis. Secondary goals are improving patient happiness, decreasing healthcare expenses, and

decreasing death rates.

Within six months of execution, this diagram would be ideal. A screening tool, healthcare

provider education, and the intervention's success evaluation may be accomplished within this time

frame. The overarching reason for this PICOT inquiry is to enhance the early recognition and cure

of sepsis in adult patients in acute care settings to increase patient outcomes and decrease

healthcare costs.

Literature Search Strategy Employed

Boolean operators like "AND" and "OR" were used to combine search phrases for a more

excellent exhaustive investigation. To locate any new research that fulfilled our inclusion criteria,

we manually searched relevant journals' reference lists.

6

After retrieving 148 publications from the digital libraries, we culled the list down to 34

that handed our first title and abstract screening. Following a comprehensive assessment of these

papers, 15 research met our inclusion criteria and were included in our proposal.

Studies that examined the application of screening instruments, therapies, and results of

sepsis management in acute care settings were blanketed in this proposal. These studies were

randomized controlled trials, observational studies, or systematic reviews. Patient outcomes such

as death, length of hospital stay, and healthcare expenditures have been examined, and insights

into the efficacy of screening techniques and redress for early detection and management of sepsis

were presented.

Overall, the literature search approach for this proposal enabled a thorough examination of

the existing facts concerning the diagnosis and cure of sepsis in hospital emergency rooms. The

included lookup provides solid proof for the planned change software to enhance healthcare

facilities' ability to discover and treat sepsis.

Evaluation of the Literature

In this proposal, we performed a literature study to demonstrate the importance of

recognizing and treating sepsis as quickly as possible to enhance affected patient outcomes in

intensive care units. The analyzed studies all agreed that using standardized screening techniques

to better notice sepsis early on would result in more on-the-spot and effective treatment. Several

studies have proven that screening methods decrease death prices and enhance patient effects,

including shorter hospital stays and decreased healthcare expenses.

Evidence-based therapies, in addition to standardized screening measures, are

indispensable in the management of sepsis. According to various studies, patients with sepsis have

a better chance of survival if they get antibiotics and intravenous fluids as soon as possible.

7

Additional measures, including vasopressors and mechanical ventilation, may also be required in

severe sepsis and septic shock.

The research implies that higher patient outcomes can also result from using a standardized

screening tool for sepsis in acute care settings in conjunction with evidence-based therapies.

Healthcare professionals, medical institution management, and quality improvement groups must

all work together to apply these initiatives efficaciously. For these methods to be profitable and

long-lasting in clinical practice, the literature also emphasizes the want for constant assessment

and improvement.

Adaptation to New Paradigms or Nursing Theories

As a nursing theory, the Transtheoretical Model of Behavior Change highlights the value

of recognizing people's several transitional states earlier than achieving a lasting behavioral shift.

The health promotion, disorder prevention, and chronic disease administration tenets of the model

created by Prochaska and DiClemente in the Eighties have found widespread software in nursing.

Precontemplation, musing, planning, doing, and keeping on doing are the five pillars of the

Transtheoretical Model of Behavior Change. Individuals in the pre-contemplation stage are often

resistant to change (Curtin et al., 2020) and unaware of the necessity for change. The contemplation

stage is characterized by an awareness of the want for change without an accompanying readiness

to take decisive action. At this point, humans start making deliberate plans for making a change.

In the third and remaining phase, known as "action," people certainly put effort into altering their

circumstances. Individuals' efforts to sustain their newly acquired behaviors symbolize this

maintenance phase.

The suggested screening device and intervention plan will incentivize healthcare

practitioners to follow the Transtheoretical Model of Behavior Change steps and undertake the

8

new practices. In order to support the acceptance of the new screening instrument and intervention

plan, healthcare professionals should be familiar with the phases of change so that they may better

reflect on their attitudes and actions about the proposed change. To maintain the positive aspects

made in the early detection and treatment of sepsis, the model will additionally offer a framework

for regular overview and upkeep of the improvements made.

The following are the measures that are deliberate to be taken to accomplish this proposal:

Step 1: Education and Training

Step one in implementing the recommended intervention method is teaching clinical staff

how to use the standardized screening instrument and recognize the signs of sepsis in their patients.

This will be achieved using a mixture of classroom instruction, online tutorials, and printed

materials.

Success will be determined by how many medical workforce members take the education

and by the responses to pre- and post-training questionnaires that test their sepsis- and screening-

tool-related knowledge.

Step 2: Screening Tool Implementation

Standardized screening for sepsis in acute care placing (Curtin et al., 2020) will be

implemented next. This tool will be included in the electronic medical file system and completed

through nursing staff upon admission, every 12 hours, and each time there is a change in the

patient's condition.

The number of sufferers who undergo screening with the instrument and the timeliness

with which they undergo screening will serve as consequence measures for this phase's success.

Information gathered will be utilized for screening tool evaluation and enhancement planning.

Step 3: Early Intervention and Management

9

In the third phase of the plan's execution, sepsis sufferers are treated immediately after

diagnosis. This will require giving the affected person therapy like antibiotics and intravenous

fluids as soon as viable and keeping a careful eye on how they are doing to ensure they respond.

The number of sepsis patients who get early care, as correctly as patient outcomes along

with death, duration of hospital stay, and readmission prices, will be used to evaluate the efficacy

of this step.

Evaluation of the Intervention Strategy's Use of Available Research Evidence

The recommended intervention method to better recognize and deal with sepsis in

healthcare was grounded in the best accessible data. A literature review found quite a few studies

supporting standardized screening tools and evidence-based interventions for sepsis administration

(Curtin et al., 2020). These studies were used to inform the following elements of an intervention

plan:

The suggested intervention strategy includes using a standardized screening instrument to

detect sepsis at an early stage. Better early detection of sepsis in health facility settings is possible

using this evidence-based technique.

The recommended intervention strategy includes educational and education opportunities

for healthcare providers to increase their familiarity with sepsis and its symptoms and the best

practices for treating sepsis primarily based on scientific data.

As part of the planned intervention, clinicians will be given entry to clinical decisions to

assist tools to aid in the fast and precise diagnosis and cure of sepsis.

Care Coordination and Communication Enhancement: The recommended intervention

approach consists of process improvement things to do, including the creation of sepsis-specific

approaches and the usage of multidisciplinary teams.

10

This suggested intervention method is grounded on evidence-based practice principles and

pursuits to enhance sepsis diagnosis and remedy in healthcare facilities. In order to be successful,

the strategy must be practical, well-received, and broadly adopted by the intended audience, all of

which have been considered in its development.

Plan for Evaluating the Proposed Nursing Intervention

Quantitative measures:

Tracking the incidence of sepsis and evaluating it to data collected earlier than the

screening tool and intervention strategy had been put into place is a vital part of this study.

In order to decide whether or not the intervention approach was successful, we will track

deaths from sepsis and evaluate them to data collected earlier than we began treatment.

Adoption of the screening tool will be monitored using gauging how well healthcare

practitioners adhere to the screening tool's established guidelines.

The size of time it takes for patients with sepsis to begin remedy will be tracked and

compared to data amassed before any interventions were made.

Qualitative measures:

Using questionnaires and focal point groups, healthcare providers will be asked for their

ideas on the success of the screening tool and intervention method.

Patient feedback will be gathered via interviews and questionnaires to decide how satisfied

sepsis patients and their households are with the treatment they received.

To determine what is standing in the way of the widely implemented screening device and

intervention plan, we will conduct behavior surveys and hold focus groups.

T-tests and chi-square analyses, amongst others, will be used for the quantitative

information gathered. In order to extract meaningful insights from the qualitative data, a content

11

material analysis will be performed. After the assessment, any required changes will be made to

the intervention strategy, and best practices will be recommended.

References

Cardwell, K. (2020). Reducing medication errors and transitions of care. Age and Ageing, 49(4),

537-539. Retrieved from: https://doi.org/10.1093/ageing/afaa065.

Curtin, D., Jennings, E., Daunt, R., Curtin, S., Randles, M., Gallagher, P., &amp; O&#39; Mahony,

D.

(2020). Deprescribing in older people approaching the end of life: a randomized controlled

trial using STOPPFrail criteria. Journal of the American Geriatrics Society, 68(4), 762-

769. Retrieved from: https://doi.org/10.1111/jgs.16278.

Meulenbroeks, I., Epp, J., &amp; Schroeder, L. (2021). The value of caregiver-inclusive practices

in

Geriatric transitions of care: A systematic review. Health Policy, 125(7), 888-898.

Retrieved from: https://doi.org/10.1016/j.healthpol.2021.05.001.

Nursing Care Plan and Diagnosis for Chronic Pain

Nursing Care Plan and Diagnosis for Chronic Pain

This nursing care plan is designed for patients with chronic discomfort. According to Nanda,

chronic pain is the condition in which an individual experiences persistent or intermittent pain

that lasts for more than six months. This definition differs from that of acute pain, in which a

person experiences agony from one second to six months.

The patient may report typical symptoms of distress, but they have persisted for at least six

months. Due to the patient experiencing these symptoms for more than six months, the nurse

may observe social and familial relationship disruption, irritability, depression, a "beaten"

appearance, exhaustion, or somatic preoccupation.

There are numerous causes of chronic pain, including musculoskeletal disorders such as back

pain, treatment-related therapies such as chemotherapy, and pregnancy.

This nursing care plan for chronic back pain includes a nursing diagnosis, nursing interventions,

and nursing objectives.

What are intentions for geriatric care? How is a nursing care plan developed? Which nursing

care plan literature would you recommend to assist in the creation of a nursing care plan?

Care Plans are frequently developed in various formats. The format is not always crucial, and the

format of care plans may vary between nursing institutions and medical employment. Some

hospitals may display the information digitally or utilize pre-made templates. The most essential

aspect of the care plan is its content, as it will serve as the basis for your care.

Nursing Care Plan for Chronic Pain

Please observe the video below for a tutorial on how to construct a care plan in nursing school.

Otherwise, please continue down to view the finished care plan.

Scenario

A 56-year-old male presents with complaints of back discomfort. He states that he has

experienced consistent lower back pain for the past year. He explains that he decided to come in

to have it "checked out" because it is "taking a toll" on his ability to function. He reports that the

back pain has left him despondent and exhausted because he cannot perform the same tasks he

did a year ago. He also reports that his relationship with his wife and children has been affected.

You observe that the patient appears fatigued with dark circles under his eyes and is frequently

rubbing his back.

Nursing Diagnosis

Inflammation of the lumbar spine is the cause of the patient's one-year history of consistent

lower back pain, disruption of social and familial relationships, depression, fatigue, a "beaten

look," and rubbing of the painful area.

Subjective Data

He states that he has experienced consistent lower back pain for the past year. He explains that

he decided to come in to have it "checked out" because it is "taking a toll" on his ability to

function. He reports that the back pain has left him despondent and exhausted because he cannot

perform the same tasks he did a year ago. He also reports that his relationship with his wife and

children has been affected.

Objective Data

A 56-year-old male presents with complaints of back discomfort. You observe that the patient

appears fatigued with dark circles under his eyes and is frequently rubbing his back.

Nursing Outcomes

-At the next follow-up appointment, the patient will report an improvement in back pain and an

increase in daily activities.

-The patient will verbalize his expectations regarding the course of pain treatment and his

intended treatment outcomes and objectives.

-The patient will identify five noninvasive pain relief methods to aid in pain management.

-The patient will be instructed verbally on how to take the back pain medication prescribed for

him as needed.

Nursing Interventions

At the next follow-up appointment, the nurse will evaluate the patient's report of reduced back

pain and an increase in daily activities.

-The nurse will evaluate the patient's expectations regarding the duration of pain treatment and

his desired treatment outcomes.

-The nurse will educate the patient on five noninvasive pain relief techniques to aid in pain

management.

-The nurse will instruct the patient on how to take the back pain medication prescribed for him as

needed.

SAMPLE Block format Soap Note

PATIENT INFORMATION

Name: Mr. W.S.

Age: 65-year-old

Sex: Male

Source: Patient

Allergies: None

Current Medications: Atorvastatin tab 20 mg, 1-tab PO at bedtime

PMH: Hypercholesterolemia

Immunizations: Influenza last 2018-year, tetanus, and hepatitis A and B 4 years ago.

Surgical History: Appendectomy 47 years ago.

Family History: Father- died 81 does not report information

Mother-alive, 88 years old, Diabetes Mellitus, HTN

Daughter-alive, 34 years old, healthy

Social Hx: No smoking history or illicit drug use, occasional alcoholic beverage consumption on

social celebrations. Retired, widow, he lives alone.

SUBJECTIVE:

Chief complain: “headaches” that started two weeks ago

Symptom analysis/HPI:

The patient is 65 years old male who complaining of episodes of headaches and on 3 different

occasions blood pressure was measured, which was high (159/100, 158/98 and 160/100

respectively). Patient noticed the problem started two weeks ago and sometimes it is

accompanied by dizziness. He states that he has been under stress in his workplace for the last

month.

Patient denies chest pain, palpitation, shortness of breath, nausea or vomiting.

ROS:

CONSTITUTIONAL: Denies fever or chills. Denies weakness or weight loss.

NEUROLOGIC: Headache and dizzeness as describe above. Denies changes in LOC. Denies

history of tremors or seizures.

HEENT: HEAD: Denies any head injury, or change in LOC. Eyes: Denies any changes in

vision, diplopia or blurred vision. Ear: Denies pain in the ears. Denies loss of hearing or

drainage. Nose: Denies nasal drainage, congestion. THROAT: Denies throat or neck pain,

hoarseness, difficulty swallowing.

Respiratory: Patient denies shortness of breath, cough or hemoptysis.

Cardiovascular: No chest pain, tachycardia. No orthopnea or paroxysmal nocturnal

dyspnea.

Gastrointestinal: Denies abdominal pain or discomfort. Denies flatulence, nausea, vomiting or

diarrhea.

Genitourinary: Denies hematuria, dysuria or change in urinary frequency. Denies difficulty

starting/stopping stream of urine or incontinence.

MUSCULOSKELETAL: Denies falls or pain. Denies hearing a clicking or snapping sound.

Skin: No change of coloration such as cyanosis or jaundice, no rashes or pruritus.

Objective Data

CONSTITUTIONAL: Vital signs: Temperature: 98.5 °F, Pulse: 87, BP: 159/92 mmhg, RR 20,

PO2-98% on room air, Ht- 6’4”, Wt 200 lb, BMI 25. Report pain 0/10.

General appearance: The patient is alert and oriented x 3. No acute distress noted.

NEUROLOGIC: Alert, CNII-XII grossly intact, oriented to person, place, and time. Sensation

intact to bilateral upper and lower extremities. Bilateral UE/LE strength 5/5.

HEENT: Head: Normocephalic, atraumatic, symmetric, non-tender. Maxillary sinuses no

tenderness. Eyes: No conjunctival injection, no icterus, visual acuity and extraocular eye

movements intact. No nystagmus noted. Ears: Bilateral canals patent without erythema, edema,

or exudate. Bilateral tympanic membranes intact, pearly gray with sharp cone of light. Maxillary

sinuses no tenderness. Nasal mucosa moist without bleeding. Oral mucosa moist without

lesions,.Lids non-remarkable and appropriate for race.

Neck: supple without cervical lymphadenopathy, no jugular vein distention, no thyroid swelling

or masses.

Cardiovascular: S1S2, regular rate and rhythm, no murmur or gallop noted. Capillary refill < 2

sec.

Respiratory: No dyspnea or use of accessory muscles observed. No egophony, whispered

pectoriloquy or tactile fremitus on palpation. Breath sounds presents and clear bilaterally on

auscultation.

Gastrointestinal: No mass or hernia observed. Upon auscultation, bowel sounds present in all

four quadrants, no bruits over renal and aorta arteries. Abdomen soft non-tender, no guarding, no

rebound no distention or organomegaly noted on palpation

Musculoskeletal: No pain to palpation. Active and passive ROM within normal limits, no

stiffness.

Integumentary: intact, no lesions or rashes, no cyanosis or jaundice.

Assessment

Essential (Primary) Hypertension (ICD10 I10): Given the symptoms and high blood pressure

(156/92 mmhg), classified as stage 2. Once the organic cause of hypertension has been ruled out,

such as renal, adrenal or thyroid, this diagnosis is confirmed.

Differential diagnosis:

Ø Renal artery stenosis (ICD10 I70.1)

Ø Chronic kidney disease (ICD10 I12.9)

Ø Hyperthyroidism (ICD10 E05.90)

Plan

Diagnosis is based on the clinical evaluation through history, physical examination, and routine

laboratory tests to assess risk factors, reveal identifiable causes and detect target-organ damage,

including evidence of cardiovascular disease.

These basic laboratory tests are:

· CMP

· Complete blood count

· Lipid profile

· Thyroid-stimulating hormone

· Urinalysis

· Electrocardiogram

Ø Pharmacological treatment:

The treatment of choice in this case would be:

Thiazide-like diuretic and/or a CCB

· Hydrochlorothiazide tab 25 mg, Initial dose: 25 mg orally once daily.

Ø Non-Pharmacologic treatment:

· Weight loss

· Healthy diet (DASH dietary pattern): Diet rich in fruits, vegetables, whole grains, and low-fat

dairy products with reduced content of saturated and trans l fat

· Reduced intake of dietary sodium: <1,500 mg/d is optimal goal but at least 1,000 mg/d

reduction in most adults

· Enhanced intake of dietary potassium

· Regular physical activity (Aerobic): 90–150 min/wk

· Tobacco cessation

· Measures to release stress and effective coping mechanisms.

Education

· Provide with nutrition/dietary information.

· Daily blood pressure monitoring at home twice a day for 7 days, keep a record, bring the record

on the next visit with her PCP

· Instruction about medication intake compliance.

· Education of possible complications such as stroke, heart attack, and other problems.

· Patient was educated on course of hypertension, as well as warning signs and symptoms, which

could indicate the need to attend the E.R/U.C. Answered all pt. questions/concerns. Pt verbalizes

understanding to all

Follow-ups/Referrals

· Evaluation with PCP in 1 weeks for managing blood pressure and to evaluate current

hypotensive therapy. Urgent Care visit prn.

· No referrals needed at this time.

References

Domino, F., Baldor, R., Golding, J., Stephens, M. (2017). The 5-Minute Clinical Consult 2017

(25th ed.). Print (The 5-Minute Consult Series).

Codina Leik, M. T. (2014). Family Nurse Practitioner Certification Intensive Review (2nd ed.).

ISBN 978-0-8261-3424-0

Patient Assessment and Care Plan

Instructions to student:

1) Bring one copy of this packet with you to clinical each week.

2) Your instructor will inform you of the number of packets and the dates each packet is due.

They may have you complete only portions of or all of the packet.

3) Read the rubric! Each packet is Pass/Fail. You must meet the requirements listed to receive a

Pass. Your instructor may ask you to resubmit packets that are incomplete or incorrect.

4) If your instructor asks you to submit the packet electronically, then please record your answers

in bold or in a colored or lower case font. This helps us identify your answers more quickly.

PATIENT ASSESSMENT FORM

STUDENT NAME: DATE:

CLIENT INITIALS: ROOM # DOB: AGE GENDE

R:

ADMISSIO

N DATE:

CODE STATUS: ALLERGIES: MARITAL

STATUS:

OCCUPATIO

N

(FORMER):

MEDICAL DX:

CHIEF

COMPLAINT

:

PAST HISTORY

(SURGERY/PROCEDUR

ES) WITH DATES

ORDERS

RATIONAL

E (Why is

this ordered

for this

client???)

EXAMPLE: DIET

2 g Sodium

diet with

nectar thick

liquids only

Sodium is

restricted due

to edema in

the bilateral

lower

extremities

and nectar

thick liquids

due to

dysphagia

from a past

stroke.

DIET

ACTIVITY

I/O

VS

BGM

FOLEY

NG

PEG/PEJ TUBE

WOUND CARE

RESPIRATORY

TREATMENT

TRACHEOSTOMY

SUCTIONING

CHEST TUBE

SPECIAL EQUIPMENT

LAB ORDERS

OTHER

REHAB SERVICES ACTIVITY

OR

RATIONAL

E

TREATMEN

T PLAN &

SCHEDULE

PHYSICAL THERAPY

SPEECH THERAPY

OCCUPATIONAL

THERAPY

……/ 5 pts

IVs

IV FLUID AND RATE: SITE LOCATION AND CONDITION:

LAST DRESSING CHANGE: LAST TUBING CHANGE:

GAUGE: REASON FOR IV ACCESS:

DIAGNOSTIC

TESTS: DATE RESULTS

REASON FOR TESTING AND

IMPLICATIONS FOR NURSING CARE

LAB

TEST DATE RESULTS

NORMS

REFERENCE

RANGES

IMPLICATIONS FOR NURSING CARE

(WHAT S&S I SHOULD BE AWARE OF

AND WHAT YOU CAN DO TO HELP

IMPROVE AN ABNORMAL RESULT?)

GROWTH and DEVELOPMENT: (see pages 378-379 Taylor, Lillis and White) or (Erikson’s

Stages of Development)

CLIENT’S DEVELOPMENTAL STAGE ACCORDING TO

HAVIGHUSRT

TASKS OF THIS

STAGE:

ASSESSMENT OF CLIENT’S SUCESSFUL ACHIEVEMENT OF

TASKS

…../ 5 pts

MEDICATIONS

If your client has more than 12 medications, select the 12 medications that are most important,

most frequently given or those that pertain to the client’s most significant medical problems. See

the example below.

Brand Name and Generic Name Normal Dosage Ranges Contraindications

Coreg (carvedilol)

3.125 mg – 50 mg BID Asthma, heart block

Pharmacotherapeutic Class Dosage, Route & Frequency Adverse Reactions

β-adrenergic blocker

6.25 mg p.o. BID

Bradycardia, CHF,

thrombocytopenia,

hyperglycemia, bronchospasm

Why this Patient Receives this

Med

Effects of the Med on the

Client

Nursing Considerations and

Teaching

He has a history of hypertension

but has been taking Coreg for 2

years to control his hypertension

BP’s for past 3 days have

been 128/78, 132/72, 138/80

How is this medication

impacting your client??B/P

readings, lab results, pain

management, etc……..

Do not discontinue abruptly or

before surgery

Caution with Upper airway

dysfunction

Rise slowly to minimize

orthostatic hypotension, check

B/P and heart rate prior to

administration

Take before meals

#1 Brand Name and Generic

Name Normal Dosage Ranges Contraindications

Pharmacotherapeutic Class Dosage, Route &

Frequency Adverse Reactions

Why this Patient Receives this

Med

Effects of the Med on the

Client

Nursing Considerations and

Teaching

#2 Brand Name and Generic

Name Normal Dosage Ranges Contraindications

#3 Pharmacotherapeutic Class Dosage, Route and

Frequency Adverse Reactions

Why this Patient Receives this

Med

Effects of the Med on the

Client

Nursing Considerations and

Teaching

#4 Brand Name and Generic

Name Normal Dosage Ranges Contraindications

Pharmacotherapeutic Class Dosage, Route and

Frequency Adverse Reactions

Why this Patient Receives this

Med

Effects of the Med on the

Client

Nursing Considerations and

Teaching

#5 Brand Name and Generic

Name Normal Dosage Ranges Contraindications

Pharmacotherapeutic Class Dosage, Route and

Frequency Adverse Reactions

Why this Patient Receives this

Med

Effects of the Med on the

Client

Nursing Considerations and

Teaching

# 6 Brand Name and Generic

Name Normal Dosage Ranges Contraindications

Pharmacotherapeutic Class Dosage, Route and

Frequency Adverse Reactions

Why this Patient Receives this

Med

Effects of the Med on the

Client

Nursing Considerations and

Teaching

#7 Brand Name and Generic

Name Normal Dosage Ranges Contraindications

Pharmacotherapeutic Class Dosage, Route and

Frequency Adverse Reactions

Why this Patient Receives this

Med

Effects of the Med on the

Client

Nursing Considerations and

Teaching

#8 Brand Name and Generic

Name Normal Dosage Ranges Contraindications

Pharmacotherapeutic Class Dosage, Route and

Frequency Adverse Reactions

Why this Patient Receives this

Med

Effects of the Med on the

Client

Nursing Considerations and

Teaching

#9 Brand Name and Generic

Name Normal Dosage Ranges Contraindications

Pharmacotherapeutic Class Dosage, Route and

Frequency Adverse Reactions

Why this Patient Receives this

Med

Effects of the Med on the

Client

Nursing Considerations and

Teaching

#10 Brand Name and Generic

Name Normal Dosage Ranges Contraindications

Pharmacotherapeutic Class Dosage, Route and

Frequency Adverse Reactions

Why this Patient Receives this

Med

Effects of the Med on the

Client

Nursing Considerations and

Teaching

#11 Brand Name and Generic

Name Normal Dosage Ranges Contraindications

Pharmacotherapeutic Class Dosage, Route and

Frequency Adverse Reactions

Why this Patient Receives this

Med

Effects of the Med on the

Client

Nursing Considerations and

Teaching

#12 Brand Name and Generic

Name Normal Dosage Ranges Contraindications

Pharmacotherapeutic Class Dosage, Route and

Frequency Adverse Reactions

Why this Patient Receives this

Med

Effects of the Med on the

Client

Nursing Considerations and

Teaching

…../ 20 pts

NURSES NOTES FOR CLINICAL

For this clinical, we are having you write out your assessment findings in the form of a narrative

nurse’s note. We have provided some samples of assessments. We have also provided a

worksheet that you may use to take into a patient’s room to take notes during your assessment.

Record your vital signs and type your physical assessment findings. This form will expand to fit

your typing. A sample of charting for a long

resident follows below.

TEMP: APICAL HR: RESP: BP: HT: WT:

DATE / TIME

(TYPE HERE)

Sample Narrative Note — Head to Toe format

Temp: 98.6 Apical HR: 72 Resp: 16 BP 128/62 Ht: 5’10” Wt: 145

12/22/2010

1400

Resident in semi-fowlers position in bed. Pressure reduction mattress in place.

Alert and oriented x 3. Appropriate mood and affect. Well groomed. Recent and

remote memory intact. Facial symmetry noted. Pupils are equal, reactive to light

and accommodation. Oral mucosa moist, pink. Frequent oral care rendered with

sponge toothette and toothbrush. Dentition intact. Hearing intact. Oropharynx clear

without erythema or exudate. No chewing or swallowing difficulties. 75% of

general diet taken at breakfast. Skin pink, warm, dry, free of lesions with elastic

turgor. Hair and nails unremarkable. Carotid and radial pulses present and equal.

Motor and sensory functions grossly intact. No weakness or paralysis. Upper

extremities equal strength bilaterally, full ROM w/ capillary refill < 3 sec. Fine

resting tremor in the left hand” No involuntary movement or abnormal posture.

Lungs clear bilaterally to auscultation. Tracheostomy dressing clean, dry, and

intact. Connected to ventilator with settings: TV-550, Fio2-40%, Rate 10, and

PEEP-5cm. Sao2-92%. Suctioned for moderate amount of white, thin secretion.

Apical pulse regular (rate) and rhythm. Double lumen picc line note to left

antecubital space. Tegaderm dressing is clean, dry, and intact. Last dressing

change on 11/28/16. Chlorhexadine caps intact to all lumens. Bowel sounds active

x 4. Abdomen soft, non-distended, non-tender. Last bowel movement this

morning, passed a large, soft- formed brown stool and a moderate amount of clear

yellow urine. Bilateral lower extremities, no tenderness, swelling or joint

deformities noted. Denies numbness or tingling to extremities. Toe nails thick and

yellowed w/ capillary refill < 3 sec. No peripheral edema noted, pedal pulses

palpable and equal bilaterally.

PHYSICAL ASSESSMENT WORKSHEET (Use this sheet for jotting down

your assessment findings.)

ROUTINE FINDINGS PATIENT VARIATIONS/ABNORMALS

COGNITION/NEUROLOGICAL (SAMPLE)

Alert and oriented x3, recent and remote

memory intact. Denies any numbness or

tingling to extremities”

(SAMPLE) “Fine resting tremor of left hand

SKIN

SENSORY

Wound measurements and complete

description if available at the very least

Document dressing including the type of

dressing and description of condition!

BREASTS – DEFERRED.

RESPIRATORY –

(Include ventilator settings as indicated in

narrative note)

CARDIOVASCULAR

Include any vascular access device, IV lines,

AV fistulas, perma -cath lines, etc.

ABDOMEN –

.

Include any enteral feedings here and route

BOWEL CONTINENCE? LAST BM?

BOWEL PLAN?

MUSCULOSKELETAL –

GENITOURINARY –

URINARY CONTINENCE? TOILETING

PLAN?

PELVIC –

DEFERRED.

RECTAL – DEFERRED.

……/ 10 pts

NURSING CARE PLAN Begin your NCP by listing ALL your clients individual problems (at

least 10) and then identify an appropriate nursing diagnosis that you can think of that would

apply to your client. Determine which 3 problems/nursing diagnoses are of greatest priority and

then add a #1, #2, and #3 to indicate which of the two have highest priority. Risks would not be

priority 1, 2, or 3!!!!!

Expectation is to have at least 10 nursing diagnosis listed!

# List the Client

problem

An appropriate

Nursing Diagnosis

stem

(REFER TO YOUR

NURSING

DIAGNOSIS LIST)

Related to part of the

statement (This is

individual to your

client)

As evidenced by part of the

statement (This is

individual to your client)

REMEMEBR THIS IS

NOT USED IN A “Risk

For” diagnosis

1

SAMPLE:

Reports severe

pain in the right

hip.

“Acute Pain” “related to” fractured

right hip

“as evidenced by” verbal

report of pain rated at an 8

on a scale of 0 –to 10.

2 SAMPLE:

Complete bed rest

“Risk for Impaired

skin integrity”

“related to “

immobility

NONE it is a “Risk for”

diagnosis so there is no

evidence statement

From the list above your faculty member will give you direction regarding how many and which

diagnoses they want you to develop for either a Nursing Care Plan and/or a Concept Map.

SAMPLE NCP

NANDA DIAGNOSIS STATEMENT /RELATED TO STATEMENT/AS EVIDENCED

BY STATEMENT: Acute Pain related to right hip fracture as evidenced by a verbal

report of pain rated 8 on a scale of 0 -10.

ASSESSMEN

T

(Data that

directly

pertains to the

above nursing

diagnosis)

OUTCOME

STATEMEN

T

(Patient

centered,

realistic,

specific,

measurable,

target time)

INTERVENTIONS

(Individualized,

specific, frequency)

Minimum of 4-5

interventions per plan

SCIENTIFIC

RATIONALE

(Supporting statement

from text or other

source, cite source)

EVALUATIO

N OF

OUTCOME

(Met, partially

met, unmet,

unknown by

target time)

SUBJECTIVE

DATA: “My

right hip hurts

me so much

every time I

move. I am so

afraid to start

physical

therapy”

SHORT

TERM:

Client will

report pain

level rated at

a 3 or lower

30 minutes

after pain

medication

taken

1. Educate the client on

the importance of pain

relief to enhance her

rehabilitation efforts

and include education

on various types of

methods to relieve pain.

