What are the characteristics of the patient or population?

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Discussion Questions

By the due date assigned, post your response to the assigned discussion questions in the below Discussion Area. It is important to support what you say with relevant citations in the APA format from both the course materials and outside resources. Include the South University Online Library in your research activities utilizing not only the nursing resource database, but also those pertaining to education, business, and human resources.

No later than by the end of the week, review and comment on the discussion question responses posted by at least two of your peers. Always use constructive language. All comments should be posted to the appropriate topic in this Discussion Area.

Discussion Question

Formulating the Research Question, Problem Statement, Research Purpose

In the Week 1 discussion forum you had an opportunity to present a potential problem and an innovative solution specific to your role specialization. In addition, you have reviewed the literature to identify qualitative and quantitative research articles and submitted annotated bibliographies to provide evidence supporting the problem.

Considering the feedback provided to you by the faculty member it is now time to prepare your problem statement, research purpose, and research question.

First share your refined problem and proposed solution (given your review of literature this may have changed depending on the evidence you were able to provide). Next, follow the steps to help define your research question.

  1. Craft the problem statement and research purpose.
  2. Design your research question aimed at solving (a part of) the problem and include the following components which will focus the literature review.

PICOT Question:

Patient, Population or Problem

  1. What are the characteristics of the patient or population?
  2. What is the condition or disease you are interested in?

Intervention or exposure

  1. What do you want to do with this patient (e.g. treat, diagnose, observe)?

Comparison

  1. What is the alternative to the intervention (e.g. placebo, different drug, surgery)?

Outcome

  1. What are the relevant outcomes (e.g. morbidity, death, complications)?
  2. Ensure that the research question is answerable, feasible and clinically relevant

The next step in Submissions Area will be to develop a research hypothesis from the research question.

Describe the early signs of dehydration in Mrs. K.B.

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Instructions

After having read Chapters 1-3 and reviewed the learning materials for this week, please complete the following case study. Remember that your answers may be combined with medical terminology, but they must be defined and explained in physiological terminology.

Mrs. K.B. is age 64 and has been a patient of yours for many years. You are calling her today to tell her the results of her Pap test which was done last week during her routine annual checkup in your office. The test showed marked dysplasia of cervical cells but no sign of infection. Unfortunately, when you call, there is no answer.

Since you saw Mrs. K.B. last week she has had gastritis with severe vomiting for 3 days. She has a history of heart problems and is presently feeling dizzy and lethargic. Her eyes appear sunken, her mouth is dry, she walks unsteadily, and she complains of muscle aching, particularly in the abdomen, and she is concerned about her chronic back pain as well and how she is going to handle her pain if she can’t keep her medication down. She is thirsty but is unable to retain food or fluid. A neighbor has brought Mrs. K.B. to the hospital, where examination shows that her blood pressure is low, and her pulse and respirations are rapid. Laboratory tests demonstrate elevated hematocrit, hypernatremia, decreased serum bicarbonate, serum pH 7.35, and urine of high specific gravity. This case study illustrates a combination of fluid, electrolyte, and acid-base imbalances. Specific laboratory values are not given to focus on the basic concepts. For clarity, this case study is discussed in multiple parts. Further information about the specific problems involved is given in each part and is followed by a series of questions.

Part 1

Later in the afternoon, you receive a phone call from Mrs. K.B.’s daughter Sara who tells you that she has been admitted to the hospital with vomiting. Sara is asking about her mother’s test results. Please answer the following questions regarding your conversation with Sara.

  1. Sara is requesting her Mother’s test results and she seems to know that her Mom had a Pap test last week. Sara is really concerned because her Mom had an abnormal Pap test a few years ago and her sister also has a history of Ovarian Cancer. How do you handle this conversation with Sara?
  2. In thinking about how you might discuss these results with Mrs. K.B. or Sara, explain how each of these terms might apply to this scenario: prognosis, latent stage, remission, exacerbations, and predisposing factors.
  3. Explain cellular adaptations and in particular, dysplasia and how testing and or additional testing is done regarding this condition.
Part 2: Day 1

Initially, Mrs. K.B. lost water, sodium in the mucus content, and hydrogen and chloride ions in the hydrochloric acid portion of the gastric secretions.

