Review the discussion board prior to selecting a proposal or prior to posting your message to the discussion board in order to avoid duplicating resources.

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Locate current or proposed legislation, city rules, or ordinances that have the potential to affect the environment in your area. Summarize the legislation and draw conclusions about the impact legislation will have on environmental practices.
Visit the website of a legislative body that has the ability to create rules, codes, or ordinances that impact the environment. Examples of these types of agencies include: Green Dallas, Fort Worth Environmental Management Department, Texas House of Representatives Committee on Environmental Regulation, U.S. House of Representatives Committee on Natural Resources, U.S. Senate Committee on Environment and Public Works and U.S. Environmental Protection Agency (EPA). Select one piece of legislation (or rule, or ordinance), either proposed or actual, and summarize it for the class. Ideally, you should select legislation that will directly impact your community.

  • Review the discussion board prior to selecting a proposal or prior to posting your message to the discussion board in order to avoid duplicating resources.
  • List the title of the legislative bill, rule, or ordinance. Include the title of the legislative body that drafted, proposed, or authorized the legislation.
  • Summarize the environmental legislation in one or two paragraphs. Identify key concepts included in the legislation.
  • In your opinion, what is the potential or realized impact of this legislation on the community?
  • Do you agree or disagree with the legislation? Support your answer.
  • Your original post should consist of complete sentences and should be at least two complete paragraphs but no more than three paragraphs.

Develop      practicum objectives aligned to the American Association of Colleges of      Nursing Essentials, professional standards, and specialty guidelines

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In order to ensure that you are building nursing-related skills and competencies within your practicum setting, it is important to develop specific, appropriate objectives for your practicum hours each quarter. The Practicum Experience allows you to compile your learning objectives and planned timeline for completing your practicum hours and developing your specialty area knowledge and skills. At the end of this quarter, you will use the information in your Practicum Experience to evaluate your progress and achievements in your practicum setting.

If you have previously enrolled in NURS 8600, be sure to develop unique objectives for your Practicum Experience. These may be extensions of previous objectives, or they may be completely new and original objectives intended to expand your experiences in the practicum setting. If you are experiencing difficulty formulating new objectives for your Practicum Experience, consult with your Instructor in this course for additional guidance.

To prepare:

  • Think      about learning objectives that would guide your practicum hours, as well      as the activities you will undertake to achieve those objectives. Draft      three learning objectives that are related to the AACN Essentials      (see attached file), your practice area specialty competencies, and the      focus of this course.
  • Refer      to the Practicum Time Log and Journal document.
  • Develop      a timeline for your Practicum Experience.

To complete:

By tomorrow 8/28/19, write a 2-page paper in APA format with at least 3 scholarly references that includes the level one headers as numbered below:

1) Three learning objectives for your practicum hours that are aligned to the American Association of Colleges of Nursing (AACN) Essentials, your specialty area competencies, the focus of this course (i.e., implementation, evaluation, and dissemination of an evidence-based project), and other aspects of your professional growth and development (see attached file).

2) Activities you will undertake to fulfill your identified learning objectives

3) A proposed timeline for accomplishing your practicum hours (a total of 216 hours over 11 weeks)

P.S.  Use the template attached to complete this assignment. Also, refer to previous class learning objectives to help you write this assignment

Required Reading

Class Learning Objectives

Students will:

  • Participate      in a scholarly forum with colleagues and the course Instructor
  • Develop      practicum objectives aligned to the American Association of Colleges of      Nursing Essentials, professional standards, and specialty guidelines

The primary objective of your practicum is to “build and assimilate knowledge for advanced specialty practice at a high level of complexity,” (AACN, 2006, p. 19). Thus, focus on ways to expand your specialty practice knowledge at the aggregate level and consider roles you are interested in occupying after the completion of the DNP program.

American Association of Colleges of Nursing (AACN). (2006). The essentials of doctoral education for advanced nursing practice. Retrieved from http://www.aacn.nche.edu/publications/position/DNPEssentials.pdf (see attached file).

Use the information in this report to guide the formulation of goals for your practicum experience.