2. Encourage client to

express any questions

or concerns she may

have regarding pain

management methods

1. “There are many

ways to manage pain. In

addition to

pharmacologic and non-

pharmacologic

measures, simple

nursing interventions

can alter patients’ pain

experience and speed

their recovery.” Taylor,

Lillis and White pg.

1168.

2. “Common fears

include a loss of control

Short Term

Goal: Met;

pain was rated

at a 2 on a

scale of 0 to 10

after

administration

of Vicodin.

to alleviate anxiety and

fears.

3. Educate the client on

her responsibility to

honestly report pain

when it occurs as well

as reporting if the

current pain

management is

effective or ineffective

for providing her pain

relief

4. Provide for

alternative/complement

ary measures of pain

relief, such as, reduce

lighting and noise,

soothing music, pet

therapy, massage, and

hot/cold packs

according to client

preferences.

and embarrassment by

being unable to deal

with pain maturely…

The patient may view

the need of for

medication as a sign of

weakness or may fear

addiction or loss of

effectiveness at a later

date.” Taylor, Lillis and

White pg. 1169.

3. “As a patient

advocate, ensure that a

strong emphasis on the

need for aggressive,

individualized strategies

that can minimize or

eliminate acute pain and

improve patient

outcomes. Preventing

pain is easier then

treating it once after it

occurs.” Taylor, Lillis

and White pg. 1178.

4.

Alternative/complement

ary measures will

provide an added benefit

of distraction from pain

experience and augment

analgesic effect.

Cold/hot therapy can

provide constriction and

or dilation which will

reduce pain

inflammation in each

specific circumstance

Daniels. Pg 378

Long Term

Goal. In

progress

OBJECTIVE

DATA:

Alert and

oriented 70

year old

widowed

female. Lives

in an

apartment

independently.

2 daughter live

nearby and

visit often.

History of a

fall while out

shopping 1 ½

weeks ago.

Right hip

surgically

repaired 7

days ago.

Surgical

dressing to

right hip is

clean, dry and

intact.

Circulation,

motion and

sensation

intact to right

lower

extremity.

Afebrile; BP

124/80; R-18

AP 84 and

regular. 5 foot

7 inches

weighs 142

pounds. No

hearing

deficits; wears

eye glasses

LONG

TERM:

Client will

report pain

level of 2 or

less using

ibuprofen

with

alternative

pain control

methods by

discharge.

Medical

history

positive for

osteoarthritis

and

osteoporosis

Non weight

bearing to

right leg and

to use a

walker for

ambulation

To start

physical

therapy for

gait and

strength

training BID

times 7 days

and

occupational

therapy to

develop upper

body strength

once daily

times 7 days

Reports pain

level is at 8 on

a scale of 0 to

10.

Has Vicodin

5mg/325 mg

po 2 tabs

every 4 hours

prn for severe

pain

Ibuprofen 400

mg every 6

hours prn for

moderate pain.

Short term outcome: An outcome that can be accomplished by the end of the student clinical day.

Interventions: Each nursing intervention must come from a reliable nursing reference or source.

Please note: do not use nursing care planning book exclusively. Not more than one

intervention can come from a source outside your textbooks.

Rationales: Cite a reliable source for each intervention (name of text, author, page number,

internet site and date retrieved (reliable sites: .gov or .edu. or .org)

NANDA DIAGNOSIS STATEMENT /RELATED TO STATEMENT/AS EVIDENCED

BY STATEMENT:

ASSESSMENT

(Data that directly

pertains to the

above nursing

diagnosis)

OUTCOME

STATEMENT

(Patient centered,

realistic, specific,

measurable,

target time)

INTERVENTIONS

(Individualized,

specific, frequency)

SCIENTIFIC

RATIONALE

(Supporting

statement from

text or other

source, cite

source)

EVALUATION

OF OUTCOME

(Met, partially

met, unmet,

unknown by

target time)

SUBJECTIVE

DATA: SHORT TERM:

OBJECTIVE

DATA: LONG TERM:

Short term outcome: An outcome that can be accomplished by the end of the student clinical day.

Interventions: Each nursing intervention must come from a reliable nursing reference or source.

Please note: do not use nursing care planning book exclusively. Not more than one

intervention can come from a source outside your textbooks.

Rationales: Cite a reliable source for each intervention (name of text, author, page number,

internet site and date retrieved (reliable sites: .gov or .edu. or .org)

…../30

NANDA DIAGNOSIS STATEMENT /RELATED TO STATEMENT/AS EVIDENCED

BY STATEMENT:

ASSESSMENT

(Data that directly

pertains to the

above nursing

diagnosis)

OUTCOME

STATEMENT

(Patient centered,

realistic, specific,

measurable,

target time)

INTERVENTIONS

(Individualized,

specific, frequency)

SCIENTIFIC

RATIONALE

(Supporting

statement from

text or other

source, cite

source)

EVALUATION

OF OUTCOME

(Met, partially

met, unmet,

unknown by

target time)

SUBJECTIVE

DATA: SHORT TERM:

OBJECTIVE

DATA: LONG TERM:

Short term outcome: An outcome that can be accomplished by the end of the student clinical day.

Interventions: Each nursing intervention must come from a reliable nursing reference or source. .

Please note: do not use nursing care planning book exclusively. Not more than one

intervention can come from a source outside your textbooks.

Rationales: Cite a reliable source for each intervention (name of text, author, page number,

internet site and date retrieved (reliable sites: .gov or .edu. or .org)

…./30

NANDA DIAGNOSIS STATEMENT /RELATED TO STATEMENT/AS EVIDENCED

BY STATEMENT:

ASSESSMENT

(Data that directly

pertains to the

OUTCOME

STATEMENT

INTERVENTIONS

(Individualized,

specific, frequency)

SCIENTIFIC

RATIONALE

EVALUATION

OF OUTCOME

above nursing

diagnosis)

(Patient centered,

realistic, specific,

measurable,

target time)

(Supporting

statement from

text or other

source, cite

source)

(Met, partially

met, unmet,

unknown by

target time)

SUBJECTIVE

DATA: SHORT TERM:

OBJECTIVE

DATA: LONG TERM:

Short term outcome: An outcome that can be accomplished by the end of the student clinical day.

Interventions: Each nursing intervention must come from a reliable nursing reference or source. .

Please note: do not use nursing care planning book exclusively. Not more than one

intervention can come from a source outside your textbooks.

Rationales: Cite a reliable source for each intervention (name of text, author, page number,

internet site and date retrieved (reliable sites: .gov or .edu. or .org)

……………./30

Key Problem: Impaired urinary elimination

Data:

Intake=3800 Output=3200

Polyuria

3+ glucose in urine

AEB: Polydipsia and polyuria

Outcomes:

Pt. will have urine output of 1000 – 2000 ml/24 hours.

Interventions:

Monitor I & O q shift.

Monitor BGM a.c. and h.s.

Monitor kidney function tests

Administer antihyperglycemics as ordered.

Key Problem: Knowledge deficit

Data: Pt verbalizes confusion about diagnosis, new meds, diet, exercise routine

AEB: Verbal statements and questions.

Outcomes:

Pt will verbalize understanding of ADA diet and administer insulin using appropriate technique

by discharge.

Interventions:

Assess level of knowledge regarding diabetes/ treatment and client’s preferred learning style.

Provide information q shift according to teaching plan recorded in EMR and document pt’s

response.

Reassess level of knowledge daily.

Provide written information.

Provide educational resources available in the community.

Medical Problems (Pathophysiology)/Surgical Procedures:

Newly diagnosed diabetic

Key Assessments:

S/S of hyper and hypoglycemia, good intake, I/O, glucose level, vitals

Tests: FBS, hemoglobin A1C

“I don’t know how this fits”

Recent widow

Kids live out of state

? support system

Key Problem: Acute anxiety

Data: Restless, verbally states she is anxious.

AEB: Pt states “I don’t know what I will do with diabetes, this is too much.”

Outcomes: Pt. will verbalize under-standing of resources available by discharge.

Interventions:

Provide pt. with an opportunity each shift to verbalize anxiety by asking open ended questions.

Demonstrate progressive relaxation exercises and have pt. return demonstrate.

Provide pt. with a list of community resources for newly diagnosed diabetics.

Identify client’s perception of anxiety

Utilize empathy.

Past Medical History: Hypertension x 20 years; appendectomy at age 9.

Risk Factors: Mother had Type 2 diabetes; hypertension; Native American descent; sedentary

lifestyle; 290 pounds, age 52

Key Problem:

Imbalanced nutrition, more than

Data:

BMI: 35.0–39.9; Ht: 5”9; Wt: 290 lbs

AEB: Anthropometric measurements.

Outcomes: Client will verbalize a realistic weight loss goal and three strategies to reach it prior

to discharge.

Interventions:

Assess client’s knowledge of nutrition and its relationship to diabetes.

Arrange for dietary consultation.

Reinforce teaching by dietician.

Encourage physical activity as a weight loss strategy.

Provide pt with community resources that can assist her with weight loss goal.

“I DON’T KNOW HOW THIS FITS”

PAST MEDICAL HISTORY

RISK FACTORS

MEDICAL PROBLEMS (PATHOPHYSIOLOGY)/SURGICAL PROCEDURES:

KEY ASSESSMENTS:

Key Assessments:

Tests:

KEY PROBLEM:

DATA:

AEB:

OUTCOMES:

INTERVENTIONS:

KEY PROBLEM:

DATA:

AEB:

OUTCOMES:

INTERVENTIONS:

RUBRIC for Grading Packets

/60pts

KEY PROBLEM:

DATA:

AEB:

OUTCOMES:

INTERVENTIONS:

KEY PROBLEM:

DATA:

AEB:

OUTCOMES:

INTERVENTIONS:

Student Name: Clinical Date: Site:

Section Grading Criteria Satisfactory Or

Unsatisfactory

Comments,

Kudos,

Things to

Improve for

Next Time

10 points

Patient Demographics,

Diagnoses, Surgeries,

Orders, Rehab, IV,

Imaging and Lab

Page 1 fully and correctly

completed 5 pts

Page 2 fully and correctly

completed 5 pts

_/5___

_/5___

20 points

Medications

Medication Trade Name 2 pts

Medication Generic Name 2 pts

Pharmacological Classification 2

pts

Normal Dosage Range 2 pts

Dose ordered 2 pts

Route and Frequency 2 pts

Contraindications 2 pts

Adverse Effects/Reactions 2 pts

Nursing Considerations & Teaching

2 pts

(Legible or typed) 2 pts

/ 2

/ 2

/ 2

/ 2

/ 2

/ 2

/ 2

/ 2

/ 2

/ 2

_/20__

10 points

Narrative Notes

Head-to-Toe

Assessment

Narrative note is in Head to Toe

order

Head-to-toe assessment

documented Abnormal results

noted 10 pts Nursing Care Plan and

Diagnosis for Chronic Pain

___/10_

60 points (either a

Concept Map or a

Patient Care Plan)

Concept Map

Correct Medical Diagnosis 15 pts

Pathophysiology 15 pts

Key Assessments 15 pts

____/60

OR

At least 3 problems identified 15

pts

Nursing Care Plan and Diagnosis

for Chronic Pain

60 points (either a

Concept Map or a

Patient Care Plan)

Patient Care Plan

3 nursing diagnoses Related to”

“As evidenced by” 18 pts

2 Outcomes specific, measurable,

timed 8 pts

4-5 Interventions are logical,

appropriate 15 pts

4-5 Scientific Rationales supporting

each intervention 15 pts 2

Evaluations 4 pts

Evidence-Based Practice in Nursing

Examine the importance of incorporating current research evidence into clinical decision-making

and discuss the steps involved in implementing evidence-based practice in nursing care.

Evidence-based practice (EBP) in nursing is a systematic approach that integrates the best

available research evidence, clinical expertise, and patient preferences to guide clinical decision-

making and improve patient outcomes. It involves critically appraising and applying research

findings to inform nursing practice, ensuring that interventions and care are based on the most up-

to-date and reliable evidence. Here is a detailed explanation of evidence-based practice in nursing:

1. Importance of Evidence-Based Practice:

• Enhancing Patient Outcomes: By incorporating current research evidence into

clinical decision-making, nurses can provide care that is more effective, safe, and

aligned with best practices, leading to improved patient outcomes.

• Ensuring Quality and Safety: Evidence-based practice promotes the use of

interventions and procedures that have been shown to be safe and effective through

rigorous research. This reduces the risk of harm to patients and enhances the overall

quality and safety of nursing care.

• Advancing Professional Development: Engaging in evidence-based practice

encourages nurses to stay updated with the latest research findings, enhancing their

knowledge and professional growth. It also fosters a culture of lifelong learning

within the nursing profession.

2. Steps in Implementing Evidence-Based Practice:

• Formulating a Clinical Question: The first step in evidence-based practice is

formulating a clear and focused clinical question based on the patient's problem or

the nursing intervention under consideration. The question should be structured

using the PICO framework (Population, Intervention, Comparison, Outcome) to

guide the search for relevant evidence.

• Conducting a Literature Search: Once the clinical question is identified, nurses

conduct a systematic search of the literature using databases and other reliable

sources to find relevant research evidence. This includes peer-reviewed journals,

systematic reviews, meta-analyses, and clinical practice guidelines.

• Appraising the Evidence: After identifying relevant research articles, nurses

critically appraise the evidence to evaluate its validity, relevance, and applicability

to the clinical question. This involves assessing the study design, sample size,

methodology, and statistical analysis to determine the quality and strength of the

evidence.

• Synthesizing the Evidence: Nurses analyze and synthesize the findings from

multiple research studies to develop a comprehensive understanding of the

evidence. This includes comparing and contrasting the results, identifying patterns

or consistencies, and determining the overall strength of the evidence.

• Integrating the Evidence: Based on the synthesis of the evidence, nurses integrate

the findings into their clinical decision-making process. They consider the patient's

unique circumstances, preferences, and values, along with their own clinical

expertise, to develop an individualized care plan.

• Evaluating Outcomes: Nurses implement the evidence-based intervention and

closely monitor the patient's response. They collect data on outcomes, evaluate the

effectiveness of the intervention, and make adjustments as necessary. This step

contributes to the ongoing cycle of evidence-based practice, as outcomes are

assessed and used to inform future practice decisions.

3. Barriers and Facilitators of Evidence-Based Practice:

• Barriers: Some common barriers to implementing evidence-based practice in

nursing include time constraints, lack of access to research literature, limited skills

in critically appraising research, resistance to change, and organizational culture

that does not prioritize evidence-based practice.

• Facilitators: Organizations can support evidence-based practice by providing

resources, promoting a culture of inquiry, and offering training and mentorship to

nurses. Collaboration between nurses, researchers, and educators can also facilitate

the integration of research evidence into practice.

4. Ethical Considerations: Nurses must consider ethical principles when implementing

evidence-based practice. This includes obtaining informed consent from patients, ensuring

patient confidentiality, respecting patient autonomy, and considering the potential risks and

benefits of interventions based on the available evidence.

Evidence-based practice is a continuous process that requires ongoing learning, critical thinking,

and integration of research findings into nursing practice. By incorporating

PLEASE READ PROPERLY AND LET ME KNOW IF THIS IS DOABLE AND CAN BE

DELIVERED ON TIME!

Prepare this assignment as a 1,500-1,750 word paper using the instructor feedback from

the previous course assignments and the guidelines below.

PICOT Question

Revise the PICOT question you wrote in the Topic 1 assignment using the feedback you received

from your instructor.

The final PICOT question will provide a framework for your capstone project (the project

students must complete during their final course in the RN-BSN program of study).

Research Critiques

In the Topic 2 and Topic 3 assignments, you completed a qualitative and quantitative research

critique on two articles for each type of study (4 articles total). Use the feedback you received

from your instructor on these assignments to finalize the critical analysis of each study by

making appropriate revisions.

The completed analysis should connect to your identified practice problem of interest that is the

basis for your PICOT question.

Refer to "Research Critiques and PICOT Guidelines – Final Draft." Questions under each

heading should be addressed as a narrative in the structure of a formal paper.

Proposed Evidence-Based Practice Change

Discuss the link between the PICOT question, the research articles, and the nursing practice

problem you identified. Include relevant details and supporting explanation and use that

information to propose evidence-based practice changes.

PICOT QUESTION 1: Describe the difference between a nursing practice problem and a

medical practice problem. Provide one example of each. Discuss why is it important to ensure

your PICOT is based on a nursing practice problem.

ANSWER TO QUESTION:

Pathology is unique to a medical diagnosis, the emphasis is on the disease. On the other hand,

nursing diagnosis focuses on the patient and the reaction to physiology and psychology.

The doctors who make the medical diagnosis come up with such a diagnosis that will cure the

medical condition, while the nurses' diagnosis, thus a nursing diagnosis, focuses on treating such

patients. Furthermore, a medical model deals with sickness or medical status. Using a problem-

solving technique, the doctor focuses on the defect, or dysfunction, within the patient. The

nursing model is not established, but nursing has several practice models/theories that emphasize

nursing's more holistic approach to disease. Finally, a model of nursing deals with the human

reaction to real or possible responses, this kind of practice problem looks at the clinical judgment

about an individual patient, a family, or a community and how they respond to actual or potential

health problems that they are exposed to. A nursing practice problem,therefore, provides nurses

with a basis from which they select appropriate.

On a clinical level, ethical questions arise every day. In a study of the ethical issues encountered

by nurses, Ulrich et al. (2010) found that more than 60% of nurses identified patient’s rights,

autonomy, and informed consent as frequent or daily problems. Other common issues included

advanced care planning, surrogate decision making, end-of-life decision making, and breeches of

confidentiality (Ulrich et al., 2007). Such problems include acute pain, nausea, constipation,

self-care deficit,and risk injury among others. For example, the complimentary nurse practice

problems ofimpaired verbal communication, interrupted family processes, the risk for falls, and

powerlessness provides a general and a more holistic understanding of the impacts of a condition

on a particular patient or family. Also, they help direct nursing interventions .

Ulrich, C. M., Taylor, C., Soeken, K., O’Donnell, P., Farrar, A., Danis, M. & Grady, C. (2010).

Everyday ethics: Ethical issues and stress in nursing practice. Journal of Advanced Nursing

66(11)

Ulrich, C., O’Donnell, P, Taylor, C., Farrar, A., Danis, M. & Grady, C. (2007). Ethical climate,

ethics stress, and the job satisfaction of nurses and social workers in the United States. Social

Science & Medicine

PROFESSOR'S RESPONSE: TOPIC 2

Cinita, Thank you for posting DQ1 Module 2. You discussed strategies that would help a

researcher manage and organize qualitative data. References included. Your post was 1 day late.

Per GCU policy, 10% deducted from the grade.

PROFESSOR'S RESPONSE TOPIC 3":

Cinita, Thank you for posting DQ1 Module 3. Examples of experimental and nonexperimental

research design presented. Level of control for reach research included in post. References

included. Good job

NR602: Pediatric Study Topics

1Pediatric Study Topics

Quiz 2

The following topics could potentially be tested on week 2 quiz. Please note that this is not all inclusive and

questions are randomly generated.

1. Growth and development – There are a lot of potential questions covering from birth to age 17 2. Puberty 3. Tanner Staging 4. Developmental milestones from birth to adolescent 5. Vaccinations 6. Dermatology – contact dermatitis, Atopic dermatitis, Scabies, Hives, Fleas, Ticks, seborrheic dermatitis,

tinea capitis, hemangioma, 7. Upper Respiratory Tract Infection 8. dacryocystitis 9. Otitis Media and Otitis Externa

Quiz 3

The following topics could potentially be tested on week 3 quiz. Please note that this is not all inclusive and

questions are randomly generated.

1. Respiratory Infections 2. Foreign Body Aspiration 3. Restrictive Airway Disease 4. Sinusitis 5. Bronchiolitis 6. Asthma – all levels of severity 7. Pneumonia 8. Rotavirus 9. Salmonella 10. Clostridium difficile 11. Cryptosporidium 12. Pyloric stenosis 13. Pinworms 14. GERD 15. UTI 16. Primary enuresis 17. Glomerulonephritis 18. Osgood-Schlatter 19. Juvenile Rheumatoid Arthritis

NR602: Pediatric Study Topics

20. Osteomyelitis 21. Transient Synovitis of the hip 22. Legg-Calve’-Perthes Disease 23. Idopathic Scoliosis 24. Croup 25. Respiratory syncytial or RSV

Week 4 Midterm

The following topics could potentially be tested on Midterm. Please note that this is not all inclusive and questions

are randomly generated.

1. Growth and development – There are a lot of potential questions covering from birth to age 17 1. Chalazions 2. Blepharitis 3. Otitis media 4. Conjunctivitis 5. Otitis Externa 6. Hand-Foot-Mouth Syndrome 7. Strep Pharyngitis 8. Congenital Heart Defects in Children 9. Kawasaki Disease 10. Rheumatic Fever 11. RSV Bronchiolitis 12. Asthma – all levels of severity 13. Milia 14. Port-wine stain (nevus flammeus 15. Salmon patch 16. Café au lait spot 17. Hemangioma 18. Impetigo 19. Molluscum Contagiosum 20. Verruca Vulgaris 21. Herpetic whitlow 22. Rotavirus 23. Diarrhea 24. Salmonella 25. Clostridium difficile 26. Cryptosporidium 27. Pyloric stenosis 28. Intussusception 29. Celiac Disease 30. Juvenile Idiopathic arthritis 31. Juvenile Rheumatoid Arthritis 32. Osteomyelitis 33. Transient Synovitis of the hip 34. Legg-Calve’-Perthes Disease 35. Idopathic Scoliosis 36. Dysplasia of the hip

NR602: Pediatric Study Topics

37. Scoliosis 38. Osgood-Schlatter 39. Febrile Seizures 40. Contraceptives 41. Testicular Torsion 42. Iron Deficiency Anemia 43. Wilm’s Tumor 44. Turner Syndrome 45. Down Syndrome 46. Precocious puberty 47. Menarche 48. Puberty 49. Primary Dysmenorrhea 50. Coarctation of the aorta 51. Supravalvular Aortic Valve Stenosis 52. Mitral Valve prolapse 53. Dissecting aortic arch 54. Iron Deficiency Aemia 55. Headaches

1

Research Question to Research Implication

Vera Obata

Walden University

SOCW 3004

Dr. Deborah Mills

August 5th , 2021

2

Research Question to Research Implication

Background Information

Drug and alcohol abuse is becoming a major problem that has significantly affected the

lives of many people not only in the United States but also in many countries in the world. In the

25-30 age range, approximately 45% of deaths from homicides, accidents, and suicides involve

drug or alcohol abuse (Jenkins, Slemon & Haines-Saah, 2017). Individuals who abuse alcohol

are at a greater risk of using drugs such as cocaine, marijuana, and heroin. Some people abuse

alcohol and drugs to compensate for depression, anxiety, trauma, and lack of positive social

skills. Apart from being related to lower academic performances, drugs and alcohol have led to

addiction, health-related issues, crime, violence, mental disorders, depression, low self-esteem,

and cyberbullying. It is also a significant influencer of theft and risky sexual behaviors (Tembo,

Burns & Kalembo, 2017). With the increasing negative impacts of drugs and alcohol, significant

strategies should be taken to enable safer use and reduce the challenging effects. Some of these

strategies include education, family-based treatment, connecting with the community, and

community policing.

According to statistics conducted by the National Survey on Drug Use and Health

(NSDUH), roughly 20 million adults in the U.S are battling substance abuse disorder. About

74% of individuals with substance abuse problems also struggle with alcoholism and

approximately 38% suffer from illicit drug use disorder (NIH, 2021). The same body of research

found out that 8.5 million adults have both SUD and mental illnesses. About 40% to 60% of

people’s risk of addiction is caused by genetics counting the impacts of people’s environments

on genetic factor expression. Influences of drug and alcohol abuse include domestic abuse and

violent households, influence, poor achievements in school, and the attitudes of community

3

members towards drugs (Fatima, 2017). Nonetheless, approximately 1.3 million people received

treatment for alcoholism and addiction in 2020. That is estimated to be less than 10 percent of

the people who needed it.

Summary of the Articles

Article 1: Developing harm reduction in the context of youth substance use: insights from a

multi-site qualitative analysis of young people’s harm minimization strategies by Jenkins et

al.

In this article, Jenkins and his colleagues use facts gathered from the Researching

Adolescent Distress and Resilience (RADAR) research study to provide a look into mental issues

and substance use among the youth. The researchers collected data from interviews with young

people in a sample of three communities the rural, suburban, and urban areas (Jenkins, Slemon &

Haines-Saah, 2017). They also conducted a multi-site qualitative analysis to find the themes in

each site of research. The results and findings showed that substance abuse among young people

was shaped by political contexts, socioculturals, and geographic contexts. The strength of this

article is that it provides a rationale of young adult’s experiences of substance use and harm

reduction strategies that can be effectively integrated into this research. This is also one of the

major reasons why it is related to my research question. The authors suggest further research on

reduction strategies across, socially, culturally, and geographically differentiated contexts.

Article 2: The association between levels of alcohol consumption and mental health

problems and academic performance among young university students by Tembo, Burns &

Kalembo

In this article, the researchers investigate the link between alcohol abuse levels and

mental issues and school performance of students in universities. They use a cross-sectional

4

design using information collected from Youth Alcohol Project in 2014. Repondents were

arbitrarily selected from a group of 6000 undergraduates (Tembo, Burns & Kalembo, 2017). The

data collection technique was through an online survey through email invitations. Results

showed that approximately 44% of the participants consumed alcohol at harmful or hazardous

levels. Findings showed that High consumption of alcohol led to mental health problems and

poor academic performances. The strength of this research is that it provides comprehensive data

on mental health problems related to the harmful consumption of alcohol. This is significantly

related to my research question. The limitation is that it does not provide data from recent

studies. Further research is needed on barriers to addressing drug use and mental helath issues

among the youth.

Article 3: Drug Abuse among Youth: Causes, Effects and Control by Iqura Fatima

This article provides an analysis of drug abuse among the youth. Using statistics and data

from government records and other sources the author provides facts and figures on the

prevalence of drug abuse in the country. First, the author provides statistics and facts on drug

abuse including cigarettes and alcohol use. She then provides an analysis of the causes of drug

abuse among young adults including, peer pressure, and depression. She also provides solutions

and remedies to drug abuse (Fatima, 2017). This article is related to my research question and its

main strength is that it provides significant information concerning the prevalence of drug abuse

among young adults. It is also significant since it provides facts and statistics that can be used in

this research. However, one limitation of the methodologies presented in this article is that there

is no primary research. The authors recommend more research on individual interventions for

addressing drug abuse.

5

Article 4: Sensitive periods of substance abuse: Early risk for the transition to dependence

by Jordan and Andersen.

Jordan and Andersen provide an analysis of the sensitive period of substance abuse. They

also provide al look inti lifelong substance abuse disorder (SUD) among the youth and how it

interferes with neurodevelopment. The authors collected data from a different secondary and

primary sources, such as case studies and books to provides the answers to their research

questions (Jordan & Andersen, 2017). The strength of this article is that, it provides data on the

effects of substance abuse and the preventive measures that can be used to answer research

questions effectively. However, the limitation is that the researchers did not have field research

for substantial data. The researchers recommend further research on adolescent and juvenile

periods and sex differences to understand the early risks of substance abuse problems and

effective prevention strategies.

Why it is Important to Know the Limitations of Studies before Using them.

It is imperative to undertand the studies’ limitations to align them with the best reasons

for conducting particular research. By understanding the limitations of research studies,

researchers will be able to anticipate the criticism in their research. It will help them work with

limited resources that dictate the scope of their investigation, possibly realize mistakes in the

design or experimentation post-hoc and what went wrong. Nonetheless, understanding

limitations helps me to build a reputation as a researcher who weighs all the evidence carefully.

Since I want my work to get published in reputable peer-reviewed journals and attract plenty of

citations to help my career, it is critical to understand the limitations of studies.

6

How this Research will Inform my Practice

Evidence-based practice also consists of the practitioner’s expertise and the client’s

preferences, but using the available research will always be a big part. This research will help me

understand which interventions work and who they work with in regards to different cultures and

different presenting problems. “Proving” the efficacy of an intervention is also crucial for

funding as most social workers in non-profit organizations. This research gives me a broader

perspective on the problems, the causes, and the right intervention strategies. This research gave

me the information I needed to design effective interventions for people with alcohol and drug

abuse problems. It also gives me a broader perspective of what clients may be dealing with.

Also, it is vital for delivering high quality.

7

References

Fatima, I. (2017). Drug Abuse among Youth: Causes, Effects, and Control. J Integ Comm Health

2017, 6(1), 1-5. ISSN: 2319 – 9113.

Jenkins, E. K., Slemon, A., & Haines-Saah, R. J. (2017). Developing harm reduction in the

context of youth substance use: insights from a multi-site qualitative analysis of young

people’s harm minimization strategies. Harm reduction journal, 14(1), 1-11. DOI:

https://doi.org/10.1186/s12954-017-0180-z

Jordan, C. J., & Andersen, S. L. (2017). Sensitive periods of substance abuse: Early risk for the

transition to dependence. Developmental cognitive neuroscience, 25, 29-44.

https://doi.org/10.1016/j.dcn.2016.10.004

National Institute On Alcohol Abuse And Alcoholism (NIH). (2021). Alcohol Facts and

Statistics | National Institute on Alcohol Abuse and Alcoholism (NIAAA). NIH.

https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-and-

statistics

Tembo, C., Burns, S., & Kalembo, F. (2017). The association between levels of alcohol

consumption and mental health problems and academic performance among young

university students. PLoS One, 12(6), e0178142.

https://doi.org/10.1371/journal.pone.0178142

● Dysmenorrhea

○ painful menstruation

■ attributed to prostaglandin activity

■ increased leukotriene levels

○ one of the most common complaints

○ pain prevents normal activity and requires medication

○ 3 types of dysmenorrhea:

■ primary (no organic cause)

■ secondary (pathologic cause)

● endometriosis, adenomyosis, pelvic inflammatory disease, cervical stenosis, fibroids, and

endometrial polyps

■ membranous (cast of endometrial cavity shed as a single entity

● rare; it causes intense cramping pain due to passage of a cast of the endometrium

through an undilated cervix

○ Clinical Findings

■ almost always is associated with ovulatory cycles, it does not usually occur at menarche but

rather later in adolescence

■ 14–26% of adolescents miss school or work

■ pain occurs on the first day of the menses – about the time the flow begins

● may not be present until the second day.

■ Nausea

■ Vomiting

■ Diarrhea

■ Headache

■ No significant pelvic disease

■ When symptomatic – generalized pelvic tenderness, perhaps more so in the area of the uterus

than in the adnexa.