Alkalosis develops for two reasons, the first being the direct loss of _______________ ions, and the second being the effects of chloride ion loss. When chloride ions are lost in the gastric secretions, it is replaced by chloride from the serum (See Fig. 2.9 in Chapter 2 of your Gould text). To maintain equal numbers of cations and ____________ in the serum, chloride ions, and bicarbonate ions can exchange places when needed. Therefore, more bicarbonate ions shift into the serum from storages sites in the _______________ to replace the lost chloride ions. More bicarbonate ions in the serum raise serum pH, and the result is hypochloremic alkalosis.

  1. Which compartments are likely to be affected in this case by early fluid-loss?
  2. Explain how a loss of sodium ions contributes to dehydration.
  3. Describe the early signs of dehydration in Mrs. K.B.
  4. Describe the compensations for the losses of fluid and electrolytes that should be occurring in Mrs. K.B.
  5. Explain why Mrs. K.B. may not be able to compensate for losses as well as a younger adult.
Part 3: Days 2-3

As Mrs. K.B. continues to vomit and is still unable to eat or drink any significant amounts, loss of the duodenal contents, which include intestinal, pancreatic, and biliary secretions, occurs. No digestion and absorption of any nutrients occurs.

Losses at this stage include water, sodium ions, potassium ions, and bicarbonate ions. Also, intake of glucose and other nutrients is minimal. Mrs. K.B. shows elevated serum sodium levels.

Sara has been at the hospital all morning waiting for the provider to come by with an update. Sara is rubbing her Mom’s back and she continues to complain back pain.

  1. Explain why serum sodium levels appear to be in high in this case
  2. Explain how high serum sodium levels might affect the intracellular fluid
  3. Using your knowledge of normal physiology, explain how continued fluid loss is likely to affect the following:
    1. Blood volume
    2. Cell function
    3. Kidney function
  4. Given Mrs. K.B.’s history, why might a potassium imbalance have more serious effects on her?
  5. As the provider, when you enter the room, you find Sara rubbing her Mom’s back – you introduce yourself and what is the first thing that you would then need to do?
  6. In regard to Mrs. K.B.’s back pain, what type of questions or history would you like to obtain?

Mrs. K.B. reports using herbal compresses at home to help her back pain and that she usually takes two “extra-strong” Acetaminophen tablets every 4 hours and a Tylenol #3 whenever the pain is severe. Sara states that she has tried to get her Mom to use “more natural” treatments for her back but she “loves her Tylenol.”

  1. When considering sources for Herbal and Natural Remedies there are many to choose from but not all are FDA approved, and who has time to vet every website. Take a look at Natural Medicines, which is in the Research Guides at the Regis Library. What type of Natural Medicine treatment would you recommend for Mrs. K.B. knowing that her back pain is due to arthritis that was diagnosed 10 years prior, that could offer her relief from her back pain?
  2. What should Mrs. K.B. and Sara understand about the dosage of acetaminophen that she is taking?
  3. Finally, Sara commented that her Mom seems to be suffering more frequently from insomnia but claims that her medication controls her back pain. Could the Tylenol #3 tablets be interring with her sleep and if so how is this occurring?
Part 4: Day 3

Mrs. K.B. has spent the night in the ED due to a bed shortage and she is finally admitted to Med-Surg.

After a prolonged period of vomiting, metabolic acidosis develops. This change results from several factors.

