Mike and Joanne are the parents of James and Samuel, identical twins born eight years ago. James is currently suffering from acute glomerulonephritis, kidney failure

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Case Study: Healing and Autonomy

Mike and Joanne are the parents of James and Samuel, identical twins born eight years ago. James is currently suffering from acute glomerulonephritis, kidney failure. James was originally brought into the hospital for complications associated with a strep throat infection. The spread of the A streptococcus infection led to the subsequent kidney failure. James’ condition was acute enough to warrant immediate treatment. Usually cases of acute glomerulonephritis caused by strep infection tend to improve on their own, or with an antibiotic. However, James also had elevated blood pressure and enough fluid buildup that required temporary dialysis to relieve.

The attending physician suggested immediate dialysis. After some time of discussion with Joanne, Mike informs the physician that they are going to forego the dialysis and place their faith in God. Mike and Joanne had been moved by a sermon their pastor had given a week ago, and also had witnessed a close friend regain mobility when she was prayed over at a healing service after a serious stroke. They thought it more prudent to take James immediately to a faith healing service instead of putting James through multiple rounds of dialysis. Yet Mike and Joanne agreed to return to the hospital after the faith healing services later in the week, and in hopes that James would be healed by then.

Two days later the family returned, and was forced to place James on dialysis, as his condition had deteriorated. Mike felt perplexed and tormented by his decision to not treat James earlier. Had he not enough faith? Was God punishing him or James? To make matters worse, James kidneys had deteriorated such that his dialysis was now not a temporary matter, and was in need of a kidney transplant. Crushed and desperate, Mike and Joanne immediately offered to donate one of their own kidneys to James, but they were not compatible donors. Over the next few weeks, amidst daily rounds of dialysis, some of their close friends and church members also offered to donate a kidney to James. However, none of them were tissue matches.

James’ nephrologist called to schedule a private appointment with Mike and Joanne. James was stable, given the regular dialysis, but would require a kidney transplant within the year. Given the desperate situation, the nephrologist informed Mike and Joanne of a donor that was an ideal tissue match, but as of yet had not been considered—James’ brother Samuel.

Mike vacillates and struggles to decide whether he should have his other son Samuel lose a kidney, or perhaps wait for God to do a miracle this time around. Perhaps this is where the real testing of his faith will come in? “This time around, it is a matter of life and death, what could require greater faith than that?” Mike reasons.

 

© 2015. Grand Canyon University. All Rights Reserved.

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Question 1.Ray has been diagnosed with hypertension, and an ACE inhibitor is determined to be needed. Prior to prescribing this drug, the nurse practitioner should assess for: Hypokalemia

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Question 1.Ray has been diagnosed with hypertension, and an ACE inhibitor is determined to be needed. Prior to prescribing this drug, the nurse practitioner should assess for:

Hypokalemia

Impotence

Decreased renal function

Inability to concentrate

Question 2. A potentially life-threatening adverse response to ACE inhibitors is angioedema. Which of the following statements is true about this adverse response?

Swelling of the tongue and hoarseness are the most common symptoms.

It appears to be related to a decrease in aldosterone production.

The presence of a dry, hacky cough indicates a high risk for this adverse response.

Because it takes time to build up a blood level, it occurs after being on the drug for about one week.

Question 3. Rodrigo has been prescribed procainamide after an episode of MI. He is monitored for dyspnea, jugular venous distention, and peripheral edema because they may indicate:

Widening of the area of infarction

Onset of congestive heart failure

An electrolyte imbalance involving potassium

Renal dysfunction

Question 4. Which of the following is true about procainamide and its dosing schedule?

It produces bradycardia and should be used cautiously in patients with cardiac conditions that a slower heart rate might worsen.

GI adverse effects are common, so the drug should be taken with food.

Adherence can be improved by using a sustained-release formulation that can be given once daily.

Doses of this drug should be taken evenly spaced around the clock to keep an even blood level.

Question 5. Furosemide is added to a treatment regimen for heart failure, which includes digoxin. Monitoring for this combination includes:

Hemoglobin

Serum potassium

Blood urea nitrogen

Serum glucose

Question 6. Art is a fifty-five-year-old smoker who has been diagnosed with angina and placed on nitrates. He complains of headaches after using his nitrate. An appropriate reply might be:

“This is a parasympathetic response to the vasodilating effects of the drug.”

“Headaches are common side effects with these drugs. How severe are they?”

“This is associated with your smoking. Let’s work on having you stop smoking.”

“This is not related to your medication. Are you under a lot of stress?”

Question 7. Donald has been diagnosed with hyperlipidemia. On the basis of his lipid profile, atorvastatin is prescribed. Rhabdomyolysis is a rare but serious adverse response to this drug. Donald should be told to:

Become a vegetarian since this disorder is associated with eating red meat

Stop taking the drug if abdominal cramps and diarrhea develop

Report muscle weakness or tenderness and dark urine to his provider immediately

Expect “hot flash” sensations during the first two weeks of therapy

Question 8.