■ Occasionally, ultrasonography or laparoscopy is necessary to rule out pelvic abnormalities such

as endometriosis, pelvic inflammatory disease, or an accident in an ovarian cyst.

○ Treatment

■ continuous heat to the abdomen in addition to NSAIDs decreases pain significantly

● Ibuprofen and Naproxen are prefered – First Line

■ Severe Pain

● Codeine or stronger pain medications

● cyclooxygenase-2 (COX-2)

○ Rofecoxib, valdecoxib, and lumiracoxib are effective for treating primary

dysmenorrhea

■ must be used at the earliest onset of symptoms, usually at the onset of, and sometimes 1–2 days

prior to, bleeding or cramping

■ Cyclic administration of oral contraceptives, usually in the lowest dosage but occasionally with

increased estrogen, prevents pain in most patients who do not obtain relief from

antiprostaglandins or cannot tolerate them

● given for 6–12 months. Many women continue to be free of pain after treatment has been

discontinued

● Cystocele aka Anterior Vaginal Prolapse

○ vaginal wall weakens and stretches and allows the bladder to bulge into the vagina

○ Causes-

■ childbirth

■ chronic constipation

■ violent coughing

■ heavy lifting

■ Overweight

■ Age

■ hysterectomy (increased vag weakness)

○ Sx

■ felling of fullness or pressure in vagina

■ increased discomfort when you strain/cough/bear down

■ feeling of incomplete empty

■ repeated bladder infection

■ pain or urinary leak during sex

■ bulge of tissue into vaginal opening

○ Prevention

■ Kegels

■ prevent constipation

■ avoid heavy lifting

■ avoid wt gain

● Rectocele aka Posterior Vaginal Prolapse

○ When thin tissue of vagina separates the vaginal and rectum allowing vaginal wall to bulge

○ Sx

■ soft bulge of tissue in vaginal

■ difficult BM

■ sensation of rectal pressure

■ incomplete emptying after BM

■ sexual concerns-dyspareunia

○ Causes

■ constipation/strain

■ chronic cough

■ heavy lifting

■ Overweight

■ Childbirth

■ age

○ Prevention

■ Kegels

■ prevent constipation

■ avoid heavy lifting

■ Cough

■ avoid wt gain

● Uterine prolapse aka Apical Prolapse

○ pelvic floor muscles and ligaments stretch and weaken and no longer provide support for uterus and

protrude into vagina.

○ Causes

■ Pregnancy

■ large baby delivery

■ lower estrogen level after menopause

■ obesity

■ Common in postmenopausal and one or more childbirth

○ Sx

■ heaviness or pulling into pelvis

■ tissue protruding from vagina

■ urinary probs (leakage, retention)

■ trouble having BM

■ feeling of sitting on small ball

■ sexual concerns

○ Prevention

■ Kegels

■ treat constipation

■ correct lifting

■ avoid wt gain

○ Tx

■ pessary

● STDs

○ Chlamydia Trachomatis

■ Reportable

■ Most infections are asymptomatic

■ 25+ yoa most prevalent

■ Most common STD in USA

■ Annual screening of all sexually active women < 25 as is screening in older women at increased

risk for infection (new sexual partner, more than 1 partner, sexual partner with STI)

■ Sites of infection

● Females: Cervicitis, endometritis, salpingitis, PID

● Males: epididymitis, prostatitis

● Both genders: urethritis, pharyngitis, proctitis

■ Complications:

● PID

● tubal scarring

● ectopic pregnancy

● Infertility

● Reiter’s Syndrome

● Fits-Hugh-Curtis Syndrome

■ Labs

● NAATs- gold standard

● negative whiff w/ mucopurulent d/c and + clue cells

■ Treatment:

● Azithromycin 1g PO single dose OR

● Doxycycline 100mg BID PO x 7d

● Treat partner too.

● Abstain from sex for 7 days after tx.

● Can tx partner without seeing partner in most states

● Pregnant women

○ Do test of cure 3 weeks after tx then again within 3 months

○ Azithromycin 1g PO single dose OR

○ Amoxicillin 500mg TID x 7d.

● Complicated Infections (PID)

○ Rocephin 250 mg IM x 1 dose plus Doxycycline PO BID x 14d with or without

Metronidazole PO BID x 14d.

○ Syphilis

■ chronic, systemic disease caused by a sphirochete transmitted via contact with infectious moist

lesion.

■ Sexually acquired or vertically transmitted from infected mom.

■ Reportable disease

■ Prevention

● Condom

● wash w/ soap and water after sex

● screen ppl @ high risk (men that have sex with men, drug trafficers, correctional facilities)

■ Screen for syphilis if HIV infection, MSM, presence of genital ulcer, previous STD, pregnancy,

intravenous drug use, or high risk.

■ Primary:

● Painless chancre (heals in 6-9 wks if not tx)

● Chancre has clean base, well demarcated with indurated margins

○ Women can have on cervix or inside vagina.

○ Any mucus membrane

■ Secondary:

● Condyloma lata (infectious white papulae in moist areas that look like white warts)

● Maculopapular rash on palms and soles that is NOT pruritic (may be generalized)

● Typically 6 wks – 6 months after onset of primary chancre

● Flu-like symptoms

● General diffuse lymphadenopathy

● Patchy alopecia

● Hepatitis

● Nephritis

■ Latent Stage

● Asymptomatic but has positive titers

■ Tertiary (3-10yrs)

● Neurosyphilis

○ Blindness, paralysis, paresthesias, tabes dorsalis, gait abnormalities,

confusion/dementia

● gumma (soft tissue tumors)

● Aneurysms

● valvular damage

■ Labs

● T pallidum spirochetes on dark field exam of cutaneous lesion

○ Not commonly used.

● 2 types of tests needed to dx syphilis

○ Treponemal

○ Nontreponemal

● Step 1: (Nontreponemal) order rapid plasma regain (RPR) or VDRL. If reactive then order

confirmatory test

● Step 2: (Treponemal) fluorescent treponemal antibody absorption (FTA-ABS),

microhemagglutination test for antibodies (MHA-TP), TPPA

● If RPR and FTA-ABS positive then diagnostic for syphilis.

● If RPR used then order additional RPR to document Tx response

○ Use same laboratory to monitor

● If RPR or VDRL shows fourfold or higher (>1:4) decrease in titers, then pt is responding

to tx.

■ Treatment

● Primary Syphilis, Secondary, or Early Latent Syphilis (<1yr)

○ Benzathine PCN G 2.4 million units IM x 1 dose

● Latent Syphilis (>1yr), Latent unknown duration, Late (tertiary)

○ Benzathine PCN G 2.4 million units IM once per wk x 3 wks

○ PCN allergy: Doxycycline, tetracycline, and for neurosyphilis, Rocephin; use

these with close lab f/u; refer to specialist

■ Follow-up

● Recheck RPR or VDRL at 6-12 months after tx

● TX sexual partners from previous 90 days even if partner testing negative

● Test partner and pt for for HIV and other STDs

● Refer to ID for suspected neurosyphilis, poor response to tx, PCN allergy, or if not

familiar with management.

○ HSV-1 & HSV-2

■ Asymptomatic shedding occurs intermittently and pt is still contagious

■ HSV-1: usually oral infection, sometimes genital

■ HSV-2: causes most cases of recurrent genital herpes, can be oral

■ Clinical Manifestations

● May have prodrome (itching, burning, and tingling) on site.

● Sudden onset of small vesicles sitting on erythematous base.

○ Easily ruptures and is painful

○ Vesicle fluid and crusts are contagious

● Primary episode is more severe and can last from 2-4 wks.

● Recurrent breakouts

○ Virus lays dormant and can be reactivated

■ Treatment

● Herpes viral culture or RPR assay for HSV-1 and HSV-2 DNA.

● Tzanck Smear

○ Old test

● First episode

○ Acyclovir 400 mg TID x 7-10d

■ 200mg 5 times/d x 7-10d.

○ Famciclovir 1g BID x 7-10d

○ Valacyclovir (Valtrex) TID x 7-10d

● Flare-up Tx

○ Best if tx srt within 1 d of onset

○ Famciclovir 125 mg BID x 5d

○ Zovirax BID or TID x 5d or Valtrex BID x 5d

● Suppressive Tx

○ Acyclovir 400 mg BID

○ Famciclovir 250 mg PO BID

■ Prevention

● consistent condom use b/c viral shedding can occur in asymptomatic periods and can

lead to transmission.

■ ALL cases of genital ulcers R/O syphilis and HSV

■ Pregnant women, mechanical methods are used to destroy genital warts

○ Chancroid pg 704

■ Transmitted via sexual contact or on hands that have touched lesion. Caused by Haemophillus

ducreyi

■ Reportable disease

■ Sx

● erythematous papule that evolves into pustule and degenerates into saucer shaped

ragged ulcer that is circumscribed by inflammatory wheal.

● Tender

● heavy foul discharge that is contagious

■ Dx

● culture that grows H ducreyi

■ Tx

● Azithromycin 1 g PO once, ceftriaxone 250 mg IM once, cipro 500 mg PO BID x3 days,

erythromycin 500 mg PO TID x 7d.

● Personal hygiene, clean w/ soap and water, sitz bath

○ Neisseria Gonorrhoeae

■ Reportable

■ Gram negative

■ Can become systemic

■ If positive for gonorrhea, tx for chlamydia too.

■ NO QUINOLONES due to high resistance

■ Labs:

● NAATs

■ Clinical Manifestations

● Purulent green vaginal discharge

● May walk with shuffling gait to avoid pelvic pain

● Speculum exam reveals friable cervix with purulent discharge

● Males will have Penile Discharge with Dysuria

● Vag discharge

● Urinary frequency

● Dysuria

● unilateral swelling of intoitus

● anal itching

● Pain

● Pharyngitis

● Conjunctivitis

● systematic triad (polyarthalgia, tenosynovitis, and dermatitis)

● Usually hx of new partner with in last 3 months or multiple partners

● Inconsistent condom use

● Cervicitis

○ Mucopurulent cervix

○ Pain

○ Bleeding after intercourse

○ Dyspareunia

● Urethritis

○ Scant-copious purulent discharge

○ Dysuria

○ Frequency

○ Urgency

● Proctitis

○ Pruritus

○ Rectal pain

○ Tenesmus

○ Feeling urge to defecate when no stool present

○ Avoidance of defecation due to pain

● Pharyngitis

○ Severe sore throat not responsive to traditional tx

○ Purulent green discharge on posterior pharynx

● Bartholin’s Gland Abscess

○ Cystic lump that is red and warm

■ Located on introitus or vestibule

○ Can have purulent discharge

● Endometritis

○ Menometrorrhagia (heavy prolonged menstrual bleeding)

● Salpingitis and PID

○ One-sided pelvic/lower-abdominal pain

○ Adnexal pain

○ Dyspareunia

○ Cervical motion tenderness

■ Treatment

● Uncomplicated

○ Rocephin 250 mg IM x one dose PLUS

○ Azithromycin 1 g PO once OR

■ Doxycycline 100mg BID x 7d

● Complicated (PID, Salpingitis, Tubo-ovarian abscess, disseminated, asymmetric arthritis

and maculopapular rash

○ Rocephin 250 mg IM once PLUS

○ Doxycycline 100 mg BID x 14d WITH OR WITHOUT

■ Metronidazole 500mg BID x 14d

■ Disseminated Gonococcal infection refer to EMERGENCY DEPARTMENT for ID consult.

● Give rocephin 1g IM or IV q 24hrs

■ Prevention

● Screen all high risk ppl sexually active women age 25 or less

● Use condoms

● Sex partner w/ in 60 days evaluate to tx that sex partner

● > 60 days tx most recent sex partner

● NB receive erythro ointment after delivery

○ Trichomoniasis

■ Caused by flagellated protozoan, mobile

■ Prevention

● Condoms

● decrease # of sex partners

● vulvular hygiene

■ Sx

● purulent malodorous d/c w/ burning itching

● Dysuria

● Frequency

● painful sexl.

● Postcoital bleeding may occur foamy white green d/c

● strawberry appearing cervix

■ Dx

● motile flagellated organisms on saline wet smear, Affirm

■ Tx

● Metronidazole 2g PO single dose OR tinidazole 2 gm in single dose

○ Candidiasis

■ white curd like discharge

■ Common after antibiotic use.

■ Dx

● potassium hydroxide prep—distinct presence of hyphae

■ Tx

● topical azole drugs or PO fluconazole

○ BV

■ most prevalent vaginal infection.

■ * Loss of lactobacilii and increase in vaginal pH

■ fishy odor

■ Risk factors

● multiple sex partner

● Douching

● lack of condom use

● lack of vag lactobacilli

■ Prevention

● condom use

● no douching

■ Sx

● 3 of 4 Amsel criteria

■ Dx

● Gram stain is gold standard

○ saline wet mount with “clue cells”

● Amsel criteria: need 3 of 4 to be dx.

○ thin homogenous white/yellow discharge

○ “clue cells on microscopy

○ fishy odor w/ k hydroxide solution

○ pH of 4.5

■ Tx

● metronidazole 500 mg PO x7 days

● metronidazole gel 0.75 %x5 days

● clinda cream 2% x3 nights OR tinidazole PO x2 days

○ HIV

■ Reportable disease

■ wide spectrum of disease that begins w/ acute viral illness and transitions to chronic and latent

illness.

■ Will progress to AIDS.

■ It depletes CD4 lypmphocyetes which maintains immunity and when falls below 200 pts are @

risk for lifethreatening infections

■ Transmitted

● sexual contact

● parenteral exposure to blood or body fluid infected woman to fetus.

● Heterosexual

■ Prevention

● condom use

● avoid sharing needles

● universal precautions w/ jobs

● good prenatal care

● Screen high risk populations

■ Sx

● wt loss

● Fever

● night sweats

● Pharyngitis

● Lymphadenopathy

● reddened maculopapular rash

● extragenital lymphadenopathy

■ Dx

● HIV-1 antibody

○ Ppl develop detectable levels after 12 wks of exposure.

● ELISA.

● Viral load/CD4 count is useful in determining activity of disease

■ Tx

● managed by specialist

● Use high active antiretroviral therapy (HAART)

■ maternal transmission of HIV can occur transplacentally before birth, peripartum via blood and

bodily fluid exposure or thru BF.

○ Hepatitis B

■ Reportable disease

■ caused by Hep B virus

■ transmitted via blood with other concentration in wound exudate, semen vag secretions, and

saliva.

■ Transmitted via percutaneous or mucous mem w/exposure to blood or body fluid.

■ Can cause liver failure and death

■ Risk factors

● unprotected sex w/ infected partner

● hx of STD

● illegal injection drug use.

■ Prevention

● Hep B immune globulin-provides 3-6 mo protection and used post exposure prophylaxis

in adjunct to vaccine or in unvaccinated person and Hep B vaccine.

● Hep B Vaccine

○ contains HBsAg provides protection from pre and post exposure, require series.

● Routinely screen ALL preg women.

● Unvaccinated or those who do not respond to Hep b vaccine series should be given

HBIG and vaccine if exposed.

■ Sx

● Asymptomatic

● Constitutional @ first

○ Anorexia

○ Nausea

○ Jaundice

○ RUQ pain

■ Dx

● presence of igM antibody is dx

■ Tx

● supportive care.

● No effective antiviral drugs

○ Hepatitis C

■ Caused by Hep C virus through parenteral exposure of contaminated blood

■ Prevention

● no vaccine

● reducing transmission and chronic liver disease.

● + pt do not donate blood

● don’t use razors or toothbrushes

■ Sx

● asymptomatic or mild illness.

■ Dx

● nucleic acid PCR

■ Tx

● interferon and ribavirin

● Vosevi (sofosbuvir/ velpatasvir/voxilaprevir; Gilead) and Mavyret

(glecaprevir/pibrentasvir; AbbVie) were approved by the US Food and Drug

Administration (FDA) for the treatment and cure of HCV.

● Lichen Sclerosus

○ Most common nonneoplastic epithelial vulvar disorder

○ Benign chronic inflammatory process

○ Causes

■ Vit A deficiency

■ Autoimmune

■ excess enzyme elastase

■ decreased activity of 5-alpha reductase

○ Clinical Findings

■ Intense pruritus occurs, usually in women >60

■ Vulvar pain

■ Dyspareunia

■ Can have asymptomatic white lesions

■ Clinical progression

● Erythema and edema of vulvar skin

● White plaques

● Uniting of white plaques

● Intense itching

● Telangiectasias (small broken blood vessels) and subepithelial hemorrhages

● Erosions, fissures, and ulcerations

● Vulvar skin is thin, wrinkled, and white if chronic

■ HIGH rate of SQUAMOUS CELL cancer.

● Biopsy all new lesions

○ Dx

■ Fixed labia

■ Adhesions

■ Vulvar biopsy to confirm.

○ Treatment

■ Medications

● Oral antihistamines

● Clobetasol dipropionate 0.05% is recommended at the start for immediate relief BID x 2

wks then SID x 2 wks then twice weekly for 2 wks.

○ Decreases incidence of vulvar carcinoma

○ Treat as needed for rest of woman’s life.

● Vulvodynia-Long one…pg 635 got info from FB file

○ persistent pain/burning

○ Sx

■ introital pain on vestibular or vag entry (entry dyspareunia) vestibular tenderness

○ Commonly affects 20-30 yr

○ Tx

■ pelvic floor PT

■ maintain vulvar hygiene

■ avoid constricting clothes and irritating agents.

■ 5% lido cream for pain relief

■ topical estrogen prep

■ after 3 months and no relief tx w/ TCA

● Lichen Simplex Chronicus

○ Clinical Findings

■ Epithelial thickening

■ Hyperkeratosis

■ Usually form chronic irritation from scented pads or chronic vulvovaginal infections.

■ Itching causes the thickening and humid environment causes maceration.

■ Raised white lesion develops and may spread to adjacent thighs, perineum, or perianal skin.

○ Biopsy necessary.

○ Does NOT have inflammatory infiltrate like Lichen Sclerosus

○ Treatment

■ Sitz baths

■ Oral antihistamine

■ Lubricants

■ Medium-potency steroids twice daily.

● Betamethasone dipropionate 0.05%

● Betamethasone valerate 0.1%

● Fluocinolone 0.025%

● Triamcinolone Acetonide 0.1%

■ Intractable cases

● Antidepressants

● subQ intralesional injections of steroids considered.

● Amenorrhea pg 889

○ Primary (no menses by 13 w/o 2ndary sex characteristics OR 15 w/ secondary sex; causes-

chromosomal defect, anatomic anomalies, hormone imbalance, tumor, trauma)

○ absence of menses

○ Pregnancy is most common cause & must be considered in every pt for eval.

○ Primary

■ No menses by age 13 in absence of normal growth or secondary sexual dev. OR

■ No menses by 15 w/ normal growth & secondary sex dev.

● Usually from chromosomal dx such as Turner syndrome

○ Secondary

■ No menses x6 mo

■ pelvic pathology

■ most common cause=pregnancy

■ eating disorder most frequent etiology

■ no menses for 3 or more cycles OR 6 consecutive months in previous menstruation.

○ Causes

■ pregnancy (most common)

■ hypothalamic amenorrhea

■ pit amenorrhea

■ androgen disorders (PCOS, adult onset adrenal hyperplasia),

■ galactorrhea-amenorrhea syndrome.

■ female athlete triad (anorexia, amenorrhea, osteoporosis)

● ASCUS/HSIL results from paper test report

○ ASCUS

■ < 20 yoa: repeat cytology/Pap in 12 months

■ 21-24: repeat pap in 12 months (ok to reflex HPV test)

■ 25-29: preferred is to reflex to HPV. Acceptable is repeat pap in 12 months

■ 30+: if oncogenic HPV positive (subtypes 16 & 18), refer for colposcopy. If HPV negative, repeat

co-testing in 3 years.

■ Per CDC:

● For non-pregnant women between 25 and 65 years of age with ASCUS cytology who

have not had HPV co-testing already, HPV testing is the preferred next step (high-risk

HPV testing only).

● With a negative HPV test (either on co-test or after cytology), repeat co-testing every

three years is recommended.

○ HSIL

■ Suggests more serious changes in the cervix than ISIL. More likely to be associated with

precancer and cancer.

■ Ages 21-24: refer for colposcopy with cervical biopsy

■ 25+: refer for immediate excisional treatment.

● LEEP or cervical conization surgery.

● Pelvic Mass- not in book wondering if they just want us to know how to work it up.

● Vulvar Carcinoma pg 796 in book – from fb file

○ post menopausal women, pruitus

○ 4th most common gyn malignancy

○ 90% of tumors are squamous cell carcinoma

○ disease in postmenopausal women 60-70 yrs

○ Sx

■ vulvar itching

■ Mass

■ vulvar bleeding/pain

■ tumor found incidentally during pelvic

○ Dx

■ biopsy

○ Tx

■ surgery, removal of tumor

● Molluscum Contagiosum

○ Benign epithelial poxvirus-induced tumors

○ Transmit

■ direct person-to-person contact, sexual contact w/ affected

○ Sx

■ Dome shaped

■ Up to 1cm (pin size up to eraser size)

■ Multiple contagious lesions

■ Look-a-likes of Chondylomata Acuminata

■ Have inclusion bodies (molluscum) under microscope

■ have small indentation (umbilication)

■ Itchy

■ may be seen on genitals

■ lower abd and inner thighs if was spread sexually

○ Prevent

■ wash hands

■ avoid touching bumps

■ avoid sexual contact

■ cover bumps

○ Treatment

■ Individual lesions

■ Desiccation

■ Freezing

■ Curettage

■ Chemical cauterization

■ Topical imiquimod

○ Scarring is frequent

● Condyloma Acuminate (Genital Warts)

○ Verruciform warts

○ Soft flesh pedunculated, flat, papular growths that are keratinized

○ High-risk oncogenic types

■ 16 & 18

■ Any age

○ Cervical HPV usually asymptomatic and appears normal

○ HPV vaccine given at age 11-12 boys and girls

■ 2 doses 6-12 months apart

■ Recommended for gay men

○ Warts may appear on the vagina, external genitals, urethra, anus, penis, nasal mucosa, oropharynx,

conjunctiva

○ Medications

■ Podofilox 0.5% gel or cream BID x 3d Hold tx x 4d then repeat up to 4x.

● NOT in Pregnancy

■ Imiquimod (Aldara) 5% or Zyclara 3.75%

● NOT in Pregnancy

● Apply 3x wk at bedtime for 16 wks

● Leave on skin for 6-10 hrs then wash off

■ Sinecatechins 10% (External Warts only)

● Apply to each wart while wearing glove 3x/d x 16wks

● Wash off for sexual contact or before inserting tampons

● Weakens condoms and diaphragms

○ Other Tx

■ Corry Laser

■ Electrocautery

■ Bichloracetic or Trichloroacetic Acid surgical excision in clinic.

● Condyloma Lata (Secondary Syphilis) see syphilis

○ Generalized maculopapular rash on trunk and proximal extremities and spreads to entire body including

palms, soles and scalp.

● Androgen insensitivity/resistance Syndrome

○ when a person who is genetically male (who has one X and one Y chromosome) is resistant to male

hormones (called androgens).

○ As a result, the person has some or all of the physical traits of a woman, but the genetic makeup of a

man.

○ caused by genetic defects on the X chromosome

○ Two Types

■ complete AIS

● the penis and other male body parts fail to develop.

● At birth, the child looks like a girl.

● The complete form of the syndrome occurs in as many as 1 in 20,000 live births.

■ partial AIS

● people have different numbers of male traits.

● Can include other disorders, such as:

● Failure of one or both testes to descend into the scrotum after birth

● Hypospadias, a condition in which the opening of the urethra is on the underside

of the penis, instead of at the tip

● Reifenstein syndrome (also known as Gilbert-Dreyfus syndrome or Lubs

syndrome)

■ Infertile male syndrome is also considered to be part of partial AIS

○ From the book word for word

■ The complete forms of androgen insensitivity are also associated with amenorrhea and normal

breast development. Affected persons have normal testicular function but are not responsive to

testosterone, and the development of breasts is secondary to the small amounts of unopposed

estrogens produced by the testis. Pubic and axillary hair is scant or often absent. A short blind

vaginal pouch is present. Once pubertal development has been completed, surgical extirpation of

the gonads and reconstruction of the vagina are necessary. Recent data suggest that regardless

of the technique used, sexual function may be impaired in some of these young women. A study

of 66 women with complete forms of androgen insensitivity showed that 90% had sexual

difficulties, most commonly sexual infrequency and vaginal penetration difficulty.

● Turner’s Syndrome aka Gonadal Dysgenesis pg 593

○ Disorder of females by absence of all/part of 2nd sex chromosome. 1 of 2 X chromosomes. Infertile

○ Sx

■ congenital lymphedema

■ short stature

■ gondal dysgenesis

■ broad chest

■ small nipples

■ webbed neck

■ coarctation of aorta

■ renal abdnormalities

■ epicanthal folds

■ Nevi

■ short 4th metacarpal

○ Need gondal hormone therapy for sex dev., enhancement of growth, & maintenance of sex reprod tissue

● CDC Recommendations regarding STDs and PID- think I answered in STI section.

○ From FB file

■ STD screening recommendations— ● All adults & adol 13-64 @ lease 1x for HIV ● Annual chlamydia & gonorrhea screen for sex active women less than 25 OR older

if multiple sex partner ● Syphillis, HIV, Hep B for all preg women, chlamydia and gonorrhea early in preg ● Yearly for syphilis, gonorrhea, chlamydia for Gay, bisexual, and MSM

● UTI- pg 748 from FB files

○ Can be complicated OR uncomplicated.

○ E.Coli is primary cause

○ Risk factors

■ Preg

■ DM

■ no void after sex

■ Improper toileting hygeine

○ UA dipstick:

■ +WBC

■ Nitrates + or – (E.coli converts nitrate to nitrite)

■ RBC cast (pylonephritis)

■ WBC cast (glomeruloarnephritis inflamm)

○ *Uncomplicated (healthy 18-65 yr- 3 day tx) not necessary for C&S.

■ Check for previous Abx.

■ Tx w/ Bactrim BID, Macrobid x5 days.

■ If sx persist then do culture.

■ Pyrdium for pain.

○ *Complicated (elderly, recurrent, children) Tx for 7 days or longer

■ Cipro 500 mg BID x7-10 days OR

■ Macrobid 7-10 days, if allergy Keflex

● Interstitial Cystitis aka Painful Bladder Syndrome

○ NOT an STD/STI

○ chronic condition causing bladder pressure, pain, and sometimes-pelvic pain

○ Sx

■ pelvic pain

■ persistent urge to urinate

■ Frequency

■ pain as bladder fills

■ pain w/ sex

○ Risk factors

■ female, >30

○ Tx

■ pelvic PT

■ NSAIDs

■ TCA (relax bladder and block pain)

■ Antihistamine

■ pentosan polysulfate sodium

● PID – 721

○ inflamm of upper female genital tract w/ combo of endometritis, salpingitis, tubo-ovarian abscess, and

pelvic peritonitis.

○ Prevention

■ Screening

■ tx sexually active women and sex partners for gonorrhea and chlamydia

○ Sx

■ insidious or acute lower abd/pelvic pain usually bilateral

■ Pelvic pressure/back pain ass w/ purulent vag discharge

■ Nausea

■ HA

■ fever is NOT necessary

■ Abd tenderness

■ may be distended bowel sounds hypo or absent

■ Bimanual= extreme tenderness or cervix

○ ****CDC says empiric tx should be initiated in sex active young women and those @ risk for STD and if 1

or more of following criteria- cervical motion tenderness, uterine tenderness, and adnexal tenderness.

○ DX

■ +endocervical swabs…but all may be normal.

○ Tx

■ empirically with presumptive dx.

■ Rocephin 250 IM AND doxycycline 100 mg BID x14 PLUS metronidazole 500 mg BID x14

● Pyelonephritis- 484 and 364

○ bacteria in urine culture/ bacterial infection of kidney

○ Sx

■ Fever

■ Shaking

■ Chills

■ CVA tenderness

■ N/V

■ HA

■ increased urinary frequency

■ dysuria

■ –pyuria on UA w/ WBC casts….absence of pyuria should raise suspicion for other dx.

○ Dx

■ UA w/ culture

○ Tx

■ (outpt) Bactrim 14-21 days

■ antipyretics for fever

● Cervical Cancer Screening – 609? Or 819

○ Screening Methods for Average-Risk Asymptomatic Women

■ Age 21 to 29: Every 3 years with cytology (Pap testing), regardless of age of onset of sexual

activity or other risk factors.

■ Age 30 to 65: Every 5 years with HPV co-test (Pap + HPV test) OR every 3 years with cytology.

○ When NOT to Screen

■ Younger Than Age 21: Screening is not recommended for women younger than age 21.

■ Older Than Age 65: No screening past age 65 if adequate prior screening can be assessed

accurately (three consecutive negative cytology results or two consecutive negative HPV results

within 10 years before screening cessation, with the most recent test occurring within 5 years)

and not otherwise at high risk for cervical cancer.

■ No Cervix: No screening if the cervix was removed for a benign reason.

● USPSTF recs regarding breast exams

○ Women, Age 50-74 Years

■ The USPSTF recommends biennial screening mammography for women 50-74 years.

○ Women, Before the Age of 50 Years

■ the decision to start regular, biennial screening mammography before the age of 50 years should

be an individual one and take patient context into account, including the patient's values

regarding specific benefits and harms.

○ Women, 75 Years and Older

■ The USPSTF concludes that the current evidence is insufficient to assess the benefits and harms

of screening mammography in women 75 years and older.

○ All Women

■ The USPSTF recommends against teaching breast self-examination (BSE).

● BMI

○ Below 18.5 = Underweight

○ 18.5-24.9 = Normal

○ 25.0-29.9 = Overweight

○ 30.0+ = Obese

● Cervix/Uterus examination

○ Cervix

■ firm structure 3-4 cm diameter

■ projects into vagina.

■ Multiparous may have laceration

■ irregular shape or nodularity may be r/t nabothian cyst

■ Firm may be tumor or cancer

■ Normally mobile can be moved 2-4cm w/o pain

● restricted movement could mean inflammation

○ Friable cervix

■ easily irritated

■ prone to bleeding esp after intercourse

■ suspicious for cervical cancer firm and easily friable

○ Uterus

■ 1/2 size of pt’s fist

■ Pear shaped thick walled organ between base of bladder and rectum.

■ 2 portions

● The body

● smaller cervix below.

● Gravida/Para

○ Gravida = total number of pregnancies, regardless of outcomes

○ Para= number of births

■ Broken down into

● Full-term

● Preterm at or beyond 20 wks

● Abortions pregnancy ending before 20 wks either induced or spontaneous

● Living Children

● Mammogram

○ Breast US & mammo reason

○ screening method for breast ca.

■ Cancer may be id 2 yr before size detected via palpation.

○ US

■ not recommended for screening in general population.

■ IS AN ADJUNCT TO ABNORMAL MAMMO.

■ May be added to high-risk woman.