  • Loss of bicarbonate ions in duodenal secretions
  • Lack of nutrients leading to ______________ of stored fats and protein with production of excessive amounts of ketoacids
  • Dehydration and decreased blood volume leading to decreased excretion of acids by the __________________
  • Decreased blood volume leading to decreased tissue perfusion, less oxygen to cells, and increased _________________ metabolism with increased lactic acid.
  • Increased muscle activity and stress leading to increased metabolic acid production.
  • These factors lead to an increased amount of acids in the blood, which bind with bicarbonate buffer and result in decreased serum bicarbonate and decreased serum pH or metabolic _________________.
  1. List several reasons why Mrs. K.B. is lethargic and weak.
  2. Predict the serum level of carbon dioxide, lactic acid, pH, pO2, K+, Na+, LFTs—note you should indicate low, normal or high and explain why in a brief sentence to indicate you understand the pathophysiology of the process.
  3. If Mrs. K.B. continues to lose body fluid, why might serum pH decrease below 7.35?
  4. If serum pH drops below 7.35 what signs would be observed in Mrs. K.B.
  5. Describe the effect of acidosis on serum potassium levels.
  6. Mrs. K.B. will be given replacement fluid therapy. Why is it important that sodium and potassium be given as well as water?

 

Case Study Rubric

Note: Scholarly resources are defined as evidence-based practice, peer-reviewed journals; textbook (do not rely solely on your textbook as a reference); and National Standard Guidelines. Review assignment instructions, as this will provide any additional requirements that are not specifically listed on the rubric.

Case Study Rubric – 100 PointsCriteriaExemplary
Exceeds ExpectationsAdvanced
Meets ExpectationsIntermediate
Needs ImprovementNovice
InadequateTotal PointsContent of Case StudyThe writer demonstrates a well-articulated understanding of the case study subject matter in a clear, complex, and informative manner. The case study content and theories are well developed and linked to the course content, assignment requirements, and practical experience. The case study includes relevant material that fulfills all objectives of the assignment.

Cites three or more references, using at least one new scholarly resource that was not provided in the course materials.

30 pointsThe writer demonstrates an understanding of the subject matter, and the components of the case study are accurately represented with evidence-based practice, ethics, theory, and/or role content. Course materials and scholarly resources are present to support required concepts. The paper includes relevant material that fulfills all objectives of the case study.

Cites two references.

26 pointsThe writer demonstrates a moderate understanding of the subject matter, as evidenced by components of the case study and use of evidence-based practice, theory, or role-development. Course content is present but missing depth and/or development.

Cites only one reference.

23 pointsAbsent application to evidence-based practice, theory, or role development.

Demonstrates incomplete understanding of content and/or inadequate preparation.

Significant content of case study is vague, inaccurately portrayed, or missing.

No references cited.

Submits assignment late.

20 points30Analysis and Synthesis of Case Study Content and MeaningThrough critical analysis, the submitted case study provides an accurate, clear, concise, and complete summary of the scenario.

Information from scholarly resources is synthesized, providing new information or insight related to the context of the assignment by providing both supportive and alternative information or viewpoints.

All instruction requirements noted.

30 pointsCase study is complete, providing evidence of further synthesis of course content via scholarly resources.

Information is synthesized to help fulfill the case study requirements. The content supports at least one viewpoint.

Submission provides clarification of the assignment by correctly answering all posed questions within the instructions.

All instruction requirements noted.

26 pointsLacks clarification or new information. Scholarly reference supports the content without adding any new information or insight. Case study content may be confusing or unclear, and the summary may be incomplete.

Most instruction requirements are noted.

23 pointsSubmission is primarily a summation of the assignment without further synthesis of course content or analysis of the scenario.

Demonstrates incomplete understanding of content and/or inadequate preparation.

Missing some instruction requirements.

Submits assignment late.

20 points30Application of KnowledgeThe summary of the case study provides information validated via scholarly resources that offer a multidisciplinary approach to the scenario provided.

The student’s application in practice is accurate and plausible, and additional scholarly resource(s) supporting the application are provided.

All questions posed within the assignment are answered correctly in a well-developed manner, applying knowledge with citations for validation.

All instruction requirements noted.

30 pointsA summary of the study, findings, and knowledge gained from the assignment is presented.

Student indicates how the information will be used within their professional practice.

All questions posed within the assignment are answered within the case study. The answer to one question may be vague and/or limited in development, but as a whole all answers are correct.