Which of the following classes of drugs is contraindicated in heart failure?

Nitrates

Long-acting dihydropyridines

Calcium channel blockers

Alpha-beta blockers

Question 9. First-line therapy for hyperlipidemia is:

Statins

Niacin

Lifestyle changes

Bile acid-binding resins

Question 10. Patients who are being treated for folate deficiency require monitoring of:

Complete blood count every four weeks

Hematocrit and hemoglobin at one week and then at eight weeks

Reticulocyte count at one week

Folate levels every four weeks until the hemoglobin stabilizes

Question 11. Isosorbide dinitrate is a long-acting nitrate given twice daily (BID). The schedule for administration is 7 a.m. and 2 p.m. because:

Long-acting forms have a higher risk for toxicity.

Orthostatic hypotension is a common adverse effect.

It must be taken with milk or food.

Nitrate tolerance can develop.

Question 12. The New York Heart Association and the Canadian Cardiovascular Society have described grading criteria for levels of angina.Angina that occurs with  unusually strenuous activity or on walking or climbing stair after meals is:

Class I

Class II

Class III

Class IV

Question 13. Which of the following drugs has been associated with increased risk for MI in women?

Aspirin

Beta blockers

Estrogen replacement

Lipid-lowering agents

Question 14. Scott is presenting for follow-up on his lipid panel. He had elevated total cholesterol, elevated triglycerides, and an LDL of 122 mg/dL. He has already implemented diet changes and increased physical activity. He has mildly elevated liver studies. An appropriate next step for therapy would be:

Atorvastatin (Lipitor)

Niacin (Niaspan)

Simvastatin and ezetimibe (Vytorin)

Gemfibrozil (Lopid)

Question 15. An ACE inhibitor and what other class of drug may reduce proteinuria in patients with diabetes better than either drug alone?

Beta blockers

Diuretics

Nondihydropyridine calcium channel blockers

Angiotensin II receptor blockers

Question 16. Jose is a twelve-year-old overweight child with a total cholesterol level of 180 mg/dL and LDL of 125 mg/dL. Along with diet education and recommending increased physical activity, a treatment plan for Jose would include ____ with a reevaluation in six months.

statins

niacin

sterols

bile acid-binding resins

Question 17. Which of the following disease processes could be made worse by taking a nonselective beta blocker?

Asthma might worsen.

Diabetes might worsen.

Both might worsen.

Beta blockade does not affect these disorders.

Question 18. At which stage/classification of hypertension should drug therapy be instituted according to the JNC-7 Report?

Prehypertension

Stage 1

Stage 2

Any stage where the blood pressure is greater than 120/80 mm Hg

Question 19. Beta blockers treat hypertension because they:

Reduce peripheral resistance.

Vasoconstrict coronary arteries.

Reduce norepinephrine.

Reduce angiotensin II production.

Question 20. Because primary hypertension has no identifiable cause, treatment is based on interfering with the physiological mechanisms that regulate blood pressure. Thiazide diuretics treat hypertension because they:

Increase renin secretion.

Decrease the production of aldosterone.

Deplete body sodium and reduce fluid volume.

Decrease blood viscosity.

 

 

 

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How do you use health information technology in your daily work activities? Does the CNO (Chief Nursing Officer) in your organization use the same Health Information Technology (HIT) as the nurses at the bedside?

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Information Architecture

How do you use health information technology in your daily work activities? Does the CNO (Chief Nursing Officer) in your organization use the same Health Information Technology (HIT) as the nurses at the bedside? What about those individuals who work in admissions? In order to develop an information system that can facilitate the ability to track, share, and analyze patient data, an organization has to take into account the differing needs or views of various departments.

In this Discussion, you consider the differing viewpoints of the professionals within your organization. Imagine what your colleagues’ needs might be and how they might use a HIT system to access and share information to promote evidence-based care. What are the similarities and differences in how this technology would be used by physicians, lab techs, administrators, nurses, informaticians, and others?

To prepare:

  • Review this week’s media presentation, focusing on how the VA’s VistA system demonstrates data flow across an organization.
  • Reflect on your organization’s information architecture and the various information needs of different groups within your work setting. What constraints has your organization faced with implementing health information technology systems that meet everyone’s needs? Consider speaking with your colleagues from different areas about this topic.
  • Ask yourself: How does the flow of data across my organization support, or inhibit, evidence-based practice?

By Tomorrow 09/06/17, write a minimum of 550 words in APA format with a minimum of 3 references from the list below which include the level one headings as numbered below:

post a cohesive response that addresses the following:

1)     Differentiate the information needs within your organization. For example, how might the needs of an administrator differ from the needs of a physician or lab tech?

2)     Explain the impact of these different needs on the implementation of HIT in your present organization.