■ Can help decrease false-neg rate of mammo and eval mammographically occult palpable breast

mass

● Bartholin Glands Abscess and Cysts

○ Enlargement in postmenopausal pt may reflect malignant process.

○ Blockage of main duct of bartholin gland resulting in retention of secretions and cystic dilatation.

■ Infection

■ Congenital narrowing

■ Inspissated mucus

○ Secondary infection may result in recurrent abscess formation

○ Dx by clinical exam

○ Clinical findings

■ Pain

■ Tenderness

■ Dyspareunia

■ Difficulty walking

■ Surrounding tissues may become inflamed and edematous

■ Fluctuant tender mass palpable

○ Treatment

■ Drainage of infected cyst by marsupialization or inserting Word catheter.

■ Incision made by vestibule.

■ May need to remove entire cyst, especially in postmenopausal

■ Abx

■ Sitz Bath

■ Warm Compresses

● Skene’s Glands

○ Large paraurethral gland that opens beside the external urethral orifice in the vestibule.

○ located on the anterior wall of the vagina around the lower end of the urethra.

○ secrete a fluid that helps lubricate the urethral opening, and are surrounded with tissue that swell with

blood during sexual arousal

● Nabothian Gland and Cyst

○ Gland of the cervix that secretes mucus

○ Cysts

■ When a cleft or tunnel of columnar endocervical epithelium becomes covered by squamous

metaplasia.

■ Appear translucent or yellow

■ Carry in diameter up to 3cm.

■ don’t cause pain, discomfort, or other symptoms

■ No treatment unless very large

● Excision

● Electrocautery ablation

● Cryotherapy

● Contraceptives- i’ll do monday

○ IUD

■ Mechanism of action thought to be

● Spermicidal

● interferes w/ normal dev of ova or fertilization

● causes cervical mucus to thicken

■ T shaped frame.

■ Can cause anovulation

■ Contraindications:

● Active PID or hx PID within last yr

● Suspected or confirmed pregnancy or has STD

● Uterine or cervical abnormality

● Undiagnosed vaginal bleeding or uterine/cervical cancer

● History of ectopic pregnancy

■ Increased Risk

● Ectopic pregnancy

● Spontaneous abortion

○ If pregnant with device in place then 50/50 chance of abortion

○ Removal of device while pregnant reduces the spontaneous abortion rate by

50%

● Endometrial and pelvic infections

● Perforation of the uterus

● Heavy or prolonged menstrual periods

■ Education

● Pt to check for missing or shortening of string periodically, esp after each menstrual

period.

● If no string order pelvic ultrasound

■ Good for:

● wanting less menses flow (increased initially, but then decreases by 70%)

● experience dysmenorrhea

● have DUB.

■ Positives

● can be nulliparious,

● inserted same day

● Can start immediately postpartum

○ Implant-[Nexplanon]

■ 3 yr usage, placed in upper arm, contains 68 mg of etonogesterl

■ Can be inserted anytime after pregnancy.

■ Positives

● high efficacy, long term, can use w/ lactation

■ Negatives

● bleeding irregularities

● wt gain

● Emotions

● Acne

● Depression

■ Ovulation may not return for 12 months after removal

○ OCP- estrogen & progestin

■ Positives:

● reduction in ovarian & endometrial cancer risk

● Ectopic

● PID

● menses disorder

● benign breast disease & acne.

■ Negatives:

● Thromboembolism

● Stroke

● AMI

○ Progestin only (mini pill) ME!!!! LOL, I get migraines on estrogen.

■ Safe for breastfeeding mothers

■ MUST take at same time.

● If missed >3hrs then back-up method must be used for 2 days.

● NO PLACEBO PILLS

■ cervical mucus is less permeable to sperms and endometrial activity goes out of [phase.

■ Used for women w/ estrogen contraindication (smoke, older, sickle cell, MR, migraine HA, HTN,

SLE, breastfeeding)

○ Transdermal Patch

■ HIGHER risk of VTE; releases higher levels of estrogen

■ Removed after 7 days and new patch applied.

■ 3 wks on, 1 week off

■ Apply anywhere but breasts.

■ Breakthrough bleeding and spotting with transdermal patch use is similar w/ OCP users.

○ Vaginal Ring- Nuvaring

■ Do NOT use if >35 and smoker.

■ Flexible unfitted ring placed in vagina that releases ethinyl estradiol etonogestrel.

■ 3 wks in/1 wk out.

■ Can still work w/ 3 hours out.

○ Injection/Long acting hormone contraception [Depo medroxyprogesterone acetate]

■ Check for pregnancy before starting

■ Must be given within 5 days of beginning of cycle

■ IM inject q3 months.

■ Not recommended for women wanting pregnancy within 12 months

■ Suppresses ovulation and causes uterine atrophy

■ BLACK BOX warning:

● Avoid long-term use >2yrs because increases risk of osteopenia/osteoporosis that is not

reversible.

■ Avoid use with HX of Anorexia Nervosa

■ Positives:

● low risk of ectopic

● reduced risk of endometrial ca

● does not increase risk of DVT

■ Negatives

● May reduce bone mineral density

● wt gain

● return to baseline to get fertile may take 12 months.

○ Male/female condom/Diaphragm/Cervical cap

■ mechanical barrier between vagina and cervical canal

■ Inserted 6 hrs before and 6-24 after.

■ Has to be fitted by Dr.

■ Side effects

● vaginal wall irritation

■ Cap

● placed over cervix held in place by suction.

● Leave in place 8-48 hrs after sex

○ Emergency Contraceptive

■ delays ovulation by disrupting function of corpus luteum.

■ Med given twice, 12 hours apart.

■ Administer 1st dose within 72 hours of sex.

■ 89% effective

■ Side effects

● nausea/vomiting

○ If vomits within 1 hr of taking, repeat dose

● If no meses within 3 weeks, must return to r/o pregnancy.

● PCOS aka Stein-Leventhal Syndrome

○ Dx

■ 2 out of 3—oligiomenorrhea/amenorrhea, hyperandrogenism, polycystic ovaries on US

○ Hormonal abnormality marked by anovulation, infertility, excessive androgen production, and insulin

resistance.

■ Oligomenorrhea ( infrequent periods)

■ Amenorrhea

■ Bad acne

■ Hirsutism

■ Dark thick terminal hair on face, cheek, beard areas

○ Higher risk for

■ DMT2

■ Dyslipidemia

■ Metabolic syndrome

■ Endometrial hyperplasia

■ Obesity

■ OSA

○ Treatment

■ Transvaginal Ultrasound for multiple follicles

■ Labs

● Serum testosterone – elevated

● DHEA – elevated

● Androstenedione – elevated

● FSH – normal to low

● Fasting BG or OGTT abnormal

● Abnormal lipids

● Insulin resistance

■ Medications

● Low-dose OCPs for hirsutism

● Spironolactone

● If pt does not want OCPs give Provera (medroxyprogesterone) 5-10 mg daily for 10-14

days, repeat every 1-2 months to induce menses.

● Metformin to induce ovulation if pregnancy desired.

● Weight loss to reduce androgen and insulin levels.

■ Complications

● CAD

● DMT2

● Cancer of breast and endometrium

● Central obesity

● Infertility

● Metronidazole

○ inhibits DNA synthesis and rapidly bactericidal

○ Drug of choice for Gardenerella vaginalis, trich, BV

○ Adverse effects

■ do not take w/ ETOH (antabuse like effects)

■ HA

■ N/V

■ metallic unpleasant taste

■ prolonged use can cause peripheral neuropathy

● Cimetidine

○ H2 receptor agonist

○ acid reducer for heartburn and GERD

○ safe in pregnancy, sit up 30 min after

● ACOG guidelines regarding well woman exam

● American Cancer Society recommendations

● ACOG Pap Smear Guidelines

○ Start @ 21, every 3 yrs.

○ Age 30+ PAP & HPV repeat every 5 if negative (co-test) or 3 yr no co-test

○ @65 may stop if (-) hx for 10 yrs or hysterectomy w/o hx of cancer

○ Normal Pap and Negative HPV

■ Rescreen in 5 years

○ Normal Pap and Positive HPV

■ Repeat co-test in 1 yr OR

■ HPV DNA typing now

○ ASCUS Pap, No HPV test

■ Repeat cytology in 1 yr OR

■ Do HPV test now

○ ASCUS/ISIL Pap and Negative HPV

■ Repeat Pap and co-testing every 3 years

○ ASCUS Pap and Positive HPV

■ Colposcopy and/or referral to gynecologist

○ LSIL Pap and Positive or Unknown HPV

■ Colposcopy and/or referral to gynecologist

○ ASC-H Pap

■ Colposcopy and/or referral to gynecologist

○ HSIL Pap

■ Colposcopy and/or referral to gynecologist

NUR 225 Week 9 Course Concepts Presentation Rubric

15-12 points 11-8 points 7-4 points 3-0 points

Provide an introductory slide

• Presents concise introduction of 2 selected concepts

• Presents brief introduction of 2 selected concepts

• Presents minimal introduction of 2 selected concepts

• Lacking introduction of 1

of the selected concepts

• No introduction of 2 selected concepts

25-19 points 18-12 points 11-5 points 5-0 points

Identify and appraise the first selected concept

• Identifies the first selected concept

• Identifies a minimum of 2 exemplars from the course for each concept

• Provides 3 detailed sentences for each exemplar chosen, explaining the importance of first selected concept to each exemplar

• Identifies the first selected concept

• Lacking identification of 1 exemplar from the course for one of the concepts

• Lacks 1 detailed sentence for each exemplar chosen explaining the importance of first selected concept to each exemplar

• Does not identify the first selected concept

• Lacking identification of 1 exemplar from the course for each concept

• Lacks 2 detailed sentences for each exemplar explaining the importance of first selected concept to each exemplar

• Did not identify and appraise the first selected concept

• Lacking identification of any exemplars from the course for each concept

• Did not provide detailed sentences explaining the importance of first selected concept to exemplars in the course

• Information presented in a clear, organized, and professional manner.

• Information presented in a clear, organized, and professional manner.

• Information presented is unclear, unorganized, and/or lacks professional manner.

• All information is relevant and accurate based on sources provided

• 2 inaccuracies within information presented as related to accuracy based on resources provided

• 3 or more inaccuracies within information presented as related to accuracy based on resources provided

25-19 points 18-11 points 11-5 points 5-0 points

Identify and appraise the second selected concept

• Identifies the second selected concept

• Identifies a minimum of 2 exemplars from the course for each concept

• Provides 3 detailed sentences for each exemplar chosen, explaining the importance of first selected concept to each exemplar

• Identifies the second selected concept

• Lacking identification of 1 exemplar from the course for one of the concepts

• Lacks 1 detailed sentence for each exemplar chosen, explaining the importance of second selected concept to each exemplar

• Does not identify the second selected concept

• Lacking identification of 1 exemplar from the course for each concept

• Lacks 2 detailed sentences for each exemplar explaining the importance of first selected concept to each exemplar

• Did not identify and appraise the second selected concept

• Lacking identification of any exemplars from the course for each concept

• Did not provide detailed sentences explaining the importance of first selected

• Information presented in a clear, organized, and professional manner.

• Information presented in a clear, organized, and professional manner.

• Information presented is unclear, unorganized, and/or lacks professional manner.

• All information is relevant and accurate based on sources provided

• 2 inaccuracies within information presented as related to accuracy based on resources provided

• 3 or more inaccuracies within information presented as related to accuracy based on resources provided

concept to exemplars in the course

20-16 points 15-11 points 10-5 points 5-0 points

Identify how the two concepts impact the nurses’ need to use high level clinical judgement

• Presents 3 specific and detailed sentences for each selected topic explaining how each concept impacts the nurse’s need to use high-level clinical judgment

• Information presented in a clear, organized, and professional manner.

• All information is relevant and accurate based on sources provided

• Lacking 1 specific and detailed sentence for each selected topic explaining how each concept impacts the nurse’s need to use high-level clinical judgment

• Information presented in a clear, organized, and professional manner.

• 2 inaccuracies within information presented as related to accuracy based on resources provided

• Lacking 2 specific and detailed sentences for each selected topic explaining how each concept impacts the nurse’s need to use high-level clinical judgment

• Information presented is unclear, unorganized, and/or lacks professional manner.

• 3 or more inaccuracies within information presented as related to accuracy based on resources provided

• Lacking any specific and detailed information on how the two selected concepts impact the nurse’s need to use high- level clinical judgment

25-19 points 18-12 points 11-5 points 5-0 points

Analyze the emerging health initiatives surrounding the two selected concepts

• Identifies a minimum of 2 emerging health initiatives surrounding each of the two selected concepts

• Provides a minimum of 3 detailed sentences for each health initiative describing how/why each of the initiatives are impacting the quality of care for patients

• Identify 2 emerging health initiatives surrounding each of the two selected concepts

• Lacking 1 detailed sentence for each health initiative describing how/why each of the initiatives are impacting the quality of care for patients

• Identify only 1 health initiative surrounding each of the two selected concepts

• Lacking 2 detailed sentences for each health initiative describing how/why each of the initiatives are impacting the quality of care for patients

• Does not identify or analyze emerging health initiatives surrounding each of the two selected concepts

• Lacking any detail as to how/why each of the initiatives are impacting the quality of care for patients

20-16 points 15-11 points 10-5 points 5-0 points

Discuss how to advance workplace communication

• Provides a minimum of 3 strategies to advance workplace communication

• Provides a minimum of 2 detailed sentences describing how each of these strategies advance communication

• Provides brief information on how to advance workplace communication

• Lacks 1 detailed sentence describing how each of these strategies advance workplace communication

• Provides minimal information on how to advance workplace communication

• Lacks 2 detailed sentences describing how each of these strategies advance workplace communication

• Does not provide information on how to advance workplace communication

• Lacking any detail on how each strategy advances workplace communication

related to each chosen course concept

related to each chosen course concept

related to each chosen course concept

related to each chosen course concept

10-8 points 7-5 points 4-3 points 2-0 points

Provide a conclusion to the presentation

• Provides a minimum of 5 detailed conclusion sentences recapping important points within presentation

• Lacking 2 detailed conclusion sentences recapping important points within the presentation

• Lacking 3 or more detailed conclusion sentences recapping important points within the presentation

• Lacking any detailed conclusion sentences recapping important points within the presentation

5 points 4-3 points 2 points 1-0 points

Include 2 APA formatted references and citations

• A minimum of 2 research articles/resources used (submitted with assignment)

• Resources/references cited/listed using appropriate APA formatting with no errors noted

• A minimum of 2 research articles/ resources used (submitted with assignment)

• 2 APA errors noted

• One research article/resource used (submitted with assignment)

• 4 APA errors noted

• No research article/resource used (submitted with assignment)

• 5 or more APA errors noted

5 points 4-3 points 2 points 1-0 points

Writing skills, grammar, spelling, style, and visual format

• Appropriate use of terminology

• No spelling or grammatical errors

• Visual appeal added to presentation

• Information on slides organized and not overwhelming presentation

• Appropriate use of terminology

• 2 or more spelling grammatical errors noted

• Visual appeal added to presentation

• Information on slides organized and not overwhelming presentation

• 4 or more spelling and/or grammatical errors noted

• No visual appeal added to presentation

• Information on slides unorganized and overwhelming to presentation

• Inappropriate use of terminology

• 5 or more spelling and/or grammatical errors noted

• No visual appeal to presentation

• Information on slides unorganized and overwhelming to presentation

Possible Points 150

Note: Assignments that are plagiarized receive no credit and are handled according to the policies related to plagiarism and cheating in the Student Catalog.

How to Write a Nursing Care Plan

How to Write a Nursing Care Plan

Nursing Care Plan Components

A nursing care plan has several key components including,

• Nursing diagnosis

• Expected outcome

• Nursing interventions and rationales

• Evaluation

Each of the five main components is essential to the overall nursing process and care plan. A

properly written care plan must include these sections otherwise, it won’t make sense!

• Nursing diagnosis – A clinical judgment that helps nurses determine the plan of care for

their patients

• Expected outcome – The measurable action for a patient to be achieved in a specific time

frame.

• Nursing interventions and rationales – Actions to be taken to achieve expected

outcomes and reasoning behind them.

• Evaluation – Determines the effectiveness of the nursing interventions and determines if

expected outcomes are met within the time set.

How to Write a Nursing Care Plan

Determine the patient's most significant issues prior to composing the nursing care plan.

Consider both medical and psychosocial difficulties. At times, a patient's psychosocial concerns

may be more pressing or even hold up his or her discharge than the patient's actual medical

problems.

After compiling a list of the patient's issues and the corresponding nursing diagnosis, you must

determine which are the most significant. In general, this is done by contemplating the ABCs

(Airway, Breathing, Circulation). However, these won't ALWAYS be the most significant or

even pertinent for your patient.

Step 1: Assessment

The first step in writing an organized care plan includes gathering subjective and objective data.

Subjective data is what the patient tells us their symptoms are, including feelings, perceptions,

and concerns. Objective data is observable and measurable.

This information can come from,

• Verbal statements from the patient and family

• Vital signs

o Blood pressure

o Heart rate

o Respirations

o Temperature

o Oxygen Saturation

• Physical complaints

o Pain

o Headache

o Nausea

o Vomiting

• Body conditions

o Head-to-toe assessment findings

• Medical history

• Height and weight

• Intake and output

• Patient feelings, concerns, perceptions

• Laboratory data

• Diagnostic testing

o Echocardiogram

o X-Ray

o EKG

Step 2: Diagnosis

Using the information and data gathered in Step 1, the nursing diagnosis that best suits the

patient, his or her hospitalization goals and objectives is selected.

North American Nursing Diagnosis Association (NANDA) defines nursing diagnosis as "a

clinical judgment about the human response to health conditions/life processes, or a vulnerability

for that response, by an individual, family, group, or community."

The nursing diagnosis is founded on Maslow's Hierarchy of Needs and assists with treatment

prioritization. The next stage involves determining the goals for resolving the patient's problems

through nursing interventions based on the nursing diagnosis selected.

There are 4 types of nursing diagnoses.

1. Problem-focused – Patient problem present during a nursing assessment is known as a

problem-focused diagnosis

2. Risk – Risk factors require intervention from the nurse and healthcare team prior to a real

problem developing

3. Health promotion – Improve the overall well-being of an individual, family, or

community

4. Syndrome – A cluster of nursing diagnoses that occur in a pattern or can all be addressed

through the same or similar nursing interventions

After determining which type of the four diagnoses you will use, start building out the nursing

diagnosis statement.

The three main components of a nursing diagnosis are:

1. Problem and its definition – Patient’s current health problem and the nursing

interventions needed to care for the patient.

2. Etiology or risk factors – Possible reasons for the problem or the conditions in which it

developed

3. Defining characteristics or risk factors – Signs and symptoms that allow for applying a

specific diagnostic label/used in the place of defining characteristics for risk nursing

diagnosis

Examples:

PROBLEM-FOCUSED DIAGNOSIS

Problem-Focused Diagnosis related to ______________________ (Related Factors) as

evidenced by _________________________ (Defining Characteristics).

RISK DIAGNOSIS

The correct statement for a NANDA-I nursing diagnosis would be: Risk for _____________ as

evidenced by __________________________ (Risk Factors).

Step 3: Outcomes and Planning

After determining the nursing diagnosis, it is time to create a SMART goal based on evidence-

based practices. SMART is an acronym that stands for,

• Specific

• Measurable

• Achievable

• Relevant

• Time-Bound

It is essential to take into account the patient's medical diagnosis, overall condition, and all

collected data. A physician or other advanced healthcare professional makes a medical diagnosis.

It is essential to remember that a medical diagnosis does not change if the patient's condition

improves, and it remains a permanent part of the patient's medical history.

Examples of medical diagnosis include,

• Chronic Lung Disease (CLD)

• Alzheimer’s Disease

• Endocarditis

• Plagiocephaly

• Congenital Torticollis

• Chronic Kidney Disease (CKD)

During this period, you will also consider the patient's goals and short- and long-term outcomes.

These objectives must be achievable and desired by the patient. For instance, if a goal is for the

patient to seek counseling for alcoholism during hospitalization, but the patient is currently

detoxifying and experiencing mental distress, this goal may not be achievable.

Step 4: Implementation

Now that the objectives have been established, you must take the necessary steps to assist the

patient in achieving them. While some actions will produce immediate results (e.g.,

administering a suppository to a patient with constipation to induce a digestive movement),

others may not be observed until later in the hospitalization.

The implementation phase means performing the nursing interventions outlined in the care plan.

Interventions are classified into seven categories:

• Family

• Behavioral

• Physiological

• Complex physiological

• Community

• Safety

• Health system interventions

Some interventions will be patient or diagnosis-specific, but there are several that are completed

each shift for every patient:

• Pain assessment

• Position changes

• Fall prevention

• Providing cluster care

• Infection control

Step 5: Evaluation

The fifth and final step of the nursing care plan is the evaluation phase. This is when you

evaluate if the desired outcome has been met during the shift. There are three possible outcomes,

• Met

• Ongoing

• Not Met

On the basis of the evaluation, it can be determined whether the objectives and interventions

need to be modified. Ideally, all nursing care plans, including objectives, should be met prior to

discharge. This is not always true, particularly when a patient is being discharged to hospice,

home care, or a long-term care facility. Initially, you will discover that the majority of care plans

will have ongoing objectives that may be met within a few days or weeks. It depends on the

patient's condition and the desired outcomes.

Consider selecting objectives that the patient is capable of achieving. This will not only help the

patient feel as though they are making progress, but it will also relieve the nurse by allowing

them to monitor the patient's overall progress.

Nursing Care Plan Fundamentals

Nursing care plans contain information about a patient’s diagnosis, goals of treatment, specific

nursing interventions, and an evaluation plan. The nursing plan is constantly updated with

changes and new subjective and objective data.

Key aspects of the care plan include,

• Assessment

• Diagnosis

• Outcome and Planning

• Implementation

• Evaluation

Through subjective and objective data, constantly assessing your patient’s physical and mental

well-being, and the goals of the patient/family/healthcare team, a nursing care plan can be a

helpful and powerful tool.

How to Write a Nursing Care Plan

How to Write a Nursing Care Plan

Nursing Care Plan Components

A nursing care plan has several key components including,

• Nursing diagnosis

• Expected outcome

• Nursing interventions and rationales

• Evaluation

Each of the five main components is essential to the overall nursing process and care plan. A

properly written care plan must include these sections otherwise, it won’t make sense!

• Nursing diagnosis – A clinical judgment that helps nurses determine the plan of care for

their patients

• Expected outcome – The measurable action for a patient to be achieved in a specific time

frame.

• Nursing interventions and rationales – Actions to be taken to achieve expected

outcomes and reasoning behind them.

• Evaluation – Determines the effectiveness of the nursing interventions and determines if

expected outcomes are met within the time set.

How to Write a Nursing Care Plan

Determine the patient's most significant issues prior to composing the nursing care plan.

Consider both medical and psychosocial difficulties. At times, a patient's psychosocial concerns

may be more pressing or even hold up his or her discharge than the patient's actual medical

problems.

After compiling a list of the patient's issues and the corresponding nursing diagnosis, you must

determine which are the most significant. In general, this is done by contemplating the ABCs

(Airway, Breathing, Circulation). However, these won't ALWAYS be the most significant or

even pertinent for your patient.

Step 1: Assessment

The first step in writing an organized care plan includes gathering subjective and objective data.

Subjective data is what the patient tells us their symptoms are, including feelings, perceptions,

and concerns. Objective data is observable and measurable.

This information can come from,

• Verbal statements from the patient and family

• Vital signs

o Blood pressure

o Heart rate

o Respirations

o Temperature

o Oxygen Saturation

• Physical complaints

o Pain

o Headache

o Nausea

o Vomiting

• Body conditions

o Head-to-toe assessment findings

• Medical history

• Height and weight

• Intake and output

• Patient feelings, concerns, perceptions

• Laboratory data

• Diagnostic testing

o Echocardiogram

o X-Ray

o EKG

Step 2: Diagnosis

Using the information and data gathered in Step 1, the nursing diagnosis that best suits the

patient, his or her hospitalization goals and objectives is selected.

North American Nursing Diagnosis Association (NANDA) defines nursing diagnosis as "a

clinical judgment about the human response to health conditions/life processes, or a vulnerability

for that response, by an individual, family, group, or community."

The nursing diagnosis is founded on Maslow's Hierarchy of Needs and assists with treatment

prioritization. The next stage involves determining the goals for resolving the patient's problems

through nursing interventions based on the nursing diagnosis selected.

There are 4 types of nursing diagnoses.

1. Problem-focused – Patient problem present during a nursing assessment is known as a

problem-focused diagnosis

2. Risk – Risk factors require intervention from the nurse and healthcare team prior to a real

problem developing

3. Health promotion – Improve the overall well-being of an individual, family, or

community

4. Syndrome – A cluster of nursing diagnoses that occur in a pattern or can all be addressed

through the same or similar nursing interventions

After determining which type of the four diagnoses you will use, start building out the nursing

diagnosis statement.

The three main components of a nursing diagnosis are:

1. Problem and its definition – Patient’s current health problem and the nursing

interventions needed to care for the patient.

2. Etiology or risk factors – Possible reasons for the problem or the conditions in which it

developed

3. Defining characteristics or risk factors – Signs and symptoms that allow for applying a

specific diagnostic label/used in the place of defining characteristics for risk nursing

diagnosis

Examples:

PROBLEM-FOCUSED DIAGNOSIS

Problem-Focused Diagnosis related to ______________________ (Related Factors) as

evidenced by _________________________ (Defining Characteristics).

RISK DIAGNOSIS

The correct statement for a NANDA-I nursing diagnosis would be: Risk for _____________ as

evidenced by __________________________ (Risk Factors).

Step 3: Outcomes and Planning

After determining the nursing diagnosis, it is time to create a SMART goal based on evidence-

based practices. SMART is an acronym that stands for,

• Specific

• Measurable

• Achievable

• Relevant

• Time-Bound

It is essential to take into account the patient's medical diagnosis, overall condition, and all

collected data. A physician or other advanced healthcare professional makes a medical diagnosis.

It is essential to remember that a medical diagnosis does not change if the patient's condition

improves, and it remains a permanent part of the patient's medical history.

Examples of medical diagnosis include,

• Chronic Lung Disease (CLD)

• Alzheimer’s Disease

• Endocarditis

• Plagiocephaly

• Congenital Torticollis

• Chronic Kidney Disease (CKD)

During this period, you will also consider the patient's goals and short- and long-term outcomes.

These objectives must be achievable and desired by the patient. For instance, if a goal is for the

patient to seek counseling for alcoholism during hospitalization, but the patient is currently

detoxifying and experiencing mental distress, this goal may not be achievable.

Step 4: Implementation

Now that the objectives have been established, you must take the necessary steps to assist the

patient in achieving them. While some actions will produce immediate results (e.g.,

administering a suppository to a patient with constipation to induce a digestive movement),

others may not be observed until later in the hospitalization.

The implementation phase means performing the nursing interventions outlined in the care plan.

Interventions are classified into seven categories:

• Family

• Behavioral

• Physiological

• Complex physiological

• Community

• Safety

• Health system interventions

Some interventions will be patient or diagnosis-specific, but there are several that are completed

each shift for every patient:

• Pain assessment

• Position changes

• Fall prevention

• Providing cluster care

• Infection control

Step 5: Evaluation

The fifth and final step of the nursing care plan is the evaluation phase. This is when you

evaluate if the desired outcome has been met during the shift. There are three possible outcomes,

• Met

• Ongoing

• Not Met

On the basis of the evaluation, it can be determined whether the objectives and interventions

need to be modified. Ideally, all nursing care plans, including objectives, should be met prior to

discharge. This is not always true, particularly when a patient is being discharged to hospice,

home care, or a long-term care facility. Initially, you will discover that the majority of care plans

will have ongoing objectives that may be met within a few days or weeks. It depends on the

patient's condition and the desired outcomes.

Consider selecting objectives that the patient is capable of achieving. This will not only help the

patient feel as though they are making progress, but it will also relieve the nurse by allowing

them to monitor the patient's overall progress.

Nursing Care Plan Fundamentals

Nursing care plans contain information about a patient’s diagnosis, goals of treatment, specific

nursing interventions, and an evaluation plan. The nursing plan is constantly updated with

changes and new subjective and objective data.

Key aspects of the care plan include,

• Assessment

• Diagnosis

• Outcome and Planning

• Implementation

• Evaluation

Through subjective and objective data, constantly assessing your patient’s physical and mental

well-being, and the goals of the patient/family/healthcare team, a nursing care plan can be a

helpful and powerful tool.

Nursing Care Plan and Diagnosis for Chronic Pain Nursing Care Plan and Diagnosis for Chronic Pain

This nursing care plan is designed for patients with chronic discomfort. According to Nanda, chronic pain is the condition in which an individual experiences persistent or intermittent pain that lasts for more than six months. This definition differs from that of acute pain, in which a person experiences agony from one second to six months.

The patient may report typical symptoms of distress, but they have persisted for at least six months. Due to the patient experiencing these symptoms for more than six months, the nurse may observe social and familial relationship disruption, irritability, depression, a "beaten" appearance, exhaustion, or somatic preoccupation.

There are numerous causes of chronic pain, including musculoskeletal disorders such as back pain, treatment-related therapies such as chemotherapy, and pregnancy.

This nursing care plan for chronic back pain includes a nursing diagnosis, nursing interventions, and nursing objectives.

What are intentions for geriatric care? How is a nursing care plan developed? Which nursing care plan literature would you recommend to assist in the creation of a nursing care plan?

Care Plans are frequently developed in various formats. The format is not always crucial, and the format of care plans may vary between nursing institutions and medical employment. Some hospitals may display the information digitally or utilize pre-made templates. The most essential aspect of the care plan is its content, as it will serve as the basis for your care.

Nursing Care Plan for Chronic Pain Please observe the video below for a tutorial on how to construct a care plan in nursing school. Otherwise, please continue down to view the finished care plan.

Scenario

A 56-year-old male presents with complaints of back discomfort. He states that he has experienced consistent lower back pain for the past year. He explains that he decided to come in to have it "checked out" because it is "taking a toll" on his ability to function. He reports that the back pain has left him despondent and exhausted because he cannot perform the same tasks he did a year ago. He also reports that his relationship with his wife and children has been affected. You observe that the patient appears fatigued with dark circles under his eyes and is frequently rubbing his back.

Nursing Diagnosis

Inflammation of the lumbar spine is the cause of the patient's one-year history of consistent lower back pain, disruption of social and familial relationships, depression, fatigue, a "beaten look," and rubbing of the painful area.

Subjective Data

He states that he has experienced consistent lower back pain for the past year. He explains that he decided to come in to have it "checked out" because it is "taking a toll" on his ability to function. He reports that the back pain has left him despondent and exhausted because he cannot perform the same tasks he did a year ago. He also reports that his relationship with his wife and children has been affected.