All instruction requirements noted.

26 pointsObjective criteria are not clearly used, allowing for a more superficial application of knowledge between the assignment and the broader course content.

One question is answered incorrectly and/or two case study answers are vague or limited in development but remain correct.

Student’s indication of how they will apply this new knowledge to their clinical practice is vague.

Most instruction requirements are noted.

23 pointsThe application of knowledge is significantly lacking.

Demonstrates incomplete understanding of content and/or inadequate preparation.

Student’s indication of how they will apply this new knowledge to their clinical practice is not practical or feasible.

Application of knowledge is incorrect and/or student fails to explain how the information will be used within their personal practice.

Multiple questions are not answered or are answered incorrectly (e.g., two questions answered incorrectly, or three case study answers are vague or limited in development but remain correct).

Missing some instruction requirements.

Submits assignment late.

20 points30OrganizationWell-organized content with a clear and complex purpose statement and content argument. Writing is concise with a logical flow of ideas.

5 pointsOrganized content with an informative purpose statement, supportive content, and summary statement. Argument content is developed with minimal issues in content flow.

4 pointsPoor organization and flow of ideas distract from content. Narrative is difficult to follow and frequently causes reader to reread work. Purpose statement is noted.

3 pointsIllogical flow of ideas. Prose rambles. Purpose statement is unclear or missing.

Demonstrates incomplete understanding of content and/or inadequate preparation.

No purpose statement.

Submits assignment late.

2 points5APA, Grammar, and SpellingCorrect APA formatting with no errors.

The writer correctly identifies reading audience, as demonstrated by appropriate language (avoids jargon and simplifies complex concepts appropriately).

Writing is concise, in active voice, and avoids awkward transitions and overuse of conjunctions.

There are no spelling, punctuation, or word-usage errors.

5 pointsCorrect and consistent APA formatting of references, and cites all references used. No more than two unique APA errors.

The writer demonstrates correct usage of formal English language in sentence construction. Variation in sentence structure and word usage promotes readability.

There are minimal to no grammar, punctuation, or word-usage errors.

4 pointsThree to four unique APA formatting errors.

The writer occasionally uses awkward sentence construction or overuses/inappropriately uses complex sentence structure. Problems with word usage (evidence of incorrect use of thesaurus) and punctuation persist, often causing some difficulties with grammar. Some words, transitional phrases, and conjunctions are overused.

Multiple grammar, punctuation, or word usage errors.

3 pointsFive or more unique formatting errors, or no attempt to format in APA.

The writer demonstrates limited understanding of formal written language use; writing is colloquial (conforms to spoken language).

The writer struggles with limited vocabulary and has difficulty conveying meaning such that only the broadest, most general messages are presented.

Grammar and punctuation are consistently incorrect. Spelling errors are numerous.

Submits assignment late.

2 points5Total Points100

Identify what may be causing J.S. to have an exacerbation of asthma.

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J.S. is a 42-year-old man who lives in the Midwest and is highly allergic to dust and pollen and has a history of mild asthma. J.S’s wife drove him to the emergency room when his wheezing was unresponsive to his fluticasone/salmeterol (Advair) inhaler. J.S. was unable to lie down and began to use accessory muscles to breathe. J.S. is immediately started on 4 L oxygen by nasal cannula and intravenous (IV) D5W at 75 mL/hr. A set of arterial blood gases is sent to the laboratory. J.S. appears anxious and says that he is short of breath.

Vital signs

BP = 152/84            HR = 124 bpm                   RR = 42        Temp = 100.40F
ABGs
pH = 7.31               PaCO2 = 48             HCO3 = 26    PaO2 = 55

Investigate the condition of asthma and the manifestations of the disease. Analyze the case study provided and determine what symptoms support the diagnosis of asthma. Identify the treatment provided in the emergency department and determine what additional therapies are needed to mitigate the asthma symptoms and return the client to wellness.

  1. Do you have any concerns with the numbers above?
  2. Identify what may be causing J.S. to have an exacerbation of asthma.