Su, W. M., & Osisek, P. J. (2011). The revised Bloom’s Taxonomy: Implications for educating nurses. The Journal of Continuing Education in Nursing, 42(7), 321-327. (See attached file)

Bleich, M. R. (2011). IOM report, The Future of Nursing: Leading Change, Advancing Health: milestones and challenges in expanding nursing science. Research in Nursing & Health, 34(3), 169-170. doi:10.1002/nur.20433 (see attached file)

IOM report, The Future of Nursing: Leading Change, Advancing Health: milestones and challenges in expanding nursing science. Research in Nursing & Health by Bleich, M. R., in Research in Nursing & Health, Vol. 34/Issue 3. Copyright 2011 by John Wiley & Sons – Journals. Reprinted by permission of John Wiley & Sons – Journals via the Copyright Clearance Center.

Pritham, U. P. (2016). Assessing DNP impact using program evaluations to capture healthcare system change. The Nurse Practitioner, (4), 44.

Kotter, J. P. (2007). Leading change: Why transformation efforts fail. Harvard Business Review, 85(1), 96-103. Retrieved from https://cb.hbsp.harvard.edu/cbmp/pl/76758028/76758030/42e82c2469b7f33387aa79dc5736bb1f

In this foundational reading, Dr. John Kotter discusses errors commonly made as organizations undergo change, and he recommends steps leaders can take to help avoid them (see attached file).

Moriber, N. A., Wallace-Kazer, M., Shea, J., Grossman, S., Wheeler, K., & Conelius, J. (2014). Transforming Doctoral Education Through the Clinical Electronic Portfolio. Nurse Educator, 39(5), 221-226. doi:10.1097/NNE.0000000000000053

Murphy, M. P., Staffileno, B. A., & Carlson, E. (2015). Original Article: Collaboration Among DNP- and PhD-Prepared Nurses: Opportunity to Drive Positive Change. Journal of Professional Nursing,31388-394. doi: 10.1016/j.profnurs.2015.03.001

Sherrod, B., & Goda, T. (2016). DNP-Prepared leaders guide healthcare system change. Nursing Management, (9). 13.

Where in the World Is Evidence-Based Practice?

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Where in the World Is Evidence-Based Practice?

March 21, 2010, was not EBP’s date of birth, but it may be the date the approach “grew up” and left home to take on the world.

When the Affordable Care Act was passed, it came with a requirement of empirical evidence. Research on EBP increased significantly. Application of EBP spread to allied health professions, education, healthcare technology, and more. Health organizations began to adopt and promote EBP.

In this Discussion, you will consider this adoption. You will examine healthcare organization websites and analyze to what extent these organizations use EBP.

To Prepare:

  • Review the Resources and reflect on the definition and goal of EBP.
  • Choose a professional healthcare organization’s website (e.g., a reimbursing body, an accredited body, or a national initiative).
  • Explore the website to determine where and to what extent EBP is evident.
By Day 3 of Week 1

Post a description of the healthcare organization website you reviewed. Describe where, if at all, EBP appears (e.g., the mission, vision, philosophy, and/or goals of the healthcare organization, or in other locations on the website). Then, explain whether this healthcare organization’s work is grounded in EBP and why or why not. Finally, explain whether the information you discovered on the healthcare organization’s website has changed your perception of the healthcare organization. Be specific and provide examples.

 Respond to at least two of your colleagues on two different days by suggesting additional patient factors that might have interfered with the pharmacokinetic and pharmacodynamic processes of the patients they described.

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Respond to at least two of your colleagues on two different days by suggesting additional patient factors that might have interfered with the pharmacokinetic and pharmacodynamic processes of the patients they described.

In addition, suggest how the personalized plan of care might change if the age of the patient were different and/or if the patient had a comorbid condition, such as renal failure, heart failure, or liver failure.

Main Post

Clinical Scenario

The patient is a tall, lanky 67-year-old male with end-stage renal failure and cirrhosis of the liver.  He presents to the Emergency Department (ED) with an inguinal hernia that he cannot reduce.  He rates his pain 10/10 on a scale of 1-10, with 0 being no pain and 10 being extreme pain.  The patient appears uncomfortable, complains of dizziness, and constipation.  Social history consists of smoking a pack a day or cigarettes for 25 years, moderate alcohol consumption, daily marijuana use, poor diet, and decreased mood.  His medications are centered around pain control and include the use of narcotics every 4 hours.  The patient is given a dose of Toradol 30mg, intravenously (IV).  After ten minutes, the patient is asking for more pain medication.  Fentanyl 50 mcg, IV is given with no pain relief reported by the patient.  Finally, Hydromorphone 1mg, IV is administered.  After an hour, the patient still reports pain 10/10.