Objective Data

A 56-year-old male presents with complaints of back discomfort. You observe that the patient appears fatigued with dark circles under his eyes and is frequently rubbing his back.

Nursing Outcomes

-At the next follow-up appointment, the patient will report an improvement in back pain and an increase in daily activities.

-The patient will verbalize his expectations regarding the course of pain treatment and his intended treatment outcomes and objectives.

-The patient will identify five noninvasive pain relief methods to aid in pain management.

-The patient will be instructed verbally on how to take the back pain medication prescribed for him as needed.

Nursing Interventions

At the next follow-up appointment, the nurse will evaluate the patient's report of reduced back pain and an increase in daily activities.

-The nurse will evaluate the patient's expectations regarding the duration of pain treatment and his desired treatment outcomes.

-The nurse will educate the patient on five noninvasive pain relief techniques to aid in pain management.

-The nurse will instruct the patient on how to take the back pain medication prescribed for him as needed.

SAMPLE Block format Soap Note PATIENT INFORMATION

Name: Mr. W.S.

Age: 65-year-old

Sex: Male

Source: Patient

Allergies: None

Current Medications: Atorvastatin tab 20 mg, 1-tab PO at bedtime

PMH: Hypercholesterolemia

Immunizations: Influenza last 2018-year, tetanus, and hepatitis A and B 4 years ago.

Surgical History: Appendectomy 47 years ago.

Family History: Father- died 81 does not report information

Mother-alive, 88 years old, Diabetes Mellitus, HTN

Daughter-alive, 34 years old, healthy

Social Hx: No smoking history or illicit drug use, occasional alcoholic beverage consumption on social celebrations. Retired, widow, he lives alone.

SUBJECTIVE:

Chief complain: “headaches” that started two weeks ago

Symptom analysis/HPI:

The patient is 65 years old male who complaining of episodes of headaches and on 3 different occasions blood pressure was measured, which was high (159/100, 158/98 and 160/100 respectively). Patient noticed the problem started two weeks ago and sometimes it is accompanied by dizziness. He states that he has been under stress in his workplace for the last month.

Patient denies chest pain, palpitation, shortness of breath, nausea or vomiting.

ROS:

CONSTITUTIONAL: Denies fever or chills. Denies weakness or weight loss. NEUROLOGIC: Headache and dizzeness as describe above. Denies changes in LOC. Denies history of tremors or seizures.

HEENT: HEAD: Denies any head injury, or change in LOC. Eyes: Denies any changes in vision, diplopia or blurred vision. Ear: Denies pain in the ears. Denies loss of hearing or drainage. Nose: Denies nasal drainage, congestion. THROAT: Denies throat or neck pain, hoarseness, difficulty swallowing.

Respiratory: Patient denies shortness of breath, cough or hemoptysis.

Cardiovascular: No chest pain, tachycardia. No orthopnea or paroxysmal nocturnal

dyspnea.

Gastrointestinal: Denies abdominal pain or discomfort. Denies flatulence, nausea, vomiting or

diarrhea.

Genitourinary: Denies hematuria, dysuria or change in urinary frequency. Denies difficulty starting/stopping stream of urine or incontinence.

MUSCULOSKELETAL: Denies falls or pain. Denies hearing a clicking or snapping sound.

Skin: No change of coloration such as cyanosis or jaundice, no rashes or pruritus.

Objective Data

CONSTITUTIONAL: Vital signs: Temperature: 98.5 °F, Pulse: 87, BP: 159/92 mmhg, RR 20, PO2-98% on room air, Ht- 6’4”, Wt 200 lb, BMI 25. Report pain 0/10.

General appearance: The patient is alert and oriented x 3. No acute distress noted. NEUROLOGIC: Alert, CNII-XII grossly intact, oriented to person, place, and time. Sensation intact to bilateral upper and lower extremities. Bilateral UE/LE strength 5/5.

HEENT: Head: Normocephalic, atraumatic, symmetric, non-tender. Maxillary sinuses no tenderness. Eyes: No conjunctival injection, no icterus, visual acuity and extraocular eye movements intact. No nystagmus noted. Ears: Bilateral canals patent without erythema, edema, or exudate. Bilateral tympanic membranes intact, pearly gray with sharp cone of light. Maxillary sinuses no tenderness. Nasal mucosa moist without bleeding. Oral mucosa moist without lesions,.Lids non-remarkable and appropriate for race.

Neck: supple without cervical lymphadenopathy, no jugular vein distention, no thyroid swelling or masses.

Cardiovascular: S1S2, regular rate and rhythm, no murmur or gallop noted. Capillary refill < 2 sec.

Respiratory: No dyspnea or use of accessory muscles observed. No egophony, whispered pectoriloquy or tactile fremitus on palpation. Breath sounds presents and clear bilaterally on auscultation.

Gastrointestinal: No mass or hernia observed. Upon auscultation, bowel sounds present in all four quadrants, no bruits over renal and aorta arteries. Abdomen soft non-tender, no guarding, no rebound no distention or organomegaly noted on palpation

Musculoskeletal: No pain to palpation. Active and passive ROM within normal limits, no stiffness.

Integumentary: intact, no lesions or rashes, no cyanosis or jaundice.

Assessment

Essential (Primary) Hypertension (ICD10 I10): Given the symptoms and high blood pressure (156/92 mmhg), classified as stage 2. Once the organic cause of hypertension has been ruled out, such as renal, adrenal or thyroid, this diagnosis is confirmed.

Differential diagnosis:

Ø Renal artery stenosis (ICD10 I70.1)

Ø Chronic kidney disease (ICD10 I12.9)

Ø Hyperthyroidism (ICD10 E05.90)

Plan

Diagnosis is based on the clinical evaluation through history, physical examination, and routine laboratory tests to assess risk factors, reveal identifiable causes and detect target-organ damage, including evidence of cardiovascular disease.

These basic laboratory tests are:

· CMP

· Complete blood count

· Lipid profile

· Thyroid-stimulating hormone

· Urinalysis

· Electrocardiogram

Ø Pharmacological treatment:

The treatment of choice in this case would be:

Thiazide-like diuretic and/or a CCB

· Hydrochlorothiazide tab 25 mg, Initial dose: 25 mg orally once daily.

Ø Non-Pharmacologic treatment:

· Weight loss

· Healthy diet (DASH dietary pattern): Diet rich in fruits, vegetables, whole grains, and low-fat dairy products with reduced content of saturated and trans l fat

· Reduced intake of dietary sodium: <1,500 mg/d is optimal goal but at least 1,000 mg/d reduction in most adults

· Enhanced intake of dietary potassium

· Regular physical activity (Aerobic): 90–150 min/wk

· Tobacco cessation

· Measures to release stress and effective coping mechanisms.

Education

· Provide with nutrition/dietary information.

· Daily blood pressure monitoring at home twice a day for 7 days, keep a record, bring the record on the next visit with her PCP

· Instruction about medication intake compliance.

· Education of possible complications such as stroke, heart attack, and other problems.

· Patient was educated on course of hypertension, as well as warning signs and symptoms, which could indicate the need to attend the E.R/U.C. Answered all pt. questions/concerns. Pt verbalizes understanding to all

Follow-ups/Referrals

· Evaluation with PCP in 1 weeks for managing blood pressure and to evaluate current hypotensive therapy. Urgent Care visit prn.

· No referrals needed at this time.

References

Domino, F., Baldor, R., Golding, J., Stephens, M. (2017). The 5-Minute Clinical Consult 2017 (25th ed.). Print (The 5-Minute Consult Series).

Codina Leik, M. T. (2014). Family Nurse Practitioner Certification Intensive Review (2nd ed.). ISBN 978-0-8261-3424-0

Patient Assessment and Care Plan Instructions to student:

1) Bring one copy of this packet with you to clinical each week.

2) Your instructor will inform you of the number of packets and the dates each packet is due. They may have you complete only portions of or all of the packet.

3) Read the rubric! Each packet is Pass/Fail. You must meet the requirements listed to receive a Pass. Your instructor may ask you to resubmit packets that are incomplete or incorrect.

4) If your instructor asks you to submit the packet electronically, then please record your answers in bold or in a colored or lower case font. This helps us identify your answers more quickly.

PATIENT ASSESSMENT FORM STUDENT NAME: DATE:

CLIENT INITIALS: ROOM # DOB: AGE GENDER :

ADMISSIO N DATE:

CODE STATUS: ALLERGIES: MARITAL STATUS:

OCCUPATIO N (FORMER):

MEDICAL DX: CHIEF COMPLAINT :

PAST HISTORY (SURGERY/PROCEDURE S) WITH DATES

ORDERS

RATIONAL E (Why is this ordered for this client???)

EXAMPLE: DIET

2 g Sodium diet with nectar thick liquids only

Sodium is restricted due to edema in the bilateral lower extremities and nectar thick liquids due to dysphagia from a past stroke.

DIET ACTIVITY I/O VS BGM FOLEY NG PEG/PEJ TUBE WOUND CARE RESPIRATORY TREATMENT

TRACHEOSTOMY SUCTIONING CHEST TUBE SPECIAL EQUIPMENT LAB ORDERS OTHER

REHAB SERVICES

ACTIVITY OR TREATMEN T PLAN & SCHEDULE

RATIONAL E

PHYSICAL THERAPY SPEECH THERAPY

OCCUPATIONAL THERAPY

……/ 5 pts

IVs

IV FLUID AND RATE: SITE LOCATION AND CONDITION: LAST DRESSING CHANGE: LAST TUBING CHANGE: GAUGE: REASON FOR IV ACCESS:

DIAGNOSTIC TESTS: DATE RESULTS REASON FOR TESTING AND

IMPLICATIONS FOR NURSING CARE

LAB TEST DATE RESULTS

NORMS REFERENCE RANGES

IMPLICATIONS FOR NURSING CARE (WHAT S&S I SHOULD BE AWARE OF AND WHAT YOU CAN DO TO HELP IMPROVE AN ABNORMAL RESULT?)

GROWTH and DEVELOPMENT: (see pages 378-379 Taylor, Lillis and White) or (Erikson’s Stages of Development)

CLIENT’S DEVELOPMENTAL STAGE ACCORDING TO HAVIGHUSRT

TASKS OF THIS STAGE:

ASSESSMENT OF CLIENT’S SUCESSFUL ACHIEVEMENT OF TASKS

…../ 5 pts

MEDICATIONS

If your client has more than 12 medications, select the 12 medications that are most important, most frequently given or those that pertain to the client’s most significant medical problems. See the example below.

Brand Name and Generic Name Normal Dosage Ranges Contraindications Coreg (carvedilol)

3.125 mg – 50 mg BID Asthma, heart block

Pharmacotherapeutic Class Dosage, Route & Frequency Adverse Reactions β-adrenergic blocker

6.25 mg p.o. BID

Bradycardia, CHF, thrombocytopenia, hyperglycemia, bronchospasm

Why this Patient Receives this Med

Effects of the Med on the Client

Nursing Considerations and Teaching

He has a history of hypertension but has been taking Coreg for 2 years to control his hypertension

BP’s for past 3 days have been 128/78, 132/72, 138/80

How is this medication impacting your client??B/P readings, lab results, pain management, etc……..

Do not discontinue abruptly or before surgery

Caution with Upper airway dysfunction

Rise slowly to minimize orthostatic hypotension, check B/P and heart rate prior to administration

Take before meals

#1 Brand Name and Generic Name Normal Dosage Ranges Contraindications

Pharmacotherapeutic Class Dosage, Route & Frequency Adverse Reactions

Why this Patient Receives this Med

Effects of the Med on the Client

Nursing Considerations and Teaching

#2 Brand Name and Generic Name Normal Dosage Ranges Contraindications

#3 Pharmacotherapeutic Class Dosage, Route and Frequency Adverse Reactions

Why this Patient Receives this Med

Effects of the Med on the Client

Nursing Considerations and Teaching

#4 Brand Name and Generic Name Normal Dosage Ranges Contraindications

Pharmacotherapeutic Class Dosage, Route and Adverse Reactions

Frequency

Why this Patient Receives this Med

Effects of the Med on the Client

Nursing Considerations and Teaching

#5 Brand Name and Generic Name Normal Dosage Ranges Contraindications

Pharmacotherapeutic Class Dosage, Route and Frequency Adverse Reactions

Why this Patient Receives this Med

Effects of the Med on the Client

Nursing Considerations and Teaching

# 6 Brand Name and Generic Name Normal Dosage Ranges Contraindications

Pharmacotherapeutic Class Dosage, Route and Frequency Adverse Reactions

Why this Patient Receives this Med

Effects of the Med on the Client

Nursing Considerations and Teaching

#7 Brand Name and Generic Name Normal Dosage Ranges Contraindications

Pharmacotherapeutic Class Dosage, Route and Frequency Adverse Reactions

Why this Patient Receives this Med

Effects of the Med on the Client

Nursing Considerations and Teaching

#8 Brand Name and Generic Name Normal Dosage Ranges Contraindications

Pharmacotherapeutic Class Dosage, Route and Frequency Adverse Reactions

Why this Patient Receives this Med

Effects of the Med on the Client

Nursing Considerations and Teaching

#9 Brand Name and Generic Name Normal Dosage Ranges Contraindications

Pharmacotherapeutic Class Dosage, Route and Frequency Adverse Reactions

Why this Patient Receives this Med

Effects of the Med on the Client

Nursing Considerations and Teaching

#10 Brand Name and Generic Name Normal Dosage Ranges Contraindications

Pharmacotherapeutic Class Dosage, Route and Frequency Adverse Reactions

Why this Patient Receives this Med

Effects of the Med on the Client

Nursing Considerations and Teaching

#11 Brand Name and Generic Name Normal Dosage Ranges Contraindications

Pharmacotherapeutic Class Dosage, Route and Frequency Adverse Reactions

Why this Patient Receives this Med

Effects of the Med on the Client

Nursing Considerations and Teaching

#12 Brand Name and Generic Name Normal Dosage Ranges Contraindications

Pharmacotherapeutic Class Dosage, Route and Frequency Adverse Reactions

Why this Patient Receives this Med

Effects of the Med on the Client

Nursing Considerations and Teaching

…../ 20 pts

NURSES NOTES FOR CLINICAL For this clinical, we are having you write out your assessment findings in the form of a narrative nurse’s note. We have provided some samples of assessments. We have also provided a worksheet that you may use to take into a patient’s room to take notes during your assessment. Record your vital signs and type your physical assessment findings. This form will expand to fit your typing. A sample of charting for a long

resident follows below.

TEMP: APICAL HR: RESP: BP: HT: WT:

DATE / TIME

(TYPE HERE)

Sample Narrative Note — Head to Toe format

Temp: 98.6 Apical HR: 72 Resp: 16 BP 128/62 Ht: 5’10” Wt: 145

12/22/2010 1400

Resident in semi-fowlers position in bed. Pressure reduction mattress in place. Alert and oriented x 3. Appropriate mood and affect. Well groomed. Recent and remote memory intact. Facial symmetry noted. Pupils are equal, reactive to light and accommodation. Oral mucosa moist, pink. Frequent oral care rendered with sponge toothette and toothbrush. Dentition intact. Hearing intact. Oropharynx clear without erythema or exudate. No chewing or swallowing difficulties. 75% of general diet taken at breakfast. Skin pink, warm, dry, free of lesions with elastic turgor. Hair and nails unremarkable. Carotid and radial pulses present and equal. Motor and sensory functions grossly intact. No weakness or paralysis. Upper extremities equal strength bilaterally, full ROM w/ capillary refill < 3 sec. Fine resting tremor in the left hand” No involuntary movement or abnormal posture. Lungs clear bilaterally to auscultation. Tracheostomy dressing clean, dry, and intact. Connected to ventilator with settings: TV-550, Fio2-40%, Rate 10, and PEEP-5cm. Sao2-92%. Suctioned for moderate amount of white, thin secretion. Apical pulse regular (rate) and rhythm. Double lumen picc line note to left antecubital space. Tegaderm dressing is clean, dry, and intact. Last dressing change on 11/28/16. Chlorhexadine caps intact to all lumens. Bowel sounds active x 4. Abdomen soft, non-distended, non-tender. Last bowel movement this morning, passed a large, soft- formed brown stool and a moderate amount of clear yellow urine. Bilateral lower extremities, no tenderness, swelling or joint deformities noted. Denies numbness or tingling to extremities. Toe nails thick and yellowed w/ capillary refill < 3 sec. No peripheral edema noted, pedal pulses palpable and equal bilaterally.

PHYSICAL ASSESSMENT WORKSHEET (Use this sheet for jotting down your assessment findings.)

ROUTINE FINDINGS PATIENT VARIATIONS/ABNORMALS COGNITION/NEUROLOGICAL (SAMPLE) Alert and oriented x3, recent and remote memory intact. Denies any numbness or tingling to extremities”

(SAMPLE) “Fine resting tremor of left hand

SKIN

SENSORY

Wound measurements and complete description if available at the very least Document dressing including the type of dressing and description of condition!

BREASTS – DEFERRED.

RESPIRATORY –

(Include ventilator settings as indicated in narrative note)

CARDIOVASCULAR

Include any vascular access device, IV lines, AV fistulas, perma -cath lines, etc.

ABDOMEN –

.

Include any enteral feedings here and route

BOWEL CONTINENCE? LAST BM? BOWEL PLAN?

MUSCULOSKELETAL –

GENITOURINARY –

URINARY CONTINENCE? TOILETING PLAN?

PELVIC – DEFERRED.

RECTAL – DEFERRED.

……/ 10 pts

NURSING CARE PLAN Begin your NCP by listing ALL your clients individual problems (at least 10) and then identify an appropriate nursing diagnosis that you can think of that would apply to your client. Determine which 3 problems/nursing diagnoses are of greatest priority and then add a #1, #2, and #3 to indicate which of the two have highest priority. Risks would not be priority 1, 2, or 3!!!!!

Expectation is to have at least 10 nursing diagnosis listed!

# List the Client problem

An appropriate Nursing Diagnosis stem

(REFER TO YOUR NURSING DIAGNOSIS LIST)

Related to part of the statement (This is individual to your client)

As evidenced by part of the statement (This is individual to your client)

REMEMEBR THIS IS NOT USED IN A “Risk For” diagnosis

1 SAMPLE: Reports severe pain in the right hip.

“Acute Pain” “related to” fractured right hip

“as evidenced by” verbal report of pain rated at an 8 on a scale of 0 –to 10.

2 SAMPLE: Complete bed rest

“Risk for Impaired skin integrity”

“related to “ immobility

NONE it is a “Risk for” diagnosis so there is no evidence statement

From the list above your faculty member will give you direction regarding how many and which diagnoses they want you to develop for either a Nursing Care Plan and/or a Concept Map.

SAMPLE NCP

NANDA DIAGNOSIS STATEMENT /RELATED TO STATEMENT/AS EVIDENCED BY STATEMENT: Acute Pain related to right hip fracture as evidenced by a verbal report of pain rated 8 on a scale of 0 -10.

ASSESSMEN T

(Data that directly pertains to the above nursing diagnosis)

OUTCOME STATEMEN T

(Patient centered, realistic, specific, measurable, target time)

INTERVENTIONS

(Individualized, specific, frequency)

Minimum of 4-5 interventions per plan

SCIENTIFIC RATIONALE

(Supporting statement from text or other source, cite source)

EVALUATIO N OF OUTCOME

(Met, partially met, unmet, unknown by target time)

SUBJECTIVE SHORT 1. Educate the client on 1. “There are many ways Short Term

DATA: “My right hip hurts me so much every time I move. I am so afraid to start physical therapy”

TERM: Client will report pain level rated at a 3 or lower 30 minutes after pain medication taken

the importance of pain relief to enhance her rehabilitation efforts and include education on various types of methods to relieve pain.

2. Encourage client to express any questions or concerns she may have regarding pain management methods to alleviate anxiety and fears.

3. Educate the client on her responsibility to honestly report pain when it occurs as well as reporting if the current pain management is effective or ineffective for providing her pain relief

4. Provide for alternative/complement ary measures of pain relief, such as, reduce lighting and noise, soothing music, pet therapy, massage, and hot/cold packs according to client

to manage pain. In addition to pharmacologic and non- pharmacologic measures, simple nursing interventions can alter patients’ pain experience and speed their recovery.” Taylor, Lillis and White pg. 1168.

2. “Common fears include a loss of control and embarrassment by being unable to deal with pain maturely… The patient may view the need of for medication as a sign of weakness or may fear addiction or loss of effectiveness at a later date.” Taylor, Lillis and White pg. 1169.

3. “As a patient advocate, ensure that a strong emphasis on the need for aggressive, individualized strategies that can minimize or eliminate acute pain and improve patient outcomes. Preventing pain is easier then treating it once after it occurs.” Taylor, Lillis and White pg. 1178.

Goal: Met; pain was rated at a 2 on a scale of 0 to 10 after administration of Vicodin.

Long Term Goal. In progress

preferences.

4. Alternative/complement ary measures will provide an added benefit of distraction from pain experience and augment analgesic effect. Cold/hot therapy can provide constriction and or dilation which will reduce pain inflammation in each specific circumstance Daniels. Pg 378

OBJECTIVE DATA:

Alert and oriented 70 year old widowed female. Lives in an apartment independently. 2 daughter live nearby and visit often.

History of a fall while out shopping 1 ½ weeks ago. Right hip surgically repaired 7 days ago. Surgical dressing to right hip is clean, dry and intact. Circulation, motion and sensation intact

LONG TERM: Client will report pain level of 2 or less using ibuprofen with alternative pain control methods by discharge.

to right lower extremity.

Afebrile; BP 124/80; R-18 AP 84 and regular. 5 foot 7 inches weighs 142 pounds. No hearing deficits; wears eye glasses

Medical history positive for osteoarthritis and osteoporosis

Non weight bearing to right leg and to use a walker for ambulation

To start physical therapy for gait and strength training BID times 7 days and occupational therapy to develop upper body strength once daily times 7 days

Reports pain level is at 8 on a scale of 0 to 10.

Has Vicodin 5mg/325 mg po 2 tabs every 4 hours prn for severe pain

Ibuprofen 400 mg every 6 hours prn for moderate pain.

Short term outcome: An outcome that can be accomplished by the end of the student clinical day.

Interventions: Each nursing intervention must come from a reliable nursing reference or source. Please note: do not use nursing care planning book exclusively. Not more than one intervention can come from a source outside your textbooks.

Rationales: Cite a reliable source for each intervention (name of text, author, page number, internet site and date retrieved (reliable sites: .gov or .edu. or .org)

NANDA DIAGNOSIS STATEMENT /RELATED TO STATEMENT/AS EVIDENCED BY STATEMENT:

ASSESSMENT

(Data that directly pertains to the above nursing diagnosis)

OUTCOME STATEMENT

(Patient centered, realistic, specific, measurable, target time)

INTERVENTIONS

(Individualized, specific, frequency)

SCIENTIFIC RATIONALE

(Supporting statement from text or other source, cite source)

EVALUATION OF OUTCOME

(Met, partially met, unmet, unknown by target time)

SUBJECTIVE DATA: SHORT TERM:

OBJECTIVE DATA: LONG TERM:

Short term outcome: An outcome that can be accomplished by the end of the student clinical day.

Interventions: Each nursing intervention must come from a reliable nursing reference or source. Please note: do not use nursing care planning book exclusively. Not more than one intervention can come from a source outside your textbooks.

Rationales: Cite a reliable source for each intervention (name of text, author, page number, internet site and date retrieved (reliable sites: .gov or .edu. or .org)

…../30

NANDA DIAGNOSIS STATEMENT /RELATED TO STATEMENT/AS EVIDENCED BY STATEMENT:

ASSESSMENT

(Data that directly pertains to the above nursing diagnosis)

OUTCOME STATEMENT

(Patient centered, realistic, specific, measurable, target time)

INTERVENTIONS

(Individualized, specific, frequency)

SCIENTIFIC RATIONALE

(Supporting statement from text or other source, cite source)

EVALUATION OF OUTCOME

(Met, partially met, unmet, unknown by target time)

SUBJECTIVE DATA: SHORT TERM:

OBJECTIVE DATA: LONG TERM:

Short term outcome: An outcome that can be accomplished by the end of the student clinical day.

Interventions: Each nursing intervention must come from a reliable nursing reference or source. . Please note: do not use nursing care planning book exclusively. Not more than one intervention can come from a source outside your textbooks.

Rationales: Cite a reliable source for each intervention (name of text, author, page number, internet site and date retrieved (reliable sites: .gov or .edu. or .org)

…./30

NANDA DIAGNOSIS STATEMENT /RELATED TO STATEMENT/AS EVIDENCED BY STATEMENT:

ASSESSMENT

(Data that directly pertains to the above nursing diagnosis)

OUTCOME STATEMENT

(Patient centered, realistic, specific, measurable, target time)

INTERVENTIONS

(Individualized, specific, frequency)

SCIENTIFIC RATIONALE

(Supporting statement from text or other source, cite source)

EVALUATION OF OUTCOME

(Met, partially met, unmet, unknown by target time)

SUBJECTIVE DATA: SHORT TERM:

OBJECTIVE DATA: LONG TERM:

Short term outcome: An outcome that can be accomplished by the end of the student clinical day.

Interventions: Each nursing intervention must come from a reliable nursing reference or source. . Please note: do not use nursing care planning book exclusively. Not more than one intervention can come from a source outside your textbooks.

Rationales: Cite a reliable source for each intervention (name of text, author, page number, internet site and date retrieved (reliable sites: .gov or .edu. or .org)

……………./30

Key Problem: Impaired urinary elimination

Data:

Intake=3800 Output=3200

Polyuria

3+ glucose in urine

AEB: Polydipsia and polyuria

Outcomes:

Pt. will have urine output of 1000 – 2000 ml/24 hours.

Interventions:

Monitor I & O q shift.

Monitor BGM a.c. and h.s.

Monitor kidney function tests

Administer antihyperglycemics as ordered.

Key Problem: Knowledge deficit

Data: Pt verbalizes confusion about diagnosis, new meds, diet, exercise routine

AEB: Verbal statements and questions.

Outcomes:

Pt will verbalize understanding of ADA diet and administer insulin using appropriate technique by discharge.

Interventions:

Assess level of knowledge regarding diabetes/ treatment and client’s preferred learning style.

Provide information q shift according to teaching plan recorded in EMR and document pt’s response.

Reassess level of knowledge daily.

Provide written information.

Provide educational resources available in the community.

Medical Problems (Pathophysiology)/Surgical Procedures:

Newly diagnosed diabetic

Key Assessments:

S/S of hyper and hypoglycemia, good intake, I/O, glucose level, vitals

Tests: FBS, hemoglobin A1C

“I don’t know how this fits”

Recent widow

Kids live out of state

? support system

Key Problem: Acute anxiety

Data: Restless, verbally states she is anxious.

AEB: Pt states “I don’t know what I will do with diabetes, this is too much.”

Outcomes: Pt. will verbalize under-standing of resources available by discharge.

Interventions:

Provide pt. with an opportunity each shift to verbalize anxiety by asking open ended questions.

Demonstrate progressive relaxation exercises and have pt. return demonstrate.

Provide pt. with a list of community resources for newly diagnosed diabetics.

Identify client’s perception of anxiety

Utilize empathy.

Past Medical History: Hypertension x 20 years; appendectomy at age 9.

Risk Factors: Mother had Type 2 diabetes; hypertension; Native American descent; sedentary lifestyle; 290 pounds, age 52

Key Problem:

Imbalanced nutrition, more than

Data:

BMI: 35.0–39.9; Ht: 5”9; Wt: 290 lbs

AEB: Anthropometric measurements.

Outcomes: Client will verbalize a realistic weight loss goal and three strategies to reach it prior to discharge.

Interventions:

Assess client’s knowledge of nutrition and its relationship to diabetes.

Arrange for dietary consultation.

Reinforce teaching by dietician.

Encourage physical activity as a weight loss strategy.

Provide pt with community resources that can assist her with weight loss goal.

“I DON’T KNOW HOW THIS FITS”

PAST MEDICAL HISTORY

RISK FACTORS

MEDICAL PROBLEMS (PATHOPHYSIOLOGY)/SURGICAL PROCEDURES:

KEY ASSESSMENTS:

Key Assessments:

Tests:

KEY PROBLEM:

DATA:

AEB:

OUTCOMES:

INTERVENTIONS:

KEY PROBLEM:

DATA:

AEB:

OUTCOMES:

INTERVENTIONS:

RUBRIC for Grading Packets

/60pts

KEY PROBLEM:

DATA:

AEB:

OUTCOMES:

INTERVENTIONS:

KEY PROBLEM:

DATA:

AEB:

OUTCOMES:

INTERVENTIONS:

Student Name: Clinical Date: Site:

Section Grading Criteria Satisfactory Or Unsatisfactory

Comments, Kudos,

Things to Improve for Next Time

10 points

Patient Demographics,

Diagnoses, Surgeries, Orders, Rehab, IV, Imaging and Lab

Page 1 fully and correctly completed 5 pts

Page 2 fully and correctly completed 5 pts

_/5___

_/5___

20 points

Medications

Medication Trade Name 2 pts

Medication Generic Name 2 pts

Pharmacological Classification 2 pts

Normal Dosage Range 2 pts

Dose ordered 2 pts

Route and Frequency 2 pts

Contraindications 2 pts

Adverse Effects/Reactions 2 pts

Nursing Considerations & Teaching 2 pts

(Legible or typed) 2 pts

/ 2

/ 2

/ 2

/ 2

/ 2

/ 2

/ 2

/ 2

/ 2

/ 2

_/20__

10 points

Narrative Notes

Head-to-Toe Assessment

Narrative note is in Head to Toe order

Head-to-toe assessment documented Abnormal results noted 10 pts Nursing Care Plan and Diagnosis for Chronic Pain

___/10_

60 points (either a Concept Map or a Patient Care Plan)

Concept Map

Correct Medical Diagnosis 15 pts

Pathophysiology 15 pts

Key Assessments 15 pts

At least 3 problems identified 15 pts

Nursing Care Plan and Diagnosis for Chronic Pain

____/60

OR

60 points (either a Concept Map or a Patient Care Plan)

Patient Care Plan

3 nursing diagnoses Related to” “As evidenced by” 18 pts

2 Outcomes specific, measurable, timed 8 pts

4-5 Interventions are logical, appropriate 15 pts

4-5 Scientific Rationales supporting each intervention 15 pts 2 Evaluations 4 pts

Nursing Care Plan for Pain with Diagnosis and Nursing Intervention

Nursing Care Plan for Pain with Diagnosis and Nursing Intervention

Pain classifications Acute pain:

Mild to severe pain lasting less than six months; associated with a sympathetic nervous system response; resulting in increased pulse rate and volume, increased respiratory rate and depth, increased blood pressure, and increased glucose levels; decreased urine production and peristalsis.