Prepare a 3-5 page paper outlining the causes of asthma, the symptoms that the client presents, and the management of the disorder. Use two evidence-based articles from peer-reviewed journals or scholarly sources to support your findings. Be sure to cite your sources in-text and on a References page using APA format.

Need help finding evidence-based articles? Use this link: http://rasmussen.libanswers.com/faq/208365

Have questions about APA? Visit the online APA guide: https://guides.rasmussen.edu/apa

Module 08 Assignment

Submit your completed assignment by following the directions linked below. Please check the Course Calendar for specific due dates.

Save your assignment as a Microsoft Word document. (Mac users, please remember to append the “.docx” extension to the filename.) The name of the file should be your first initial and last name, followed by an underscore and the name of the assignment, and an underscore and the date. An example is shown below:

Jstudent_exampleproblem_101504

Need Help? Click here for complete dropbox instructions.

Mental Health

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Mental Health Key Terms:

 

1) Type the definition of each of the KEY TERM from the 1st page of each of the 39 chapters from the  Psychiatric—Mental Health Nursing: Evidence-Based Concepts, Skills, and Practices by Wanda K. Mohr.

2) Cite the page in the textbook each key term is found.

3) Submit all the Key Terms in one document.

 

 

 

 

Discussion Topics Learning Objective
1. After learning about mental illnesses in class, a classmate expresses her fear of developing a mental illness. She says to you, “I see a little bit of myself in every mental illness diagnosis we talk about. I am so afraid I may develop one of these diseases one day.”

a. What are the elements of mental health? In what way do you meet these elements?

b. What are the influences on mental health? Which mental health influences can be controlled and which ones cannot?

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2. Jane, a 43-year-old mother of two, was admitted to a mental health facility after a suicide attempt and was diagnosed with severe depression. After several weeks of antidepressant therapy, Jane’s mood greatly improved. Jane’s friend, who was unaware of her suicide attempt and diagnosis, noticed the difference in Jane. When asked about what caused the difference in her mood, Jane said she was just feeling a little down but she was feeling better now. Jane was ashamed to tell her friend about her suicide attempt and her mental health diagnosis.

a. What are the similarities and differences associated with the stigma of a physical illness and that of mental illness?

b. What stigmas about those with mental health conditions exist in society?

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3. Sarah has been working the past 5 years on a telemetry unit. After several experiences with patients suffering from mental health conditions, Sarah becomes interested in mental health nursing and is considering looking for a job as a psychiatric nurse.

a. Describe the levels of practice for the psychiatric–mental health nurse.

b. Discuss the guiding principles or beliefs on which psychiatric–mental health nursing is built.

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4. Your instructor mentions Mental Health: A Report of the Surgeon General in class.  You are curious and decide to read the report at: http://profiles.nlm.nih.gov/ps/access/NNBBHS.pdf  The instructor asks you to share your findings with the class.

a. How does stigma affect individuals with mental illness?  How can nurses seek to combat stigma in mental health care?

b. What are the risk factors in children, adults, and older adults that increase the development of a mental illness?

c. What issues associated with confidentiality does the report reveal? What do you believe could be done about these issues?

  

 

 

 

 

Discussion Topics, Mohr

Chapter 2, Neuroscience: Biology and Behavior

 

Discussion Topics Learning Objective
1. Mary is a 40-year-old woman who has been diagnosed with schizophrenia. Mary’s 20-year-old daughter, Maria, expresses concern that her mother’s mental health disorder is genetic.

a. What is the relationship between genetics and environment in the development of psychiatric disorders?

b. What deficiencies are associated with Mendel’s theory?

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2. James and Susan have just had their first child. James tells the nurse that he and his wife want to ensure that their new baby’s brain develops to its fullest potential.

a. What determines brain development in infancy and childhood?

b. What would you include in a teaching plan for these parents to promote their child’s brain development?