Pharmacokinetics and Pharmacodynamics

Pharmacokinetics studies the absorption, distribution, metabolism, and excretion of drugs within the body system (Ball, Dains, Flynn, Solomon, & Stewart, 2019).  The use of pharmacokinetics enables providers to determine the appropriate drug for a patient’s diagnosis.  Pharmacodynamics refers to how the body is affected by the use of certain medications (Fox, Hawney, & Kaye, 2011).  Due to the individualized nature of the human body, finding a drug that responds with minimal side effects are desired.Pharmacokinetics, as it relates to this patient’s pathophysiology, creates difficulty for the patient due to the diagnosis of kidney failure and cirrhosis.  Cirrhosis of the liver prevents the body from absorbing, distributing, and metabolizing the drug.  With significant disease process in effect, it is difficult for the body to absorb the drug at a rate that provides effective pain control.  The first-pass metabolism with hydromorphone is decreased in liver cirrhosis and has a likelihood of high hepatic extraction (Wehrer, 2015).  Whereas, fentanyl, is a protein-bound medication is reportedly unaffected by cirrhosis (Wehrer, 2015).  Though the patient tolerated the fentanyl in our case, no specific relief is found due to the chronic nature of the pain. Decreased kidney function reduces the excretion of drugs from the body creating an accumulation of medication in the entire body (Ball et al., 2019).  Frequent use of medications creates a tolerance to that medication and accelerates metabolism of the drug.  Tolerance and increased metabolism results in ineffective pain management outcomes (Ball et al., 2019).  The use of opioids for pain management, in this case, may create an antagonist effect causing unwanted consequences such as constipation, the potential for abuse, and withdrawal (Walter, Knothe, & Lotsch, 2016).  Due to the patient’s continued alcohol consumption and disease processes, the use of acetaminophen or ibuprofen is not encouraged (Wehrer, 2015).

Contributing Factors

For the patient above, behavioral and pathophysiological changes are contributing factors for the choice of medications given.  Alcohol use is the highest contributing factor to cirrhosis (Askgaard, Gronbaek, Kjaer, Tjonneland, & Tolstrup, 2015).  This behavior, as well as smoking, will need to be eliminated to be on the transplant list.  The pathophysiological changes created altered renal excretion and inability of the liver to metabolize medications given for pain control.

Personalized Plan of Care

The plan of care for this patient is to control the pain from the inguinal hernia until it can either be repaired or reduced.  The ability to control pain at a level of 5/10 is the first goal.  A discussion with the patient is necessary to establish realistic goals in light of the chronic conditions.  Focusing on the pain from the hernia is our primary focus.  Initiation of other medications for pain such as Ketamine, Benadryl, or Reglan can decrease pain by 50 percent.  Lastly, non-medication alternatives such as positioning, distraction, and ice-therapy can provide temporary relief.

References

Askgaard, G., Gronbaek, M., Kjaer, M. S., Tjonneland, A., & Tolstrup, J. S. (2015). Alcohol drinking pattern and risk of alcoholic liver cirrhosis: a prospective cohort study. Journal of Hepatology, 62(5), 1061-1067. http://dx.doi.org/10.1016/j.jhep.2014.12.005Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.Fox, C. J., Hawney, H. A., & Kaye, A. D. (2011). Opioids: Pharmacokinetics and Pharmacodynamics. New York, NY: Springer.Walter, C., Knothe, C., & Lotsch, J. (2016). Abuse-deterrant opioid formulations:Pharmacokinetic and pharmacodynamic considerations. Clinical Pharmacokinetics, 55(7), 751-767. http://dx.doi.org/10.1007/s40262-015-0362-3Wehrer, M. (2015, December 14). Pain management considerations in cirrhosis. U.S. Pharmacist, 40(12), HS5-HS11. Retrieved from https://www.uspharmacist.com/article/pain-management-considerations-in-cirrhosis