The protective function of acute pain is to alert the patient of injury or infection. The onset of sudden severe pain prompts the patient to seek solace. The physiological manifestations of acute pain result from the body's tension response to the pain. Acute pain may be exacerbated by the patient's cultural context, emotions, and psychological or spiritual distress. The assessment of pain can be challenging, particularly in elderly patients with cognitive impairment and sensory

perception deficits. Chronic ache:

Mild to severe pain lasting longer than six months; associated with the parasympathetic nervous system; the patient may not exhibit acute pain-related signs and symptoms. may result in despondency and diminished function

Terms for suffering

Pain threshold is the minimum quantity of stimulus required to produce a painful sensation. The maximum quantity of pain that a patient is willing or able to tolerate. Pain felt in a location other than the origin of a tissue injury Pain that cannot be relieved by conventional treatments is untreatable. Neuropathic pain: agony caused by a neurological disorder and unrelated to tissue damage Phantom pain: pain felt in an absent body part Radiating pain: pain felt at the source that spreads to other locations.

Plan of nursing care for pain that includes intervention and pain

Affiliated with suffering

medical concerns Diagnostic techniques and medical care emotionally and mentally traumatic Aspirational Cultural distress.

Desired Results

On a scale from 0 to 10, the patient reports adequate pain control with a score of less than 3 to 4. The patient is capable of utilizing both pharmacologic and nonpharmacologic pain relief strategies. Patient feels more at ease, as demonstrated by a regulated pulse, blood pressure, respiration, and calm muscle tension and posture.

May be exemplified by.

Protective behavior, body protection, egocentric, narrowed focus Relief or diversion methods

Pain masking the face Consideration of muscular tone

Nursing care plan for pain with intervention and rationale

Nursing intervention Rationale

Assessment of pain characteristics. ex. Quality, severity, location, onset, duration, precipitating and relieving factors

Assessment of the pain experience is the first step in planning pain management strategies. The patient is the most reliable source of information about his or her pain.

Screening for signs and symptoms related to pain.

Some people deny the sensation of pain even though it is present. Paying attention to signs associated with pain can help the nurse assess pain. A patient with acute pain may have elevated blood pressure, heart rate, temperature, be agitated, and have difficulty concentrating.

For scientific findings and symptoms associated with chronic pain, such as fatigue, decreased appetite, weight loss, change in posture, disruption of sleep patterns, anxiety, agitation, or depression.

Patients with chronic pain may not exhibit the physical changes and behaviors associated with acute pain. Pulse and blood pressure are usually within the normal range.

Evaluate the patient’s response to pain and pain management strategies.

It is important to assist the patient in presenting the effect of pain-relieving measures as factually as possible. Discrepancies between the patient’s behavior or demeanor and what he or she says about pain relief.

Assess patient’s expectations for pain relief.

Some patients are satisfied with pain relief, while others expect complete elimination of pain, which affects their perception of the effectiveness of the treatment method and their willingness to participate in further treatment.

Anticipate the need for pain relief. The most effective way to address pain is to prevent it. Early intervention can reduce the total amount of analgesics needed.

Eliminate additional stressors or discomfort whenever possible.

Patients may experience exaggeration of pain or diminished ability to tolerate painful stimuli if they experience additional stress from environmental, intrapersonal, or intrapsychic factors.

Provide rest periods to promote comfort, sleep, and relaxation.

The patient’s perception of pain may be exaggerated by fatigue. In a cycle, pain can lead to fatigue, which in turn can lead to exaggerated pain and fatigue. A quiet environment, a darkened room, and a phone turned off are measures that facilitate recovery.

Determine the appropriate method for pain relief.

Unless contraindicated, all patients with acute pain should receive a nonopioid analgesic around the

clock.

Hot or cold compress

Heat reduces pain by improving blood flow to the area and reducing pain reflexes. Cold reduces pain, inflammation, and spastic massage by decreasing the release of pain-inducing chemicals and slowing the transmission of pain impulses.

Massage of the painful area Increases endorphin levels and decreases tissue edema. This intervention may require another person to perform the massage.

Administer analgesics as ordered by a physician, evaluate their effectiveness, and observe signs and symptoms of side effects.

Analgesics are absorbed and metabolized differently by patients, so their effectiveness must be assessed by the patient individually. Analgesics usually have side effects that range from mild to life-threatening.

Notify the physician if interventions are unsuccessful or if current symptoms represent a marked change from the patient’s previous pain experience.

Patients who request pain medications at shorter intervals than prescribed may actually require a higher dose or stronger analgesics.

Anticipatory education about the causes of pain and appropriate measures for prevention and relief.

Knowing what to expect can help patients develop effective coping strategies for pain management. Patients need to learn the importance of reporting pain early to achieve more effective pain relief.

The patient should learn how to effectively discontinue the medication dose in relation to potentially unpleasant activities and avoidance of pain spikes.

Patients must learn to use pain relief strategies to minimize the pain experience.

Assist the patient and family in identifying lifestyle changes that can contribute to effective pain management. Guide the patient to plan activities during the times when pain is at its greatest relief.

Changes in work routine, household responsibilities, and home environment may be necessary to promote more effective pain management. Ongoing support and guidance for the patient and family will increase the success of these strategies.

How to Write a Nursing Care Plan How to Write a Nursing Care Plan

Nursing Care Plan Components A nursing care plan has several key components including,

 Nursing diagnosis

 Expected outcome  Nursing interventions and rationales  Evaluation

Each of the five main components is essential to the overall nursing process and care plan. A properly written care plan must include these sections otherwise, it won’t make sense!

 Nursing diagnosis – A clinical judgment that helps nurses determine the plan of care for their patients

 Expected outcome – The measurable action for a patient to be achieved in a specific time frame.

 Nursing interventions and rationales – Actions to be taken to achieve expected outcomes and reasoning behind them.

 Evaluation – Determines the effectiveness of the nursing interventions and determines if expected outcomes are met within the time set.

How to Write a Nursing Care Plan Determine the patient's most significant issues prior to composing the nursing care plan. Consider both medical and psychosocial difficulties. At times, a patient's psychosocial concerns may be more pressing or even hold up his or her discharge than the patient's actual medical problems.

After compiling a list of the patient's issues and the corresponding nursing diagnosis, you must determine which are the most significant. In general, this is done by contemplating the ABCs (Airway, Breathing, Circulation). However, these won't ALWAYS be the most significant or even pertinent for your patient.

Step 1: Assessment

The first step in writing an organized care plan includes gathering subjective and objective data. Subjective data is what the patient tells us their symptoms are, including feelings, perceptions, and concerns. Objective data is observable and measurable.

This information can come from,

 Verbal statements from the patient and family  Vital signs

o Blood pressure o Heart rate o Respirations o Temperature o Oxygen Saturation

 Physical complaints o Pain o Headache

o Nausea o Vomiting

 Body conditions o Head-to-toe assessment findings

 Medical history  Height and weight  Intake and output  Patient feelings, concerns, perceptions  Laboratory data  Diagnostic testing

o Echocardiogram o X-Ray o EKG

Step 2: Diagnosis

Using the information and data gathered in Step 1, the nursing diagnosis that best suits the patient, his or her hospitalization goals and objectives is selected.

North American Nursing Diagnosis Association (NANDA) defines nursing diagnosis as "a clinical judgment about the human response to health conditions/life processes, or a vulnerability for that response, by an individual, family, group, or community."

The nursing diagnosis is founded on Maslow's Hierarchy of Needs and assists with treatment prioritization. The next stage involves determining the goals for resolving the patient's problems through nursing interventions based on the nursing diagnosis selected.

There are 4 types of nursing diagnoses.

1. Problem-focused – Patient problem present during a nursing assessment is known as a problem-focused diagnosis

2. Risk – Risk factors require intervention from the nurse and healthcare team prior to a real problem developing

3. Health promotion – Improve the overall well-being of an individual, family, or community

4. Syndrome – A cluster of nursing diagnoses that occur in a pattern or can all be addressed through the same or similar nursing interventions

After determining which type of the four diagnoses you will use, start building out the nursing diagnosis statement.

The three main components of a nursing diagnosis are:

1. Problem and its definition – Patient’s current health problem and the nursing interventions needed to care for the patient.

2. Etiology or risk factors – Possible reasons for the problem or the conditions in which it developed

3. Defining characteristics or risk factors – Signs and symptoms that allow for applying a specific diagnostic label/used in the place of defining characteristics for risk nursing diagnosis

Examples:

PROBLEM-FOCUSED DIAGNOSIS

Problem-Focused Diagnosis related to ______________________ (Related Factors) as evidenced by _________________________ (Defining Characteristics).

RISK DIAGNOSIS

The correct statement for a NANDA-I nursing diagnosis would be: Risk for _____________ as evidenced by __________________________ (Risk Factors).

Step 3: Outcomes and Planning

After determining the nursing diagnosis, it is time to create a SMART goal based on evidence- based practices. SMART is an acronym that stands for,

 Specific  Measurable  Achievable  Relevant  Time-Bound

It is essential to take into account the patient's medical diagnosis, overall condition, and all collected data. A physician or other advanced healthcare professional makes a medical diagnosis. It is essential to remember that a medical diagnosis does not change if the patient's condition improves, and it remains a permanent part of the patient's medical history.

Examples of medical diagnosis include,

 Chronic Lung Disease (CLD)  Alzheimer’s Disease  Endocarditis  Plagiocephaly  Congenital Torticollis  Chronic Kidney Disease (CKD)

During this period, you will also consider the patient's goals and short- and long-term outcomes. These objectives must be achievable and desired by the patient. For instance, if a goal is for the

patient to seek counseling for alcoholism during hospitalization, but the patient is currently detoxifying and experiencing mental distress, this goal may not be achievable.

Step 4: Implementation

Now that the objectives have been established, you must take the necessary steps to assist the patient in achieving them. While some actions will produce immediate results (e.g., administering a suppository to a patient with constipation to induce a digestive movement), others may not be observed until later in the hospitalization.

The implementation phase means performing the nursing interventions outlined in the care plan. Interventions are classified into seven categories:

 Family  Behavioral  Physiological  Complex physiological  Community  Safety  Health system interventions

Some interventions will be patient or diagnosis-specific, but there are several that are completed each shift for every patient:

 Pain assessment  Position changes  Fall prevention  Providing cluster care  Infection control

Step 5: Evaluation

The fifth and final step of the nursing care plan is the evaluation phase. This is when you evaluate if the desired outcome has been met during the shift. There are three possible outcomes,

 Met  Ongoing  Not Met

On the basis of the evaluation, it can be determined whether the objectives and interventions need to be modified. Ideally, all nursing care plans, including objectives, should be met prior to discharge. This is not always true, particularly when a patient is being discharged to hospice, home care, or a long-term care facility. Initially, you will discover that the majority of care plans will have ongoing objectives that may be met within a few days or weeks. It depends on the patient's condition and the desired outcomes.

Consider selecting objectives that the patient is capable of achieving. This will not only help the patient feel as though they are making progress, but it will also relieve the nurse by allowing them to monitor the patient's overall progress.

Nursing Care Plan Fundamentals

Nursing care plans contain information about a patient’s diagnosis, goals of treatment, specific nursing interventions, and an evaluation plan. The nursing plan is constantly updated with changes and new subjective and objective data.

Key aspects of the care plan include,

 Assessment  Diagnosis  Outcome and Planning  Implementation  Evaluation

Through subjective and objective data, constantly assessing your patient’s physical and mental well-being, and the goals of the patient/family/healthcare team, a nursing care plan can be a helpful and powerful tool.

Evidence-Based Practice in Nursing

Examine the importance of incorporating current research evidence into clinical decision-

making and discuss the steps involved in implementing evidence-based practice in nursing care.

Evidence-based practice (EBP) in nursing is a systematic approach that integrates the best

available research evidence, clinical expertise, and patient preferences to guide clinical decision-

making and improve patient outcomes. It involves critically appraising and applying research

findings to inform nursing practice, ensuring that interventions and care are based on the most

up-to-date and reliable evidence. Here is a detailed explanation of evidence-based practice in

nursing:

1. Importance of Evidence-Based Practice:

 Enhancing Patient Outcomes: By incorporating current research evidence into

clinical decision-making, nurses can provide care that is more effective, safe, and

aligned with best practices, leading to improved patient outcomes.

 Ensuring Quality and Safety: Evidence-based practice promotes the use of

interventions and procedures that have been shown to be safe and effective

through rigorous research. This reduces the risk of harm to patients and enhances

the overall quality and safety of nursing care.

 Advancing Professional Development: Engaging in evidence-based practice

encourages nurses to stay updated with the latest research findings, enhancing

their knowledge and professional growth. It also fosters a culture of lifelong

learning within the nursing profession.

2. Steps in Implementing Evidence-Based Practice:

 Formulating a Clinical Question: The first step in evidence-based practice is

formulating a clear and focused clinical question based on the patient's problem or

the nursing intervention under consideration. The question should be structured

using the PICO framework (Population, Intervention, Comparison, Outcome) to

guide the search for relevant evidence.

 Conducting a Literature Search: Once the clinical question is identified, nurses

conduct a systematic search of the literature using databases and other reliable

sources to find relevant research evidence. This includes peer-reviewed journals,

systematic reviews, meta-analyses, and clinical practice guidelines.

 Appraising the Evidence: After identifying relevant research articles, nurses

critically appraise the evidence to evaluate its validity, relevance, and

applicability to the clinical question. This involves assessing the study design,

sample size, methodology, and statistical analysis to determine the quality and

strength of the evidence.

 Synthesizing the Evidence: Nurses analyze and synthesize the findings from

multiple research studies to develop a comprehensive understanding of the

evidence. This includes comparing and contrasting the results, identifying patterns

or consistencies, and determining the overall strength of the evidence.

 Integrating the Evidence: Based on the synthesis of the evidence, nurses integrate

the findings into their clinical decision-making process. They consider the

patient's unique circumstances, preferences, and values, along with their own

clinical expertise, to develop an individualized care plan.

 Evaluating Outcomes: Nurses implement the evidence-based intervention and

closely monitor the patient's response. They collect data on outcomes, evaluate

the effectiveness of the intervention, and make adjustments as necessary. This

step contributes to the ongoing cycle of evidence-based practice, as outcomes are

assessed and used to inform future practice decisions.

3. Barriers and Facilitators of Evidence-Based Practice:

 Barriers: Some common barriers to implementing evidence-based practice in

nursing include time constraints, lack of access to research literature, limited

skills in critically appraising research, resistance to change, and organizational

culture that does not prioritize evidence-based practice.

 Facilitators: Organizations can support evidence-based practice by providing

resources, promoting a culture of inquiry, and offering training and mentorship to

nurses. Collaboration between nurses, researchers, and educators can also

facilitate the integration of research evidence into practice.

4. Ethical Considerations: Nurses must consider ethical principles when implementing

evidence-based practice. This includes obtaining informed consent from patients,

ensuring patient confidentiality, respecting patient autonomy, and considering the

potential risks and benefits of interventions based on the available evidence.

Evidence-based practice is a continuous process that requires ongoing learning, critical thinking,

and integration of research findings into nursing practice. By incorporating

Student ID:2237850 1

Lack of Access to Quality Healthcare for Minority Groups

Health Policy, Politics & Social Justice HH5625

Brunel University London

Word count:2650

Student ID:2237850 2

Lack of Access to Quality Healthcare for the Minority

Through different equality policies, the government has attempted to address the healthcare disparities without successfully finding the balance between the healthcare fate of the minority groups and majority groups (Mitchell RN, 2021: 4). The minorities have not found the best way to improve their healthcare because of the continued disparity. Consequently, lack of capital hinders the minority from accessing healthcare services that could improve their health.

The State Children’s Health Insurance Program

The State Children’s Health Insurance Program (CHIP) is a policy that was incepted in 1997, targeting children in impoverished communities who did not benefit from insurance. The program tried to bring a sense of equality in healthcare delivery since children from poor minority neighborhoods could also benefit from insurance privileges as their counterparts from majority communities (Kennedy, E. M. 2005: 454). The program provoked adjustments in healthcare management for children and heightened children’s access to healthcare.

Shortcomings of the State Children’s Health Insurance Program

As much as the program provided little equality in care delivery to children from low socio- economic minority backgrounds, it failed to address its ultimate purpose due to insufficient funds. Funds insufficiency resulted in threshold factors that were considered before providing healthcare benefits to the children. Unfortunately, many children from poor minority neighborhoods could not surpass the threshold factors and ended up not benefitting from the program.

How the Proposed policy fills the gap in CHIP

Adopting and implementing the proposed policy will result in more allocation of funds to low socio-economic minority communities. Since the main setback of the prior program was the insufficiency of funds, ensuring enough funds for the minority community will fill the gap unaddressed by the program. Besides, an increase in funds will enable for the policy to run health-based programs such as health camps for screening diseases to facilitate early detection and treatment. An increased fund will also help recruit and compensate interns who will be working in various hospitals to help offset the workload. Equally, the presence of

evidence such as “Funding and Programs” and other journal articles by Smedley et al. and Kanengoni et al. supporting the proposed policy will ensure its success (Refer to the appendix).

Advantages and Disadvantages of the Proposed Program

Advantages

The policy implementation will increase the number of people seeking healthcare services in the United States (Johnson-Bibbs, 2020: 35). Equally, establishing healthcare facilities in minority neighborhoods will help save commuting fees to far- off medical facilities (Kennedy, 2017). Additionally, the policy implementation will instill new understanding in both the majority and minority communities (O′Connor and Byrne, 2022). Generally, adopting the policy will minimize the disparities witnessed in the healthcare sector.

Disadvantages

Policy adoption and implementation will be costive to the government and disrupt several government economic plans if there are inadequate funds in the government's treasury. Equally, the adoption of the policy will be overwhelming to healthcare professionals if the workforce remains the same with the adoption of the policy.

Implementation of the Proposed Policy

Adoption and implementation of the proposed policy should be overseen by a designated team specifically formed to ensure its success. The team should consist of finance personnel, medical practitioners, professionals offering the services, and an executive body to supervise the actions of other implementation team players. The finance personnel will oversee the funds, whereas the medical practitioners and professionals interact with the patients in service delivery and ensure that care is provided without any disparity.

The stakeholders responsible for the success of the proposed policy

The primary stakeholder responsible for the policy's success is the government, for the policy depends on it for funds. Equally, the implementation team and medical team are important, too, for they interact with the community directly to ensure the policy's success. Lastly are the community members who attend to the services of the program. The success of the policy will depend on the contribution of each stakeholder.

Student ID:2237850 3

Research Appendix

Lack of Access to Quality Healthcare for Minority Groups

The historical differences between minorities and the majority ethnic groups result in the

disparities challenges in the healthcare sector. The disparities in the healthcare system date back

to the enslavement period that placed African American individuals below their white

counterparts (Szczepura, 2005: 143). The majority believed they were superior to the minorities

and accumulated wealth through economic disparities. Consequently, the African American

individual took longer to industrialize and accumulate capital to put them in a position that could

allow them to access other human benefits. The minority could not live-in accessible areas

because of the programs established by the government during the Jim Crow laws that

segregated people based on their color. The minorities found themselves in areas where they

could not access employment, well-paying jobs, and social services such as education and

healthcare. The inequality in access to healthcare services is a concern that needs a new policy

whose implementation should be followed to the core.

Lack of employment forced minority groups to live in areas with poor access to

healthcare, leading to poor healthcare experience. Although the change has been gradual, the rate

at which the African American people achieve their goals has been slow compared to the

majority groups (Crook, 2002: 173). Consequently, the minorities have not found the best way to

improve their healthcare because of the continued disparity. The African American people have

no funds to build private hospitals in their zones, forcing them to depend on public medication

(Chauhan, Walton, Manias and Walpola, 2020: 299). They engage in activities that do not

generate enough funds to help them deal with healthcare needs. The government is yet to address

this issue because of the inadequate implementation of the existing policies, such as the

Student ID:2237850 4

Americans with Disabilities Act, State Children’s Health Insurance Program, and the Cross-

Cultural Health Care Program. Through different equality policies, the government has

attempted to address the healthcare disparities without successfully finding the balance between

the healthcare fate of the minority groups and majority groups (Mitchell RN, 2021: 4).

Consequently, lack of capital hinders the minority from accessing healthcare services that could

improve their health.

Low income is attributed to low-paying jobs in which the minority members engage to

earn a living. The low education levels in these areas cause disparities in academic achievements,

which translates to low-paying jobs that are available for semi-educated members of society.

These jobs do not allow individuals to seek proper medical attention when they are seeking it,

leading to increased cases of healthcare disparities (Thomas, 2014: 7499). The few families that

acquire better jobs do not help their communities. Healthcare facilities have continued to develop

in communities where many members have well-paying jobs because they financially support

such projects (Assari, 2018: 3). Such is the opposite in African American neighborhoods where

the majority are not whites, forcing them to rely on government-sponsored projects.

Consequently, the United States has been witnessing disparities in people who seek medical

attention and those affected by healthcare issues (Szczepura, 2005: 144). Although stakeholders

and other scholars have engaged in research to settle the issue, most minority groups have

continued to suffer the lack of access to proper medication, leading to high mortality rates in

African American communities.

State Children’s Health Insurance Program

The program changed its name to Children’s Health Insurance Program, covering

children who do not benefit from insurance and those in impoverished communities. At the time

Student ID:2237850 5

of its inception in 1997, many people recommended the policy as the most significant investment

in children’s health in the history of the United States. Its intention was not to provide universal

health coverage but to create a favorable healthcare environment to the uninsured children.

How it has addressed the problem

The program has addressed most problems for which congress designed it, even though a

lot remains unaddressed. The program has helped many children from low-income families to

access healthcare services despite their socioeconomic status (Kennedy, E. M. 2005: 454). The

policy enhances innovations in healthcare management for children, increases flexibility in

existing programs, and increases the children’s access to healthcare (Adeyinka, 2021).

Gaps

However, CHIP (Children’s Health Insurance Program) has not addressed inequalities

and healthcare disparities that have affected most sectors in the United States. The threshold and

factors considered before providing the healthcare benefits for the children has many children to

miss the services. Consequently, there is a need to have a policy that will deal with the financial

aspect of the program to ensure that all individuals in low-income families can access healthcare

services.

The Policy: Increasing Healthcare Funding in the Black and Minority Ethnic Communities

Although the government has been trying to solve the problem through funding

actionable policies, such as the Children’s Health Insurance Program and the Americans with

Disabilities Act, the need to help black and minority communities get access to well-equipped

healthcare facilities is the first element of the proposed policy to help communities access

healthcare (Osuafor, Golubic & Ray, 2021; 178). The government has established healthcare

Student ID:2237850 6

facilities in the areas to help minority communities to access medication without traveling long

distances. However, these facilities do not have proper equipment that can address the medical

needs of the people in minority communities. The hospitals should be affordable to the

communities because most people in the African American communities do not belong to the

higher class. They can decide not to seek medication if they realize that the amount needed to

address their medical issues is beyond their budget. Therefore, the policy will ensure that the

government has equipped the hospitals with enough affordable medicines for the people. The

policy will solve the issue of distance and affordability by establishing many healthcare facilities

and equipping them with affordable medicine.

Furthermore, funding medical camps will help the government to identify the medical

concerns affecting people in different areas. Medical camps should be as frequent as possible

with increased services to ensure they address the many medical issues in these areas (Karia,

Njoroge & Nyabuto, 2021: 34). Many African American communities do not care for medical

screening because they feel it will cost extra cash. Consequently, they wait until the situation is

dire before looking for medical interventions without knowing that the condition becomes riskier

with time. Although medical camps have existed before, the government must have them as a

policy so that many people can attend. The law will also compel the government to send highly

qualified practitioners who can address medical issues with high levels of professionalism

(Smedley, Stith & Nelson, 2003). The medical camp should also be free to allow people from

low-income families to access the services, after which they can seek further medication. The

medical camp funding will help the government to collect feasible data about the existence of

particular diseases (Pathak, Bhondve & Manapurath, 2019: 233). The government has been

giving updates on the people affected by diseases such as diabetes without getting data from

Student ID:2237850 7

those who have not screened for such conditions. Therefore, the medical camp will be an

opportunity for the country to record these facts from the people who will be screened during the

government-sponsored medical camps.

Paying interns who will work in these areas will be another directive from the policy. The

federal government will increase the finances channeled to these areas by factoring in the salaries

and allowances meant for the interns participating in the new programs (Trofimova, 2022: 35).

An increase hospital will call for more medical practitioners employed in the facilities (Riley,

2012; 170). However, the government might argue that it has no money to hire more employees,

making it necessary to rely on interns because they will not require higher salaries like registered

nurses and doctors. Furthermore, the interns will increase the number of services offered because

the practitioners will match the number of patients visiting the medical facilities. They will also

help with the basic services that have been overwhelming advanced registered nurses because of

their many other duties.

Evidence-Based Support for the Policy

The Division of Program Operations is one of the plans established by the government to

ensure the proper running of healthcare activities for the minority without disparities (Funding

and Programs, n.d.; par. 3). The program implements and monitors healthcare activities to

address disparities among minority communities. Therefore, the Division of Program Operations

will ensure that the proposed policy works within the earlier established plans. Although the

program has ensured that there is no healthcare inequality in the United States, evidence shows

that inequality continues to exist in the healthcare system. Some of the policy finances are

government grants and agreements through which the program outlines medical activities. For

example, the Minority Youth Tobacco Elimination Project has helped many young people deal

Student ID:2237850 8

with addiction (Funding and Programs, n.d. par. 4). However, the program has not been

successful because of the inadequate funds needed to rehabilitate the people affected by tobacco

from minority communities. An increase in the amount used to fund such programs will help the

country reduce the impact of health risks in the communities.

Although the government enacts and implements many programs to improve healthcare

for minorities, the disparities have remained perennial and seemingly unsolvable. Smedley et

al.,(2003; par. 5) argue that however relevant the policies might be, research shows that minority

groups are always disadvantaged. Such conclusions do not paint the countries as diversified

places for the upcoming generations who have much to learn from the current generation.

Smedley et al.,(2003) also argue that the main indicators of disparities in the healthcare sector

are access to healthcare and utilization of the available healthcare services. The government

seems to lack a practical way of tracking the public services available for minority groups to

ensure they access the needed services. The United States is one of the countries where insurance

does not cause inaccessibility to healthcare services among minority communities (Smedley,

Stith and Nelson, 2003: par. 5). This argument suggests that the government must research other

factors that might limit the minority population from accessing healthcare services. Therefore,

apart from funding and implementing the policies, the government should monitor how the

hospital management deals with the issues involving African American patients.

According to Kanengoni et al. (2020; par. 14), the disparity in medical access is also

attributed to the lack of information and poor communication in the healthcare sector. Some

minority groups do not know the right procedures needed for one to access a particular

healthcare service. Although many African American individuals were born in the United States,

they are alien to the policies and plans available to access proper healthcare. The communities

Student ID:2237850 9

have not invested in awareness to allow people access to knowledge about healthcare provision.

On the other hand, newly immigrated individuals might have communication barriers because of

language differences (Kanengoni, Andajani-Sutjahjo and Holroyd, 2020; par. 14). Therefore,

their ability to access the relevant services will depend on the available translators. They can

interpret rules, requirements, and provisions to help the incoming African American population

access medical services. The government should use the funds to hire healthcare practitioners

who will create community awareness to tell people how they can access healthcare services

(Faulkner and Davies, 2005: 40). The healthcare sector can also have translators who can help

immigrants to access medical services without encountering a challenging situation in the

healthcare sector.

Implications

Action

Implementing these policies will increase the population seeking medical attention in the

United States. Many African American individuals have failed to access healthcare services

(Johnson-Bibbs, 2020: 35). After all, they do not have money to pay for the services because

they are costly. Building healthcare facilities in all African American areas will increase the

number of people visiting them because they will not spend on transportation (Kennedy, 2017).

The medical camp will also motivate people who have never gone for medical screening for lack

of money. The medical camp will attract people and motivate them to seek medical attention

after discovering that they have underlying conditions. Some people have failed to turn up for

medical attention because they do not know that they have illnesses that might require them to

visit a healthcare facility (Kang, Kawamura and Noguchi, 2020: 928). Furthermore, the increased

number of nurses will increase the number of patients serviced at a unit. The patients will not

Student ID:2237850 10

wait long before getting services because the funding will ensure that the government hires

registered nurses and internship nurses to deal with the increasing population.

The policy will also reduce the disparity witnessed in the healthcare sector by offering

equal services to all populations. Many people have grown up knowing they cannot break the

historical gap between African American individuals and whites (Schneider, Cleary, Zaslavsky

& Epstein, 2001: 1455). Furthermore, many people from the majority communities have grown

up knowing that there can be no equality between the African American people and the whites.

However, a different approach to the issue of healthcare ethnic disparity will create a different

feeling in both communities (O′Connor & Byrne, 2022). Similarly, African American will be

happy to realize that the government can treat them the same way as their white counterparts. A

change in the healthcare sector will inspire other sectors to impress diversity and reduce the

existing disparities. Consequently, the country will benefit from a diversified country where

every individual has an equal opportunity for services.

Disadvantages of the Proposed Policy

The government is likely to struggle with the budget if it does not have enough funds for

healthcare programs. Most policies that have fallen short of their practice in the past attach these

predicaments to inadequate funds. Therefore, the government will have to stretch itself to the

extremes to address the challenges facing minority groups in the healthcare sector. Furthermore,

increasing services to low-income families will increase the number of people visiting healthcare

facilities. However, this phenomenon will overwhelm the personnel because the government

may not employ many practitioners at once as per the budget.

Student ID:2237850 11

References

Adeyinka, A., Rewane, A., & Pierre, L. 2019. Children's Health Insurance Program.

https://www.ncbi.nlm.nih.gov/books/NBK539903/

Assari, S., 2018. The Benefits of Higher Income in Protecting against Chronic Medical

Conditions Are Smaller for African Americans than Whites. Healthcare, 6(1), p.2.

Chauhan, A., Walton, M., Manias, E. and Walpola, R., 2020. The safety of health care for ethnic

minority patients: a systematic review. International Journal for Equity in Health, 19(1).

Crook, E., 2002. Low-income African Americans’ views about hypertension differ from medical

understanding. Evidence-based Healthcare, 6(4), p.173.

Faulkner, M. and Davies, S., 2005. Social support in the healthcare setting: the role of

volunteers. Health and Social Care in the Community, 13(1), pp.38-45.

Funding and Programs. [online] Available at:

<https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=1&lvlid=5> [Accessed 18 October

2022].

Galvan, T., Lill, S. and Garcini, L., 2021. Another Brick in the Wall: Healthcare Access

Difficulties and Their Implications for Undocumented Latino/a Immigrants. Journal of

Immigrant and Minority Health, 23(5), pp.885-894.

Johnson-Bibbs, L., 2020. Health care access issues among young African American and

Hispanic men. International Journal of Human Rights in Healthcare, 14(1), pp.28-41.

Student ID:2237850 12

Kanengoni, B., Andajani-Sutjahjo, S. and Holroyd, E., 2020. Improving health equity among the

African ethnic minority through health system strengthening: a narrative review of the New

Zealand healthcare system. International Journal for Equity in Health, 19(1).