3)     Evaluate how the flow of information across HIT systems within your organization supports or inhibits evidence-based practice.

 

 

Required Readings

 

Course Text: Ball, M. J., Douglas, J. V., Hinton Walker, P., DuLong, D., Gugerty, B., Hannah, K. J., . . . Troseth, M. R. (Eds.) (2011). Nursing informatics: Where technology and caring meet (4th ed.). London, England: Springer-Verlag.

Chapter 15, “Evidence-Based Clinical Decision Support”

In this chapter, the authors discuss the challenges that arise as HIT systems are employed to support evidence-based practices. The authors also provide examples of tools, features, and systems that promote evidence-based practices.

 

 

Course Text: American Nurses Association. (2008). Nursing informatics: Scope and standards of practice. Silver Spring, MD: Author.

•Metastructures, Concepts, and Tools of Nursing Informatics” (pp. 2-18

•Functional Areas for Nursing Informatics” (pp. 19-36)

These excerpts differentiate the metastructures (overarching concepts used in theory and science) of data, information, knowledge, and wisdom and examine how they are utilized in nursing informatics.

 

 

Alexander, G. L. (2008). A descriptive analysis of a nursing home clinical information system with decision support. Perspectives in Health Information Management, 5(12), 1–22.

This research study examines how data flows through a nursing home’s information system and includes a diagram to illustrate that flow.

 

 

Required Media

 

United States Department of Veterans Affairs. (Producer). (2011). Innovation in VA, The Story of VistA [Video]. Washington, DC: Author.

Note:  The approximate length of this media piece is 4 minutes.

This video, created by the Department of Veterans Affairs (VA), demonstrates how VA innovations have dramatically changed the way in which the VA operates and provides patient care. Enlisting a diverse range of medical staff and IT professionals has helped the VA stay on the cutting edge of the technological tools that ensure patient safety.

 

Optional Resources

 

Chunhau, W., Levine, B. A., & Mun, S. K. (2009). Software architecture and engineering for patient records: Current and future. Military Medicine, 174(5) (May Suppl.), 27–34.

 

 

Reddy, M., McDonald, D. W., Pratt, W., & Shabot, M. M. (2005). Technology, work, and information flows: Lessons from the implementation of a wireless alert pager system. Journal of Biomedical Informatics, 38(3), 229–238.

 

 

Schleyer, R., & Beaudry, S. (2009). Data to wisdom: Informatics in telephone triage nursing practice. AAACN Viewpoint 31(5), 1, 10–13.

 

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This was due today and with the Hurricane and lack of power/limited internet I lost track of the things pending. The professor allowed me to turn it in tomorrow. If you need more time let me know so I can speak to her again.

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Hello,

 

This was due today and with the Hurricane and lack of power/limited internet I lost track of the things pending. The professor allowed me to turn it in tomorrow. If you need more time let me know so I can speak to her again.

 

Assignment 2: Health Policy

The purpose of this assignment is for you to identify an issue of concern for your role as an advanced practice nurse and to formulate a potential policy change to address that issue. There are many potential issues which can influence your practice setting or other issues which may negatively affect the patients with whom you work. All of the course reading will help you to identify a topic for this assignment. You can think about the issue as related to your health promotion project. The policy you consider may be in reaction to the health promotion issue or something larger that is still related to that issue. There are hundreds of possible issues, but here is a list of a few to consider:

· Child and elder care

· Civil rights

· Domestic violence

· Drug abuse/addiction

· HIV/AIDS

· Homelessness

· Native American and migrant workers’ health

· Long-term care

· Immigration/illegal aliens

· Legislative issues affecting advanced practice nursing

· Barriers to practice

· Access to care

As you begin to work on the possible policy change, the following ideas and steps should be considered:

· Definition and description of the issue

· Exploration of the background of the issue

· Stakeholders

· Issue statement or statement of clarity

· Possible methods of addressing the issue

· Goals and options for changes

· Risks and benefits of the changes

· Evaluation methodology

· Recommendation or solution

By Monday, September 18, 2017, submit a Word document to the W3 Assignment 2 Dropbox. Be sure to use APA style and include all of your references.

Grading Criteria Maximum Points
Identify the type of legislation, such as state, federal, scope of practice, reimbursement, loan repayment, or others. 10
Review of the literature consists of a minimum of 3–4 peer-reviewed articles and 6–7 other outside sources. 15
Describe the current policy or health policy issue and specify how it would impact nursing or healthcare. 10
Describe the specific aspects of the proposed policy or policy change. 10
Identify the individuals who would benefit from the policy change and explain where support for the change would be found. 10
Describe the impact of the policy change on nursing practice and health care. 5
Provide an analysis of the policy from your point of view and how this will influence your practice. 10
Use good writing skills, appropriate grammar, and application of APA formatting throughout paper, citations, and references. 5
Total: 75

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