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3. You and a friend are discussing mental health disorders at lunch one day. Your friend says, “I think people should be able to control any type of mental problems; they just need to have the will to feel better.”

a. How would you respond to someone who believes that mental illness is related to a lack of willpower?

b. How are neurotransmitters involved in mental illness?

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4.  Your friend Marcia has been suffering from symptoms such as staring spells, confusion, and uncontrollable jerking of the arms and legs.  Her general physician wants to perform an electroencephalogram (EEG).

a. Describe to Marcia the use and purpose of an EEG.

b. What are the advantages and disadvantages of this neuroimaging technique?

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Discussion Topics, Mohr

Chapter 3, Conceptual Frameworks and Theories

 

Discussion Topics Learning Objective
1. You and a fellow nursing student are discussing the different psychological theories. You find that you have differing opinions on which theories are the most accurate.

a. Select a theory that seems to be the most compatible with your personal beliefs. What were your reasons for selecting this theory?

b. Select a theory that seems least compatible with your personal beliefs. What were you reasons for selecting this theory?

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2. You are receiving report from a psychiatric–mental health nurse. The nurse tells you that the patient you will be working with today is using defense mechanisms.

a. List and define one of the defense mechanisms that people use, and provide an example that would demonstrate use of that defense mechanism.

 2
3. An individual is seeking assistance from a mental health professional due to issues he is having with problem solving. The mental health professional follows the cognitive-behavioral theory.

a. Describe a problem that someone may encounter in life. If a person was following rational problem solving, explain how the problem you identified would be evaluated in the five stages.

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4.  You are a nursing student working on the psychiatric unit.  One of the new graduate nurses verbalizes not ever grasping the concepts of theory while she was in nursing school.

a. Explain to the new graduate nurse why theory is important in nursing practice.

  

 

 

Discussion Topics, Mohr

Chapter 4, Evidence-Based Practice

 

Discussion Topics Learning Objective
1. When talking to a friend, she reveals to you that she has been taking an over-the-counter herb to help treat depression, and she feels as if it is working for her.

a. What are your personal beliefs about unproved treatments?

b. Would you use a treatment or therapy that was not scientifically proven?

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2. Two nurses are having a debate as to whether evidence-based care or pseudoscience should primarily be used in mental health care.

a. Compare and contrast evidence-based care and pseudoscience.

 3, 5
3. Health information based on pseudoscience, myths, and quackery is often advertised in the media.

a. Describe an example of a product seen on the television or heard about on the radio that suggests the possibility of quackery or fraud.

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4.  You have been chosen to do a presentation for the mental health nursing class on evidence-based practice.

a. Explain the importance of the psychiatric nurse using evidence-based practice in caring for the mental health client.

b. What is the difference between evidence-based practice (EBP) and empirically supported treatments (ESTs)?

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Discussion Topics, Mohr

Chapter 5, Legal and Ethical Aspects

 

Discussion Topics Learning Objective
1. You are conducting an interview with a client and he reveals to you that he abuses his wife. He asks you not to tell anyone.

a. Would you be required to keep this client’s confidentiality or to share the information with someone?

b. How would you respond to the client?

c. How would you feel about a client sharing this information with you and what would you do with the information?

 1, 4
2. While giving report on a mental health client to another nurse, the nurse asks you, “What is the patient’s admission status?”

a. What is the difference between voluntary admission, emergency admission, and involuntary commitment?

 5
3. An ethical dilemma is a situation in which moral and ethical principles conflict with one another.

a. Provide an example of an ethical dilemma that you might be faced with as a nurse.

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4.  Your nursing instructor has been teaching the class about the Nurse Practice Act, Standards of Care, and the ANA Code of Ethics.

a. How will the Nurse Practice Act and the ANA Code of Ethics influence your nursing practice?

b. How do standards of care protect the mental health client?

 2, 6, & 8
5.  Your nursing instructor has paired you with a peer group and asked you to analyze ethical principles of autonomy, beneficence, paternalism, veracity, fidelity, and justice in relation to the care of the mental health client.

a. Discuss each of these ethical principles.

b. How would your group incorporate each ethical principle into the care of the mental health client?

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