Kang, C., Kawamura, A. and Noguchi, H., 2020. Benefits of knowing own health status: effects

of health check-ups on health behaviours and labour participation. Applied Economics

Letters, 28(11), pp.926-931.

Karia, J., Njoroge, M. and Nyabuto, W., 2021. The Role of Medical Camps in Ensuring Equity

in Accessing Health Care Services in Kenya. The International Journal of Humanities

&amp; Social Studies, 9(5).

Kennedy, B., 2017. African American Women Speak: A Phenomenological Study of African

American Women’s Beliefs and Perceptions about Compliance to Treatment Regimen in the

Healthcare System. BRK Global Healthcare Journal, (1).

Kennedy, E. M. (2005). The Role Of The Federal Government In Eliminating Health Disparities.

Health Affairs, 24(2), 452–458. doi:10.1377/hlthaff.24.2.452

Mitchell RN, A., 2021. African Americans Healthcare Disparities and Inclusive Practice; A

Literature Review. Journal of Quality in Health Care &amp; Economics, 4(1).

O′Connor, P. and Byrne, D., 2022. Fostering diversity in healthcare simulation. International

Journal of Healthcare Simulation,.

Oguz, T., 2018. Update on Racial Disparities in Access to Healthcare: An Application of

Nonlinear Decomposition Techniques. Social Science Quarterly, 100(1), pp.60-75.

Student ID:2237850 13

Osuafor, C., Golubic, R. and Ray, S., 2021. Ethnic inclusivity and preventative health research in

addressing health inequalities and developing evidence base. EClinicalMedicine, 31,

p.100672.

Pathak, B., Bhondve, A. and Manapurath, R., 2019. Mixed-method analysis of community health

camps: A novel approach beckoning. Indian Journal of Community Medicine, 44(3), p.233.

Riley, W., 2012. Health Disparities: Gaps in Access, Quality and Affordability of Medical Care.

[online] PubMed Central (PMC). Available at:

<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3540621/> [Accessed 18 October 2022].

Schneider, E., Cleary, P., Zaslavsky, A. and Epstein, A., 2001. Racial Disparity in Influenza

Vaccination. JAMA, 286(12), p.1455.

Smedley, B., Stith, A. and Nelson, A., 2003. Racial and Ethnic Disparities in Healthcare: Issues

in the Design, Structure and Administration of Federal Healthcare Financing Programs

Supported Through Direct Public Funding. [online] Ncbi.nlm.nih.gov. Available at:

<https://www.ncbi.nlm.nih.gov/books/NBK220341/> [Accessed 18 October 2022].

Szczepura, A., 2005. Access to health care for ethnic minority populations. Postgraduate

Medical Journal, 81(953), pp.141-147.

Thomas, B., 2014. Health and Health Care Disparities: The Effect of Social and Environmental

Factors on Individual and Population Health. International Journal of Environmental

Research and Public Health, 11(7), pp.7492-7507.

Student ID:2237850 14

Trofimova, L., 2022. Assessment of income in healthcare facilities in accordance with the

requirements of the Federal Standard Accounting of the public sector and IPSAS. Buhuchet

v zdravoohranenii (Accounting in Healthcare), (6), pp.33-38.

P r e p a r i n g t h e A s s i g n m e n t

1. Review the elements included in PICOT questions to guide evidence-based nursing practice.

2. Respond to the questions below using the PICOT Question Worksheet TemplateLinks to an external site. Download PICOT Question Worksheet Template.

3. Using a minimum of 3 scholarly nursing sources, current within 5 years:

• Identify and describe one practice-related issue or concern. You may choose to build on the practice issue you identified in NR500NP/NR501NP.

• Explain why the issue/concern is important to nurse practitioner practice and its impact on health outcomes.

• Describe each element of your PICOT question in one or two sentences, being sure to address all of the following:

o P-Population and problem– What is the nursing practice concern or problem and whom does it affect?

o I–Intervention– What evidence-based solution for the problem would you like to apply?

o C–Comparison– What is another solution for the problem? Note that this is typically the current practice, no intervention at all, or alternative solutions.

o O–Outcome– Very specifically, how will you know that the intervention worked? Think about how you will measure the outcome.

o T–Time frame– What is the Timeframe involved for the EBP initiative or the target date of completion?

• Construct your PICOT question in the standard PICOT question format (narrative) and define each letter separately, such as:

o P = o I = o C = o O = o T = o PICOT question written in full =

1. Abide by the Chamberlain College of Nursing Academic Integrity Policy. 2. At the graduate level, we like to see you synthesizing your ideas into your own

words. No direct quotes may be used in this worksheet. 3. Use APA formatting guidelines for references and citations. 4. Submit your worksheet using the PICOT Worksheet Template as a Word

document to the Week 2 Dropbox

ASSIGNMENT CONTENT

Category Points % Description

Practice- related Issue

20 20% This section of the worksheet includes:

• Identification of one practice-related issue or concern • Description of the issue or concern • Rationale for addressing this issue or concern • Sufficient support from current, scholarly nursing sources

Significance of the Issue

20 20% This section of the worksheet includes:

• Explanation of why the issue/concern is important to the profession of nursing and to NP practice

• Explanation of the impact of the issue or concern health outcomes

• Sufficient support from current, scholarly nursing sources

Discussion of PICOT Elements

20 20% This section of the worksheet includes:

• Accurate and clear discussion of the following elements, including 1-2 sentences to address each:

• P-Population and problem – What is the nursing practice concern or problem and whom does it affect?

• I–Intervention – What evidence-based solution for the problem would you like to apply?

• C–Comparison – what is another solution for the problem? Note that this is typically the current practice, no intervention at all, or alternative solutions.

• O–Outcome – Very specifically, how will you know that the intervention worked? Think about how you will measure the outcome.

ASSIGNMENT CONTENT

• T–Time frame – What is the Timeframe involved for the EBP initiative and the target date of completion?

PICOT Question

20 20% This section of the worksheet includes:

• Construction of the above described PICOT question in the standard PICOT question format (narrative) and define each letter separately, such as:

o P = o I = o C = o O = o T = o PICOT question =

80 80% Total CONTENT Points= [100 pts]

ASSIGNMENT FORMAT

ASSIGNMENT CONTENT

Category Points % Description

Graduate- Writing Style

10 10% For full credit in this section, the following criteria must be met:

• Correct use of spelling and sentence structure • Clarity, organization, and logical flow of ideas within

writing • Reference and citation formatting follow APA guidelines • No direct quotes are used in the worksheet

Scholarly Support

10 10% • Minimum of 3 scholarly nursing sources, current within 5

years, are integrated

20 20% Total FORMAT Points = [20pts]

ASSIGNMENT TOTAL = 100 points

Assessment 1 Instructions: Locating Credible Databases and Research

Create a 2-4 page resource that will describe databases that are relevant to EBP around a diagnosis you chose and could be used to help a new hire nurse better engage in EBP.

IntroductionIntroduction

Evidence-based practice (EBP) integrates the best evidence available to guide optimal nursing care, with a goal to enhance safety and quality. EBP is crucial to nursing practice because it incorporates the best evidence from current literature, along with the expertise of the practicing nurse. The concern for quality care that flows from EBP generates a desired outcome. Without these factors, a nurse cannot be an effective leader. It is important to lead not only from this position but from knowledge and expertise. To gain the knowledge, you require a good understanding of how to search for scholarly resources, as well as identify which databases and websites are credible for the purposes of implementing evidence-based changes in practice.

Your Online e-PortfolioYour Online e-Portfolio

Creating an ePortfolio is not required in the BSN program, but you may find it helpful to create one to attach to your professional resume while job hunting. Online ePortfolios serve two key purposes: 1) to support learning and reflection, and 2) to be used as a showcase tool. Your learning journey can be documented, and ePortfolios contribute to lifelong learning and growth through reflection and sharing. Online ePortfolios can also be shared with employers and peers to present artifacts that demonstrate your accomplishments at Capella.

Professional ContextProfessional Context

As a baccalaureate-prepared nurse, you will be responsible for providing patient-centered, competent care based on current evidence-based best practices. You will be required to do research, analysis, and dissemination of best evidence to stay abreast of these best practices. Understanding where to go to find credible sources and locate evidence, as well as which search terms to use, is the foundation of incorporation of best practices.

Course Navigation 

Tamara Jones FACULTY 7 NEW

 Dee Olsen COACH 

5/19/23, 7:12 AM Page 1 of 5

ScenarioScenario

You are supervising three nurses working on the medical-surgical floor of a local teaching hospital. This hospital is nationally recognized as a leader in education and has a computer lab with an online library where staff has access to medical research databases (that is, CINAHL, PubMed, Medline, and Cochrane library) and online sources of all hospital policies, procedures, and guidelines, and computers at nurse workstations that also have access to these resources. (For this scenario, use the Capella University Library to simulate the hospital's online library.) You have given the nurses their patient assignments and you have all participated in shift report. A new nurse who just completed orientation and training a week ago approaches you and tells you that one of the assigned patients has a diagnosis he or she is very unfamiliar with. Knowing that patient-centered care based on best practices is imperative to positive patient outcomes, you want to assist this nurse to find research that can be utilized to provide the best care for this patient. Describe how you would communicate with this nurse to encourage him or her to research the diagnosis. Assume you will assist in the quest to locate evidence, then describe where you would go within the facility and what resources you would look for. These resources may include websites, journals, facility policies or guidelines, or any other sources of online information.

You may choose the diagnosis for the patient in this scenario or health care issue/diagnosis of your choice. Or you may choose something you would find interesting to research or that applies to a clinical problem/diagnosis you would be interested in addressing. Create a list of at least five sources that could be used to find evidence, with the best source listed first, and explain why the sources you chose are best to find evidence for the diagnosis you chose and the clinical scenario. You are only evaluating the sources of evidence (database, website, policy database or website, journal article, et cetera). You are not actually completing a search and selecting evidence. Consider the following examples: a nursing journal in CINAHL may not be the best source of evidence for information on how to administer medications through a central- venous catheter, whereas a hospital policy database found on a website may not be the best source of information on caring for a patient with a rare chromosomal abnormality.

PreparationPreparation

To help ensure you are prepared to complete this assessment, review the following resources related to the Capella library. These resources will provide you an overview of the types of tools, resources, and guides available in the library. This may be useful in forming a better understanding of the library to apply to the hypothetical situation laid out in the scenario of this assessment.

BSN Program Library Research Guide. Evidence-Based Practice in Nursing & Health Sciences. Databases A-Z: Nursing & Health Sciences. Get Critical Search Skills.

Remember, it is also appropriate to look toward databases and resources outside of the Capella library, such as organizational policies, professional organizations, and government health care resources.

You are encouraged to complete the Evaluating the Credibility of Evidence activity. This activity offers an

5/19/23, 7:12 AM Page 2 of 5

You are encouraged to complete the Evaluating the Credibility of Evidence activity. This activity offers an opportunity to practice evaluating the credibility of evidence. These skills will be necessary to complete Assessment 1 successfully and is for your own practice and self-assessment. Completing this activity is also a way to demonstrate course engagement.

InstructionsInstructions

The purpose of this assessment is to understand where to find evidence that can be applied to clinical scenarios and to learn effective communication and collaboration with clinical staff during the process of evidence location. As a baccalaureate-prepared nurse, you will not only use research for self-improvement in your clinical role, but you will also serve as a mentor to supervised nursing staff. Therefore, you will need to be able to communicate and collaborate effectively to guide them toward resources to find research, as well as support them through the initial evidence location process. In doing so, nurses can gain access to evidence that can be analyzed and utilized to stay current on best practices. This allows them to provide safe, patient-centered care and improve patient outcomes.

For this assessment:

Describe your role as a baccalaureate-prepared nurse supervising clinical staff nurses with regard to communication and collaboration in locating evidence for application to a nursing practice scenario. Compile a list of five online databases or other online sources (that is, websites, journals, facility policies or guidelines, et cetera) that can be used to research evidence to apply to this scenario or clinical practice issue/diagnosis and describe to which of these you would direct a nurse colleague to search for evidence. Describe where you might go in the work place to complete this research and how you would access the desired, relevant research within research databases or other online sources.

Be sure to address the following in this assessment, which correspond to the grading criteria in the scoring guide. Please study the scoring guide carefully so that you will know what is needed for a distinguished score.

Describe communication strategies to encourage nurses to research the diagnosis/practice issue, as well as strategies to collaborate with the nurses to access resources. Describe the best places to complete research and what types of resources you would want to access to find pertinent information for the diagnosis/health care issue within the context of a specific health care setting. Identify five sources of online information (medical journal databases, websites, hospital policy databases, et cetera) that could be used to locate evidence for a clinical diagnosis/practice issue. Explain why the sources of online information selected should provide the best evidence for the chosen diagnosis/health care issue. Communicate using writing that is clear, logical, and professional with correct grammar and spelling using current APA style.

Note: While you are not selecting and evaluating specific evidence to help with the clinical diagnosis/practice issue, you should still be citing the literature and best practices to support your description of your communication and collaboration approach. Additionally, it is appropriate to cite best

5/19/23, 7:12 AM Page 3 of 5

practices related to EBP and evaluating databases to support your explanation as to why you selected the five sources of online information that you did. Example Assessment: You may use the following to give you an idea of what a Proficient or higher rating on the scoring guide would look like:

Assessment 1 Example [PDF].

Additional Requirements

Your assessment should meet the following requirements:

Length of submission: 2-4 pages (not including the title page or the reference page) description of communication, collaboration, and evidence location process, including a list of databases or other sources with description of why they are appropriate for clinical scenario diagnosis/health care issue (that is, something that would be useable in professional practice for other nurses). Be sure to include an APA-formatted reference page at the end of your submission. Number of references: Cite a minimum of three sources of scholarly or professional evidence that supports your findings and considerations. Resources should be no more than five years old. APA formatting: References and citations are formatted according to current APA style.

Competencies MeasuredCompetencies MeasuredCompetencies MeasuredCompetencies Measured

By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:

Competency 1: Interpret findings from scholarly quantitative, qualitative, and outcomes research articles and studies.

Explain why the sources selected should provide the best evidence for the chosen diagnosis/health care issue.

Competency 2: Analyze the relevance and potential effectiveness of evidence when making a decision within the context of a specific health care setting.

Describe the best places to complete research within the workplace environment and what types of resources one would want to access to find pertinent information for the diagnosis/health care issue.

Competency 4: Plan care based on the best available evidence. Identify five sources of online information (medical journal databases, websites, hospital policy databases, et cetera) that could be used to locate evidence for a diagnosis/health care issue and three out of five should be specific to the diagnosis/health care issue.

Competency 5: Apply professional, scholarly communication strategies to lead practice changes based on evidence.

Describe communication strategies to encourage nurses to research a diagnosis/health care issue, as well as strategies to collaborate with the nurses to access resources. Organize content so ideas flow logically with smooth transitions; contains few errors in grammar/punctuation, word choice, and spelling. Apply APA formatting to in-text citations and references exhibiting nearly flawless adherence to APA format.

5/19/23, 7:12 AM Page 4 of 5

SCORING GUIDE

Use the scoring guide to understand how your assessment will be evaluated.

VIEW SCORING GUIDE 

5/19/23, 7:12 AM Page 5 of 5

Nursing Care Plan and Diagnosis for Chronic Pain Nursing Care Plan and Diagnosis for Chronic Pain

This nursing care plan is designed for patients with chronic discomfort. According to Nanda, chronic pain is the condition in which an individual experiences persistent or intermittent pain that lasts for more than six months. This definition differs from that of acute pain, in which a person experiences agony from one second to six months.

The patient may report typical symptoms of distress, but they have persisted for at least six months. Due to the patient experiencing these symptoms for more than six months, the nurse may observe social and familial relationship disruption, irritability, depression, a "beaten" appearance, exhaustion, or somatic preoccupation.

There are numerous causes of chronic pain, including musculoskeletal disorders such as back pain, treatment-related therapies such as chemotherapy, and pregnancy.

This nursing care plan for chronic back pain includes a nursing diagnosis, nursing interventions, and nursing objectives.

What are intentions for geriatric care? How is a nursing care plan developed? Which nursing care plan literature would you recommend to assist in the creation of a nursing care plan?

Care Plans are frequently developed in various formats. The format is not always crucial, and the format of care plans may vary between nursing institutions and medical employment. Some hospitals may display the information digitally or utilize pre-made templates. The most essential aspect of the care plan is its content, as it will serve as the basis for your care.

Nursing Care Plan for Chronic Pain Please observe the video below for a tutorial on how to construct a care plan in nursing school. Otherwise, please continue down to view the finished care plan.

Scenario

A 56-year-old male presents with complaints of back discomfort. He states that he has experienced consistent lower back pain for the past year. He explains that he decided to come in to have it "checked out" because it is "taking a toll" on his ability to function. He reports that the back pain has left him despondent and exhausted because he cannot perform the same tasks he did a year ago. He also reports that his relationship with his wife and children has been affected. You observe that the patient appears fatigued with dark circles under his eyes and is frequently rubbing his back.

Nursing Diagnosis

Inflammation of the lumbar spine is the cause of the patient's one-year history of consistent lower back pain, disruption of social and familial relationships, depression, fatigue, a "beaten look," and rubbing of the painful area.

Subjective Data

He states that he has experienced consistent lower back pain for the past year. He explains that he decided to come in to have it "checked out" because it is "taking a toll" on his ability to function. He reports that the back pain has left him despondent and exhausted because he cannot perform the same tasks he did a year ago. He also reports that his relationship with his wife and children has been affected.

Objective Data

A 56-year-old male presents with complaints of back discomfort. You observe that the patient appears fatigued with dark circles under his eyes and is frequently rubbing his back.

Nursing Outcomes

-At the next follow-up appointment, the patient will report an improvement in back pain and an increase in daily activities.

-The patient will verbalize his expectations regarding the course of pain treatment and his intended treatment outcomes and objectives.

-The patient will identify five noninvasive pain relief methods to aid in pain management.

-The patient will be instructed verbally on how to take the back pain medication prescribed for him as needed.

Nursing Interventions

At the next follow-up appointment, the nurse will evaluate the patient's report of reduced back pain and an increase in daily activities.

-The nurse will evaluate the patient's expectations regarding the duration of pain treatment and his desired treatment outcomes.

-The nurse will educate the patient on five noninvasive pain relief techniques to aid in pain management.

-The nurse will instruct the patient on how to take the back pain medication prescribed for him as needed.

SAMPLE Block format Soap Note PATIENT INFORMATION

Name: Mr. W.S.

Age: 65-year-old

Sex: Male

Source: Patient

Allergies: None

Current Medications: Atorvastatin tab 20 mg, 1-tab PO at bedtime

PMH: Hypercholesterolemia

Immunizations: Influenza last 2018-year, tetanus, and hepatitis A and B 4 years ago.

Surgical History: Appendectomy 47 years ago.

Family History: Father- died 81 does not report information

Mother-alive, 88 years old, Diabetes Mellitus, HTN

Daughter-alive, 34 years old, healthy

Social Hx: No smoking history or illicit drug use, occasional alcoholic beverage consumption on social celebrations. Retired, widow, he lives alone.

SUBJECTIVE:

Chief complain: “headaches” that started two weeks ago

Symptom analysis/HPI:

The patient is 65 years old male who complaining of episodes of headaches and on 3 different occasions blood pressure was measured, which was high (159/100, 158/98 and 160/100 respectively). Patient noticed the problem started two weeks ago and sometimes it is accompanied by dizziness. He states that he has been under stress in his workplace for the last month.

Patient denies chest pain, palpitation, shortness of breath, nausea or vomiting.

ROS:

CONSTITUTIONAL: Denies fever or chills. Denies weakness or weight loss. NEUROLOGIC: Headache and dizzeness as describe above. Denies changes in LOC. Denies history of tremors or seizures.

HEENT: HEAD: Denies any head injury, or change in LOC. Eyes: Denies any changes in vision, diplopia or blurred vision. Ear: Denies pain in the ears. Denies loss of hearing or drainage. Nose: Denies nasal drainage, congestion. THROAT: Denies throat or neck pain, hoarseness, difficulty swallowing.

Respiratory: Patient denies shortness of breath, cough or hemoptysis.

Cardiovascular: No chest pain, tachycardia. No orthopnea or paroxysmal nocturnal

dyspnea.

Gastrointestinal: Denies abdominal pain or discomfort. Denies flatulence, nausea, vomiting or

diarrhea.

Genitourinary: Denies hematuria, dysuria or change in urinary frequency. Denies difficulty starting/stopping stream of urine or incontinence.

MUSCULOSKELETAL: Denies falls or pain. Denies hearing a clicking or snapping sound.

Skin: No change of coloration such as cyanosis or jaundice, no rashes or pruritus.

Objective Data

CONSTITUTIONAL: Vital signs: Temperature: 98.5 °F, Pulse: 87, BP: 159/92 mmhg, RR 20, PO2-98% on room air, Ht- 6’4”, Wt 200 lb, BMI 25. Report pain 0/10.

General appearance: The patient is alert and oriented x 3. No acute distress noted. NEUROLOGIC: Alert, CNII-XII grossly intact, oriented to person, place, and time. Sensation intact to bilateral upper and lower extremities. Bilateral UE/LE strength 5/5.

HEENT: Head: Normocephalic, atraumatic, symmetric, non-tender. Maxillary sinuses no tenderness. Eyes: No conjunctival injection, no icterus, visual acuity and extraocular eye movements intact. No nystagmus noted. Ears: Bilateral canals patent without erythema, edema, or exudate. Bilateral tympanic membranes intact, pearly gray with sharp cone of light. Maxillary sinuses no tenderness. Nasal mucosa moist without bleeding. Oral mucosa moist without lesions,.Lids non-remarkable and appropriate for race.

Neck: supple without cervical lymphadenopathy, no jugular vein distention, no thyroid swelling or masses.

Cardiovascular: S1S2, regular rate and rhythm, no murmur or gallop noted. Capillary refill < 2 sec.

Respiratory: No dyspnea or use of accessory muscles observed. No egophony, whispered pectoriloquy or tactile fremitus on palpation. Breath sounds presents and clear bilaterally on auscultation.

Gastrointestinal: No mass or hernia observed. Upon auscultation, bowel sounds present in all four quadrants, no bruits over renal and aorta arteries. Abdomen soft non-tender, no guarding, no rebound no distention or organomegaly noted on palpation

Musculoskeletal: No pain to palpation. Active and passive ROM within normal limits, no stiffness.

Integumentary: intact, no lesions or rashes, no cyanosis or jaundice.

Assessment

Essential (Primary) Hypertension (ICD10 I10): Given the symptoms and high blood pressure (156/92 mmhg), classified as stage 2. Once the organic cause of hypertension has been ruled out, such as renal, adrenal or thyroid, this diagnosis is confirmed.

Differential diagnosis:

Ø Renal artery stenosis (ICD10 I70.1)

Ø Chronic kidney disease (ICD10 I12.9)

Ø Hyperthyroidism (ICD10 E05.90)

Plan

Diagnosis is based on the clinical evaluation through history, physical examination, and routine laboratory tests to assess risk factors, reveal identifiable causes and detect target-organ damage, including evidence of cardiovascular disease.

These basic laboratory tests are:

· CMP

· Complete blood count

· Lipid profile

· Thyroid-stimulating hormone

· Urinalysis

· Electrocardiogram

Ø Pharmacological treatment:

The treatment of choice in this case would be:

Thiazide-like diuretic and/or a CCB

· Hydrochlorothiazide tab 25 mg, Initial dose: 25 mg orally once daily.

Ø Non-Pharmacologic treatment:

· Weight loss

· Healthy diet (DASH dietary pattern): Diet rich in fruits, vegetables, whole grains, and low-fat dairy products with reduced content of saturated and trans l fat

· Reduced intake of dietary sodium: <1,500 mg/d is optimal goal but at least 1,000 mg/d reduction in most adults

· Enhanced intake of dietary potassium

· Regular physical activity (Aerobic): 90–150 min/wk

· Tobacco cessation

· Measures to release stress and effective coping mechanisms.

Education

· Provide with nutrition/dietary information.

· Daily blood pressure monitoring at home twice a day for 7 days, keep a record, bring the record on the next visit with her PCP

· Instruction about medication intake compliance.

· Education of possible complications such as stroke, heart attack, and other problems.

· Patient was educated on course of hypertension, as well as warning signs and symptoms, which could indicate the need to attend the E.R/U.C. Answered all pt. questions/concerns. Pt verbalizes understanding to all

Follow-ups/Referrals

· Evaluation with PCP in 1 weeks for managing blood pressure and to evaluate current hypotensive therapy. Urgent Care visit prn.

· No referrals needed at this time.

References

Domino, F., Baldor, R., Golding, J., Stephens, M. (2017). The 5-Minute Clinical Consult 2017 (25th ed.). Print (The 5-Minute Consult Series).

Codina Leik, M. T. (2014). Family Nurse Practitioner Certification Intensive Review (2nd ed.). ISBN 978-0-8261-3424-0

Patient Assessment and Care Plan Instructions to student:

1) Bring one copy of this packet with you to clinical each week.

2) Your instructor will inform you of the number of packets and the dates each packet is due. They may have you complete only portions of or all of the packet.

3) Read the rubric! Each packet is Pass/Fail. You must meet the requirements listed to receive a Pass. Your instructor may ask you to resubmit packets that are incomplete or incorrect.

4) If your instructor asks you to submit the packet electronically, then please record your answers in bold or in a colored or lower case font. This helps us identify your answers more quickly.

PATIENT ASSESSMENT FORM STUDENT NAME: DATE:

CLIENT INITIALS: ROOM # DOB: AGE GENDER :

ADMISSIO N DATE:

CODE STATUS: ALLERGIES: MARITAL STATUS:

OCCUPATIO N (FORMER):

MEDICAL DX: CHIEF COMPLAINT :

PAST HISTORY (SURGERY/PROCEDURE S) WITH DATES

ORDERS

RATIONAL E (Why is this ordered for this client???)

EXAMPLE: DIET

2 g Sodium diet with nectar thick liquids only

Sodium is restricted due to edema in the bilateral lower extremities and nectar thick liquids due to dysphagia from a past stroke.

DIET ACTIVITY I/O VS BGM FOLEY NG PEG/PEJ TUBE WOUND CARE RESPIRATORY TREATMENT

TRACHEOSTOMY SUCTIONING CHEST TUBE SPECIAL EQUIPMENT LAB ORDERS OTHER

REHAB SERVICES

ACTIVITY OR TREATMEN T PLAN & SCHEDULE

RATIONAL E

PHYSICAL THERAPY SPEECH THERAPY

OCCUPATIONAL THERAPY

……/ 5 pts

IVs

IV FLUID AND RATE: SITE LOCATION AND CONDITION: LAST DRESSING CHANGE: LAST TUBING CHANGE: GAUGE: REASON FOR IV ACCESS:

DIAGNOSTIC TESTS: DATE RESULTS REASON FOR TESTING AND

IMPLICATIONS FOR NURSING CARE

LAB TEST DATE RESULTS

NORMS REFERENCE RANGES

IMPLICATIONS FOR NURSING CARE (WHAT S&S I SHOULD BE AWARE OF AND WHAT YOU CAN DO TO HELP IMPROVE AN ABNORMAL RESULT?)

GROWTH and DEVELOPMENT: (see pages 378-379 Taylor, Lillis and White) or (Erikson’s Stages of Development)

CLIENT’S DEVELOPMENTAL STAGE ACCORDING TO HAVIGHUSRT

TASKS OF THIS STAGE:

ASSESSMENT OF CLIENT’S SUCESSFUL ACHIEVEMENT OF TASKS

…../ 5 pts

MEDICATIONS

If your client has more than 12 medications, select the 12 medications that are most important, most frequently given or those that pertain to the client’s most significant medical problems. See the example below.

Brand Name and Generic Name Normal Dosage Ranges Contraindications Coreg (carvedilol)

3.125 mg – 50 mg BID Asthma, heart block

Pharmacotherapeutic Class Dosage, Route & Frequency Adverse Reactions β-adrenergic blocker

6.25 mg p.o. BID

Bradycardia, CHF, thrombocytopenia, hyperglycemia, bronchospasm

Why this Patient Receives this Med

Effects of the Med on the Client

Nursing Considerations and Teaching

He has a history of hypertension but has been taking Coreg for 2 years to control his hypertension

BP’s for past 3 days have been 128/78, 132/72, 138/80

How is this medication impacting your client??B/P readings, lab results, pain management, etc……..

Do not discontinue abruptly or before surgery

Caution with Upper airway dysfunction

Rise slowly to minimize orthostatic hypotension, check B/P and heart rate prior to administration

Take before meals

#1 Brand Name and Generic Name Normal Dosage Ranges Contraindications

Pharmacotherapeutic Class Dosage, Route & Frequency Adverse Reactions

Why this Patient Receives this Med

Effects of the Med on the Client

Nursing Considerations and Teaching

#2 Brand Name and Generic Name Normal Dosage Ranges Contraindications

#3 Pharmacotherapeutic Class Dosage, Route and Frequency Adverse Reactions

Why this Patient Receives this Med

Effects of the Med on the Client

Nursing Considerations and Teaching

#4 Brand Name and Generic Name Normal Dosage Ranges Contraindications

Pharmacotherapeutic Class Dosage, Route and Adverse Reactions

Frequency

Why this Patient Receives this Med

Effects of the Med on the Client

Nursing Considerations and Teaching

#5 Brand Name and Generic Name Normal Dosage Ranges Contraindications

Pharmacotherapeutic Class Dosage, Route and Frequency Adverse Reactions

Why this Patient Receives this Med

Effects of the Med on the Client

Nursing Considerations and Teaching

# 6 Brand Name and Generic Name Normal Dosage Ranges Contraindications

Pharmacotherapeutic Class Dosage, Route and Frequency Adverse Reactions

Why this Patient Receives this Med

Effects of the Med on the Client

Nursing Considerations and Teaching

#7 Brand Name and Generic Name Normal Dosage Ranges Contraindications

Pharmacotherapeutic Class Dosage, Route and Frequency Adverse Reactions

Why this Patient Receives this Med

Effects of the Med on the Client

Nursing Considerations and Teaching

#8 Brand Name and Generic Name Normal Dosage Ranges Contraindications

Pharmacotherapeutic Class Dosage, Route and Frequency Adverse Reactions

Why this Patient Receives this Med

Effects of the Med on the Client

Nursing Considerations and Teaching

#9 Brand Name and Generic Name Normal Dosage Ranges Contraindications

Pharmacotherapeutic Class Dosage, Route and Frequency Adverse Reactions

Why this Patient Receives this Med

Effects of the Med on the Client

Nursing Considerations and Teaching

#10 Brand Name and Generic Name Normal Dosage Ranges Contraindications

Pharmacotherapeutic Class Dosage, Route and Frequency Adverse Reactions

Why this Patient Receives this Med

Effects of the Med on the Client

Nursing Considerations and Teaching

#11 Brand Name and Generic Name Normal Dosage Ranges Contraindications

Pharmacotherapeutic Class Dosage, Route and Frequency Adverse Reactions

Why this Patient Receives this Med

Effects of the Med on the Client

Nursing Considerations and Teaching

#12 Brand Name and Generic Name Normal Dosage Ranges Contraindications

Pharmacotherapeutic Class Dosage, Route and Frequency Adverse Reactions

Why this Patient Receives this Med

Effects of the Med on the Client

Nursing Considerations and Teaching

…../ 20 pts

NURSES NOTES FOR CLINICAL For this clinical, we are having you write out your assessment findings in the form of a narrative nurse’s note. We have provided some samples of assessments. We have also provided a worksheet that you may use to take into a patient’s room to take notes during your assessment. Record your vital signs and type your physical assessment findings. This form will expand to fit your typing. A sample of charting for a long

resident follows below.

TEMP: APICAL HR: RESP: BP: HT: WT:

DATE / TIME

(TYPE HERE)

Sample Narrative Note — Head to Toe format

Temp: 98.6 Apical HR: 72 Resp: 16 BP 128/62 Ht: 5’10” Wt: 145

12/22/2010 1400

Resident in semi-fowlers position in bed. Pressure reduction mattress in place. Alert and oriented x 3. Appropriate mood and affect. Well groomed. Recent and remote memory intact. Facial symmetry noted. Pupils are equal, reactive to light and accommodation. Oral mucosa moist, pink. Frequent oral care rendered with sponge toothette and toothbrush. Dentition intact. Hearing intact. Oropharynx clear without erythema or exudate. No chewing or swallowing difficulties. 75% of general diet taken at breakfast. Skin pink, warm, dry, free of lesions with elastic turgor. Hair and nails unremarkable. Carotid and radial pulses present and equal. Motor and sensory functions grossly intact. No weakness or paralysis. Upper extremities equal strength bilaterally, full ROM w/ capillary refill < 3 sec. Fine resting tremor in the left hand” No involuntary movement or abnormal posture. Lungs clear bilaterally to auscultation. Tracheostomy dressing clean, dry, and intact. Connected to ventilator with settings: TV-550, Fio2-40%, Rate 10, and PEEP-5cm. Sao2-92%. Suctioned for moderate amount of white, thin secretion. Apical pulse regular (rate) and rhythm. Double lumen picc line note to left antecubital space. Tegaderm dressing is clean, dry, and intact. Last dressing change on 11/28/16. Chlorhexadine caps intact to all lumens. Bowel sounds active x 4. Abdomen soft, non-distended, non-tender. Last bowel movement this morning, passed a large, soft- formed brown stool and a moderate amount of clear yellow urine. Bilateral lower extremities, no tenderness, swelling or joint deformities noted. Denies numbness or tingling to extremities. Toe nails thick and yellowed w/ capillary refill < 3 sec. No peripheral edema noted, pedal pulses palpable and equal bilaterally.

PHYSICAL ASSESSMENT WORKSHEET (Use this sheet for jotting down your assessment findings.)

ROUTINE FINDINGS PATIENT VARIATIONS/ABNORMALS COGNITION/NEUROLOGICAL (SAMPLE) Alert and oriented x3, recent and remote memory intact. Denies any numbness or tingling to extremities”

(SAMPLE) “Fine resting tremor of left hand

SKIN

SENSORY

Wound measurements and complete description if available at the very least Document dressing including the type of dressing and description of condition!

BREASTS – DEFERRED.

RESPIRATORY –

(Include ventilator settings as indicated in narrative note)

CARDIOVASCULAR

Include any vascular access device, IV lines, AV fistulas, perma -cath lines, etc.

ABDOMEN –

.

Include any enteral feedings here and route

BOWEL CONTINENCE? LAST BM? BOWEL PLAN?

MUSCULOSKELETAL –

GENITOURINARY –

URINARY CONTINENCE? TOILETING PLAN?

PELVIC – DEFERRED.

RECTAL – DEFERRED.

……/ 10 pts

NURSING CARE PLAN Begin your NCP by listing ALL your clients individual problems (at least 10) and then identify an appropriate nursing diagnosis that you can think of that would apply to your client. Determine which 3 problems/nursing diagnoses are of greatest priority and then add a #1, #2, and #3 to indicate which of the two have highest priority. Risks would not be priority 1, 2, or 3!!!!!

Expectation is to have at least 10 nursing diagnosis listed!

# List the Client problem

An appropriate Nursing Diagnosis stem

(REFER TO YOUR NURSING DIAGNOSIS LIST)

Related to part of the statement (This is individual to your client)

As evidenced by part of the statement (This is individual to your client)

REMEMEBR THIS IS NOT USED IN A “Risk For” diagnosis

1 SAMPLE: Reports severe pain in the right hip.

“Acute Pain” “related to” fractured right hip

“as evidenced by” verbal report of pain rated at an 8 on a scale of 0 –to 10.

2 SAMPLE: Complete bed rest

“Risk for Impaired skin integrity”

“related to “ immobility

NONE it is a “Risk for” diagnosis so there is no evidence statement

From the list above your faculty member will give you direction regarding how many and which diagnoses they want you to develop for either a Nursing Care Plan and/or a Concept Map.

SAMPLE NCP

NANDA DIAGNOSIS STATEMENT /RELATED TO STATEMENT/AS EVIDENCED BY STATEMENT: Acute Pain related to right hip fracture as evidenced by a verbal report of pain rated 8 on a scale of 0 -10.

ASSESSMEN T

(Data that directly pertains to the above nursing diagnosis)

OUTCOME STATEMEN T

(Patient centered, realistic, specific, measurable, target time)

INTERVENTIONS

(Individualized, specific, frequency)

Minimum of 4-5 interventions per plan

SCIENTIFIC RATIONALE

(Supporting statement from text or other source, cite source)

EVALUATIO N OF OUTCOME

(Met, partially met, unmet, unknown by target time)

SUBJECTIVE SHORT 1. Educate the client on 1. “There are many ways Short Term

DATA: “My right hip hurts me so much every time I move. I am so afraid to start physical therapy”

TERM: Client will report pain level rated at a 3 or lower 30 minutes after pain medication taken

the importance of pain relief to enhance her rehabilitation efforts and include education on various types of methods to relieve pain.

2. Encourage client to express any questions or concerns she may have regarding pain management methods to alleviate anxiety and fears.

3. Educate the client on her responsibility to honestly report pain when it occurs as well as reporting if the current pain management is effective or ineffective for providing her pain relief

4. Provide for alternative/complement ary measures of pain relief, such as, reduce lighting and noise, soothing music, pet therapy, massage, and hot/cold packs according to client

to manage pain. In addition to pharmacologic and non- pharmacologic measures, simple nursing interventions can alter patients’ pain experience and speed their recovery.” Taylor, Lillis and White pg. 1168.

2. “Common fears include a loss of control and embarrassment by being unable to deal with pain maturely… The patient may view the need of for medication as a sign of weakness or may fear addiction or loss of effectiveness at a later date.” Taylor, Lillis and White pg. 1169.

3. “As a patient advocate, ensure that a strong emphasis on the need for aggressive, individualized strategies that can minimize or eliminate acute pain and improve patient outcomes. Preventing pain is easier then treating it once after it occurs.” Taylor, Lillis and White pg. 1178.

Goal: Met; pain was rated at a 2 on a scale of 0 to 10 after administration of Vicodin.

Long Term Goal. In progress

preferences.

4. Alternative/complement ary measures will provide an added benefit of distraction from pain experience and augment analgesic effect. Cold/hot therapy can provide constriction and or dilation which will reduce pain inflammation in each specific circumstance Daniels. Pg 378

OBJECTIVE DATA:

Alert and oriented 70 year old widowed female. Lives in an apartment independently. 2 daughter live nearby and visit often.

History of a fall while out shopping 1 ½ weeks ago. Right hip surgically repaired 7 days ago. Surgical dressing to right hip is clean, dry and intact. Circulation, motion and sensation intact

LONG TERM: Client will report pain level of 2 or less using ibuprofen with alternative pain control methods by discharge.

to right lower extremity.

Afebrile; BP 124/80; R-18 AP 84 and regular. 5 foot 7 inches weighs 142 pounds. No hearing deficits; wears eye glasses

Medical history positive for osteoarthritis and osteoporosis

Non weight bearing to right leg and to use a walker for ambulation

To start physical therapy for gait and strength training BID times 7 days and occupational therapy to develop upper body strength once daily times 7 days

Reports pain level is at 8 on a scale of 0 to 10.

Has Vicodin 5mg/325 mg po 2 tabs every 4 hours prn for severe pain

Ibuprofen 400 mg every 6 hours prn for moderate pain.

Short term outcome: An outcome that can be accomplished by the end of the student clinical day.

Interventions: Each nursing intervention must come from a reliable nursing reference or source. Please note: do not use nursing care planning book exclusively. Not more than one intervention can come from a source outside your textbooks.

Rationales: Cite a reliable source for each intervention (name of text, author, page number, internet site and date retrieved (reliable sites: .gov or .edu. or .org)

NANDA DIAGNOSIS STATEMENT /RELATED TO STATEMENT/AS EVIDENCED BY STATEMENT:

ASSESSMENT

(Data that directly pertains to the above nursing diagnosis)

OUTCOME STATEMENT

(Patient centered, realistic, specific, measurable, target time)

INTERVENTIONS

(Individualized, specific, frequency)

SCIENTIFIC RATIONALE

(Supporting statement from text or other source, cite source)

EVALUATION OF OUTCOME

(Met, partially met, unmet, unknown by target time)

SUBJECTIVE DATA: SHORT TERM:

OBJECTIVE DATA: LONG TERM:

Short term outcome: An outcome that can be accomplished by the end of the student clinical day.

Interventions: Each nursing intervention must come from a reliable nursing reference or source. Please note: do not use nursing care planning book exclusively. Not more than one intervention can come from a source outside your textbooks.

Rationales: Cite a reliable source for each intervention (name of text, author, page number, internet site and date retrieved (reliable sites: .gov or .edu. or .org)

…../30

NANDA DIAGNOSIS STATEMENT /RELATED TO STATEMENT/AS EVIDENCED BY STATEMENT:

ASSESSMENT

(Data that directly pertains to the above nursing diagnosis)

OUTCOME STATEMENT

(Patient centered, realistic, specific, measurable, target time)

INTERVENTIONS

(Individualized, specific, frequency)

SCIENTIFIC RATIONALE

(Supporting statement from text or other source, cite source)

EVALUATION OF OUTCOME

(Met, partially met, unmet, unknown by target time)

SUBJECTIVE DATA: SHORT TERM:

OBJECTIVE DATA: LONG TERM:

Short term outcome: An outcome that can be accomplished by the end of the student clinical day.

Interventions: Each nursing intervention must come from a reliable nursing reference or source. . Please note: do not use nursing care planning book exclusively. Not more than one intervention can come from a source outside your textbooks.

Rationales: Cite a reliable source for each intervention (name of text, author, page number, internet site and date retrieved (reliable sites: .gov or .edu. or .org)

…./30

NANDA DIAGNOSIS STATEMENT /RELATED TO STATEMENT/AS EVIDENCED BY STATEMENT:

ASSESSMENT

(Data that directly pertains to the above nursing diagnosis)

OUTCOME STATEMENT

(Patient centered, realistic, specific, measurable, target time)

INTERVENTIONS

(Individualized, specific, frequency)

SCIENTIFIC RATIONALE

(Supporting statement from text or other source, cite source)

EVALUATION OF OUTCOME

(Met, partially met, unmet, unknown by target time)

SUBJECTIVE DATA: SHORT TERM:

OBJECTIVE DATA: LONG TERM:

Short term outcome: An outcome that can be accomplished by the end of the student clinical day.

Interventions: Each nursing intervention must come from a reliable nursing reference or source. . Please note: do not use nursing care planning book exclusively. Not more than one intervention can come from a source outside your textbooks.

Rationales: Cite a reliable source for each intervention (name of text, author, page number, internet site and date retrieved (reliable sites: .gov or .edu. or .org)

……………./30

Key Problem: Impaired urinary elimination

Data:

Intake=3800 Output=3200

Polyuria

3+ glucose in urine

AEB: Polydipsia and polyuria

Outcomes:

Pt. will have urine output of 1000 – 2000 ml/24 hours.

Interventions:

Monitor I & O q shift.

Monitor BGM a.c. and h.s.

Monitor kidney function tests

Administer antihyperglycemics as ordered.

Key Problem: Knowledge deficit

Data: Pt verbalizes confusion about diagnosis, new meds, diet, exercise routine

AEB: Verbal statements and questions.

Outcomes:

Pt will verbalize understanding of ADA diet and administer insulin using appropriate technique by discharge.

Interventions:

Assess level of knowledge regarding diabetes/ treatment and client’s preferred learning style.

Provide information q shift according to teaching plan recorded in EMR and document pt’s response.

Reassess level of knowledge daily.

Provide written information.

Provide educational resources available in the community.

Medical Problems (Pathophysiology)/Surgical Procedures:

Newly diagnosed diabetic

Key Assessments:

S/S of hyper and hypoglycemia, good intake, I/O, glucose level, vitals

Tests: FBS, hemoglobin A1C

“I don’t know how this fits”

Recent widow

Kids live out of state

? support system

Key Problem: Acute anxiety

Data: Restless, verbally states she is anxious.

AEB: Pt states “I don’t know what I will do with diabetes, this is too much.”

Outcomes: Pt. will verbalize under-standing of resources available by discharge.

Interventions:

Provide pt. with an opportunity each shift to verbalize anxiety by asking open ended questions.

Demonstrate progressive relaxation exercises and have pt. return demonstrate.

Provide pt. with a list of community resources for newly diagnosed diabetics.

Identify client’s perception of anxiety

Utilize empathy.

Past Medical History: Hypertension x 20 years; appendectomy at age 9.

Risk Factors: Mother had Type 2 diabetes; hypertension; Native American descent; sedentary lifestyle; 290 pounds, age 52

Key Problem:

Imbalanced nutrition, more than

Data:

BMI: 35.0–39.9; Ht: 5”9; Wt: 290 lbs

AEB: Anthropometric measurements.

Outcomes: Client will verbalize a realistic weight loss goal and three strategies to reach it prior to discharge.

Interventions:

Assess client’s knowledge of nutrition and its relationship to diabetes.

Arrange for dietary consultation.

Reinforce teaching by dietician.

Encourage physical activity as a weight loss strategy.

Provide pt with community resources that can assist her with weight loss goal.

“I DON’T KNOW HOW THIS FITS”

PAST MEDICAL HISTORY

RISK FACTORS

MEDICAL PROBLEMS (PATHOPHYSIOLOGY)/SURGICAL PROCEDURES:

KEY ASSESSMENTS:

Key Assessments:

Tests:

KEY PROBLEM:

DATA:

AEB:

OUTCOMES:

INTERVENTIONS:

KEY PROBLEM:

DATA:

AEB:

OUTCOMES:

INTERVENTIONS:

RUBRIC for Grading Packets

/60pts

KEY PROBLEM:

DATA:

AEB:

OUTCOMES:

INTERVENTIONS:

KEY PROBLEM:

DATA:

AEB:

OUTCOMES:

INTERVENTIONS:

Student Name: Clinical Date: Site:

Section Grading Criteria Satisfactory Or Unsatisfactory

Comments, Kudos,

Things to Improve for Next Time

10 points

Patient Demographics,

Diagnoses, Surgeries, Orders, Rehab, IV, Imaging and Lab

Page 1 fully and correctly completed 5 pts

Page 2 fully and correctly completed 5 pts

_/5___

_/5___

20 points

Medications

Medication Trade Name 2 pts

Medication Generic Name 2 pts

Pharmacological Classification 2 pts

Normal Dosage Range 2 pts

Dose ordered 2 pts

Route and Frequency 2 pts

Contraindications 2 pts

Adverse Effects/Reactions 2 pts

Nursing Considerations & Teaching 2 pts

(Legible or typed) 2 pts

/ 2

/ 2

/ 2

/ 2

/ 2

/ 2

/ 2

/ 2

/ 2

/ 2

_/20__

10 points

Narrative Notes

Head-to-Toe Assessment

Narrative note is in Head to Toe order

Head-to-toe assessment documented Abnormal results noted 10 pts Nursing Care Plan and Diagnosis for Chronic Pain

___/10_

60 points (either a Concept Map or a Patient Care Plan)

Concept Map

Correct Medical Diagnosis 15 pts

Pathophysiology 15 pts

Key Assessments 15 pts

At least 3 problems identified 15 pts

Nursing Care Plan and Diagnosis for Chronic Pain

____/60

OR

60 points (either a Concept Map or a Patient Care Plan)

Patient Care Plan

3 nursing diagnoses Related to” “As evidenced by” 18 pts

2 Outcomes specific, measurable, timed 8 pts

4-5 Interventions are logical, appropriate 15 pts

4-5 Scientific Rationales supporting each intervention 15 pts 2 Evaluations 4 pts

Nursing Care Plan for Pain with Diagnosis and Nursing Intervention

Nursing Care Plan for Pain with Diagnosis and Nursing Intervention

Pain classifications Acute pain:

Mild to severe pain lasting less than six months; associated with a sympathetic nervous system response; resulting in increased pulse rate and volume, increased respiratory rate and depth, increased blood pressure, and increased glucose levels; decreased urine production and peristalsis.

The protective function of acute pain is to alert the patient of injury or infection. The onset of sudden severe pain prompts the patient to seek solace. The physiological manifestations of acute pain result from the body's tension response to the pain. Acute pain may be exacerbated by the patient's cultural context, emotions, and psychological or spiritual distress. The assessment of pain can be challenging, particularly in elderly patients with cognitive impairment and sensory

perception deficits. Chronic ache:

Mild to severe pain lasting longer than six months; associated with the parasympathetic nervous system; the patient may not exhibit acute pain-related signs and symptoms. may result in despondency and diminished function

Terms for suffering

Pain threshold is the minimum quantity of stimulus required to produce a painful sensation. The maximum quantity of pain that a patient is willing or able to tolerate. Pain felt in a location other than the origin of a tissue injury Pain that cannot be relieved by conventional treatments is untreatable. Neuropathic pain: agony caused by a neurological disorder and unrelated to tissue damage Phantom pain: pain felt in an absent body part Radiating pain: pain felt at the source that spreads to other locations.

Plan of nursing care for pain that includes intervention and pain

Affiliated with suffering

medical concerns Diagnostic techniques and medical care emotionally and mentally traumatic Aspirational Cultural distress.

Desired Results

On a scale from 0 to 10, the patient reports adequate pain control with a score of less than 3 to 4. The patient is capable of utilizing both pharmacologic and nonpharmacologic pain relief strategies. Patient feels more at ease, as demonstrated by a regulated pulse, blood pressure, respiration, and calm muscle tension and posture.

May be exemplified by.

Protective behavior, body protection, egocentric, narrowed focus Relief or diversion methods

Pain masking the face Consideration of muscular tone

Nursing care plan for pain with intervention and rationale

Nursing intervention Rationale

Assessment of pain characteristics. ex. Quality, severity, location, onset, duration, precipitating and relieving factors

Assessment of the pain experience is the first step in planning pain management strategies. The patient is the most reliable source of information about his or her pain.

Screening for signs and symptoms related to pain.

Some people deny the sensation of pain even though it is present. Paying attention to signs associated with pain can help the nurse assess pain. A patient with acute pain may have elevated blood pressure, heart rate, temperature, be agitated, and have difficulty concentrating.

For scientific findings and symptoms associated with chronic pain, such as fatigue, decreased appetite, weight loss, change in posture, disruption of sleep patterns, anxiety, agitation, or depression.

Patients with chronic pain may not exhibit the physical changes and behaviors associated with acute pain. Pulse and blood pressure are usually within the normal range.

Evaluate the patient’s response to pain and pain management strategies.

It is important to assist the patient in presenting the effect of pain-relieving measures as factually as possible. Discrepancies between the patient’s behavior or demeanor and what he or she says about pain relief.

Assess patient’s expectations for pain relief.

Some patients are satisfied with pain relief, while others expect complete elimination of pain, which affects their perception of the effectiveness of the treatment method and their willingness to participate in further treatment.

Anticipate the need for pain relief. The most effective way to address pain is to prevent it. Early intervention can reduce the total amount of analgesics needed.

Eliminate additional stressors or discomfort whenever possible.

Patients may experience exaggeration of pain or diminished ability to tolerate painful stimuli if they experience additional stress from environmental, intrapersonal, or intrapsychic factors.

Provide rest periods to promote comfort, sleep, and relaxation.

The patient’s perception of pain may be exaggerated by fatigue. In a cycle, pain can lead to fatigue, which in turn can lead to exaggerated pain and fatigue. A quiet environment, a darkened room, and a phone turned off are measures that facilitate recovery.

Determine the appropriate method for pain relief.

Unless contraindicated, all patients with acute pain should receive a nonopioid analgesic around the

clock.

Hot or cold compress

Heat reduces pain by improving blood flow to the area and reducing pain reflexes. Cold reduces pain, inflammation, and spastic massage by decreasing the release of pain-inducing chemicals and slowing the transmission of pain impulses.

Massage of the painful area Increases endorphin levels and decreases tissue edema. This intervention may require another person to perform the massage.

Administer analgesics as ordered by a physician, evaluate their effectiveness, and observe signs and symptoms of side effects.

Analgesics are absorbed and metabolized differently by patients, so their effectiveness must be assessed by the patient individually. Analgesics usually have side effects that range from mild to life-threatening.

Notify the physician if interventions are unsuccessful or if current symptoms represent a marked change from the patient’s previous pain experience.

Patients who request pain medications at shorter intervals than prescribed may actually require a higher dose or stronger analgesics.

Anticipatory education about the causes of pain and appropriate measures for prevention and relief.

Knowing what to expect can help patients develop effective coping strategies for pain management. Patients need to learn the importance of reporting pain early to achieve more effective pain relief.

The patient should learn how to effectively discontinue the medication dose in relation to potentially unpleasant activities and avoidance of pain spikes.

Patients must learn to use pain relief strategies to minimize the pain experience.

Assist the patient and family in identifying lifestyle changes that can contribute to effective pain management. Guide the patient to plan activities during the times when pain is at its greatest relief.

Changes in work routine, household responsibilities, and home environment may be necessary to promote more effective pain management. Ongoing support and guidance for the patient and family will increase the success of these strategies.

How to Write a Nursing Care Plan How to Write a Nursing Care Plan

Nursing Care Plan Components A nursing care plan has several key components including,

 Nursing diagnosis

 Expected outcome  Nursing interventions and rationales  Evaluation

Each of the five main components is essential to the overall nursing process and care plan. A properly written care plan must include these sections otherwise, it won’t make sense!

 Nursing diagnosis – A clinical judgment that helps nurses determine the plan of care for their patients

 Expected outcome – The measurable action for a patient to be achieved in a specific time frame.

 Nursing interventions and rationales – Actions to be taken to achieve expected outcomes and reasoning behind them.

 Evaluation – Determines the effectiveness of the nursing interventions and determines if expected outcomes are met within the time set.

How to Write a Nursing Care Plan Determine the patient's most significant issues prior to composing the nursing care plan. Consider both medical and psychosocial difficulties. At times, a patient's psychosocial concerns may be more pressing or even hold up his or her discharge than the patient's actual medical problems.

After compiling a list of the patient's issues and the corresponding nursing diagnosis, you must determine which are the most significant. In general, this is done by contemplating the ABCs (Airway, Breathing, Circulation). However, these won't ALWAYS be the most significant or even pertinent for your patient.

Step 1: Assessment

The first step in writing an organized care plan includes gathering subjective and objective data. Subjective data is what the patient tells us their symptoms are, including feelings, perceptions, and concerns. Objective data is observable and measurable.

This information can come from,

 Verbal statements from the patient and family  Vital signs

o Blood pressure o Heart rate o Respirations o Temperature o Oxygen Saturation

 Physical complaints o Pain o Headache

o Nausea o Vomiting

 Body conditions o Head-to-toe assessment findings

 Medical history  Height and weight  Intake and output  Patient feelings, concerns, perceptions  Laboratory data  Diagnostic testing

o Echocardiogram o X-Ray o EKG

Step 2: Diagnosis

Using the information and data gathered in Step 1, the nursing diagnosis that best suits the patient, his or her hospitalization goals and objectives is selected.

North American Nursing Diagnosis Association (NANDA) defines nursing diagnosis as "a clinical judgment about the human response to health conditions/life processes, or a vulnerability for that response, by an individual, family, group, or community."

The nursing diagnosis is founded on Maslow's Hierarchy of Needs and assists with treatment prioritization. The next stage involves determining the goals for resolving the patient's problems through nursing interventions based on the nursing diagnosis selected.

There are 4 types of nursing diagnoses.

1. Problem-focused – Patient problem present during a nursing assessment is known as a problem-focused diagnosis

2. Risk – Risk factors require intervention from the nurse and healthcare team prior to a real problem developing

3. Health promotion – Improve the overall well-being of an individual, family, or community

4. Syndrome – A cluster of nursing diagnoses that occur in a pattern or can all be addressed through the same or similar nursing interventions

After determining which type of the four diagnoses you will use, start building out the nursing diagnosis statement.

The three main components of a nursing diagnosis are:

1. Problem and its definition – Patient’s current health problem and the nursing interventions needed to care for the patient.

2. Etiology or risk factors – Possible reasons for the problem or the conditions in which it developed

3. Defining characteristics or risk factors – Signs and symptoms that allow for applying a specific diagnostic label/used in the place of defining characteristics for risk nursing diagnosis

Examples:

PROBLEM-FOCUSED DIAGNOSIS

Problem-Focused Diagnosis related to ______________________ (Related Factors) as evidenced by _________________________ (Defining Characteristics).

RISK DIAGNOSIS

The correct statement for a NANDA-I nursing diagnosis would be: Risk for _____________ as evidenced by __________________________ (Risk Factors).

Step 3: Outcomes and Planning

After determining the nursing diagnosis, it is time to create a SMART goal based on evidence- based practices. SMART is an acronym that stands for,

 Specific  Measurable  Achievable  Relevant  Time-Bound

It is essential to take into account the patient's medical diagnosis, overall condition, and all collected data. A physician or other advanced healthcare professional makes a medical diagnosis. It is essential to remember that a medical diagnosis does not change if the patient's condition improves, and it remains a permanent part of the patient's medical history.

Examples of medical diagnosis include,

 Chronic Lung Disease (CLD)  Alzheimer’s Disease  Endocarditis  Plagiocephaly  Congenital Torticollis  Chronic Kidney Disease (CKD)

During this period, you will also consider the patient's goals and short- and long-term outcomes. These objectives must be achievable and desired by the patient. For instance, if a goal is for the

patient to seek counseling for alcoholism during hospitalization, but the patient is currently detoxifying and experiencing mental distress, this goal may not be achievable.

Step 4: Implementation

Now that the objectives have been established, you must take the necessary steps to assist the patient in achieving them. While some actions will produce immediate results (e.g., administering a suppository to a patient with constipation to induce a digestive movement), others may not be observed until later in the hospitalization.

The implementation phase means performing the nursing interventions outlined in the care plan. Interventions are classified into seven categories:

 Family  Behavioral  Physiological  Complex physiological  Community  Safety  Health system interventions

Some interventions will be patient or diagnosis-specific, but there are several that are completed each shift for every patient:

 Pain assessment  Position changes  Fall prevention  Providing cluster care  Infection control

Step 5: Evaluation

The fifth and final step of the nursing care plan is the evaluation phase. This is when you evaluate if the desired outcome has been met during the shift. There are three possible outcomes,

 Met  Ongoing  Not Met

On the basis of the evaluation, it can be determined whether the objectives and interventions need to be modified. Ideally, all nursing care plans, including objectives, should be met prior to discharge. This is not always true, particularly when a patient is being discharged to hospice, home care, or a long-term care facility. Initially, you will discover that the majority of care plans will have ongoing objectives that may be met within a few days or weeks. It depends on the patient's condition and the desired outcomes.

Consider selecting objectives that the patient is capable of achieving. This will not only help the patient feel as though they are making progress, but it will also relieve the nurse by allowing them to monitor the patient's overall progress.

Nursing Care Plan Fundamentals

Nursing care plans contain information about a patient’s diagnosis, goals of treatment, specific nursing interventions, and an evaluation plan. The nursing plan is constantly updated with changes and new subjective and objective data.

Key aspects of the care plan include,

 Assessment  Diagnosis  Outcome and Planning  Implementation  Evaluation

Through subjective and objective data, constantly assessing your patient’s physical and mental well-being, and the goals of the patient/family/healthcare team, a nursing care plan can be a helpful and powerful tool.

Evidence-Based Practice in Nursing

Examine the importance of incorporating current research evidence into clinical decision-

making and discuss the steps involved in implementing evidence-based practice in nursing care.

Evidence-based practice (EBP) in nursing is a systematic approach that integrates the best

available research evidence, clinical expertise, and patient preferences to guide clinical decision-

making and improve patient outcomes. It involves critically appraising and applying research

findings to inform nursing practice, ensuring that interventions and care are based on the most

up-to-date and reliable evidence. Here is a detailed explanation of evidence-based practice in

nursing:

1. Importance of Evidence-Based Practice:

 Enhancing Patient Outcomes: By incorporating current research evidence into

clinical decision-making, nurses can provide care that is more effective, safe, and

aligned with best practices, leading to improved patient outcomes.

 Ensuring Quality and Safety: Evidence-based practice promotes the use of

interventions and procedures that have been shown to be safe and effective

through rigorous research. This reduces the risk of harm to patients and enhances

the overall quality and safety of nursing care.

 Advancing Professional Development: Engaging in evidence-based practice

encourages nurses to stay updated with the latest research findings, enhancing

their knowledge and professional growth. It also fosters a culture of lifelong

learning within the nursing profession.

2. Steps in Implementing Evidence-Based Practice:

 Formulating a Clinical Question: The first step in evidence-based practice is

formulating a clear and focused clinical question based on the patient's problem or

the nursing intervention under consideration. The question should be structured

using the PICO framework (Population, Intervention, Comparison, Outcome) to

guide the search for relevant evidence.

 Conducting a Literature Search: Once the clinical question is identified, nurses

conduct a systematic search of the literature using databases and other reliable

sources to find relevant research evidence. This includes peer-reviewed journals,

systematic reviews, meta-analyses, and clinical practice guidelines.

 Appraising the Evidence: After identifying relevant research articles, nurses

critically appraise the evidence to evaluate its validity, relevance, and

applicability to the clinical question. This involves assessing the study design,

sample size, methodology, and statistical analysis to determine the quality and

strength of the evidence.

 Synthesizing the Evidence: Nurses analyze and synthesize the findings from

multiple research studies to develop a comprehensive understanding of the

evidence. This includes comparing and contrasting the results, identifying patterns

or consistencies, and determining the overall strength of the evidence.