Management of Patients With Oral and Esophageal Disorders 

Management of Patients With Oral and Esophageal Disorders 
1. George Smith, a 55-year-old patient is admitted to the intensive care unit after a thoracotomy approach was used for an esophagectomy to remove an early stage adenocarcinoma of the distal esophagus and gastroesophageal junction. The patient has a history of GERD and Barrett’s esophagus. The patient sought medical treatment for dysphagia with solid foods, feeling that there was a lump in his throat and substernal pain with swallowing and subsequent regurgitation of undigested food and the development of hiccups. The patient has no other medical problems. (Learning Objectives 6 and 7)

  1. Describe the esophageal cancer that the patient has and how it relates to his history of GERD and Barrett’s esophagus.
  2. Explain the rationale for the early symptoms and late symptoms of esophageal cancer.
  3. What course of cancer treatment should the nurse anticipate that the patient in this case study would have?
  4. What nursing care should be provided for the patient in the intensive care unit in the early postoperative period?
  5. Explain the care the nurse should provide when the patient begins to eat.

2. Mr. Owens is a 62-year-old man who underwent a neck dissection yesterday due to cancer of the mouth. You are the nurse assigned to care for Mr. Owens during his first postoperative day. Initial assessment finds Mr. Owens sitting up in bed; he is drowsy, but oriented ×3 when aroused. He has significant edema in his neck and mouth area, but does not appear to be in respiratory distress. His respiratory rate is 16 to 18, and his oxygen saturation is 96% on 40% oxygen via face tent. He has two peripheral IV lines both infusing Lactated Ringer’s solution at 75 mL/hr. Two Jackson Pratt drainage tubes are partially filled with serosanguinous drainage. (Learning Objective 5)

  1. What is the rationale for the patient being placed in Fowler’s position after surgery?
  2. The nurse notes that there has been 240 mL output in the drainage tubes during the first 24 hours after the surgical procedure. What should the nurse do?
  3. Postoperatively, the nurse identifies that the patient is at risk for imbalanced nutrition, less than body requirements related to anorexia and dysphagia. The nurse instructs Mr. Owens to eat soft food and suggests that he tilt his head to the unaffected side to facilitate swallowing. What is the rationale for these instructions?
  4. In reviewing Mr. Owens’ medical record, what findings in his health history are associated with development of oral cancer?

Immunization Case Study Assignment

Purpose
The purpose of this assignment is to familiarize the student with the most recent guidelines and recommendations for vaccine-preventable illnesses in the United States.
Activity Learning Outcomes
Through this assignment, the student will demonstrate the ability to:

  1. Identify vaccines available in the US market for vaccine-preventable disease and describe their features.
  2. Identify contraindications and precautions for the use of vaccines available.
  3. Use recommendations from the Advisory Committee on Immunization Practice (ACIP) to identify target groups for receipt of each vaccine.

Requirements

  1. The Immunization assignment is worth 100 points and will … on the quality of the content, use of citations, use of Standard English grammar, sentence structure, and overall organization based on the required components as summarized in the directions and grading criteria/rubric.
  2. Submit the paper as a Microsoft Word Document, which is the required format at Chamberlain University. You are encouraged to use the APA Academic Writer when creating your assignment.
  3. Follow the directions below and the grading criteria located in the rubric closely. Any questions about this paper may be posted under the Q & A Forum or emailed to your faculty.
  4. The length of the paper should be 2-3 pages, excluding title page and reference page(s). The title and reference pages should be in APA format.
  5. Vaccination schedules should … directly from the Centers for Disease Control and Prevention: Resources for Healthcare Providers website and reflect the most current recommendations from the Advisory Committee on Immunization Practices (ACIP). Additional scholarly resources may be used and all sources must be cited appropriately.

Following the directions above, answer each of the following case scenario questions:
Case # 1
You are rotating in the newborn nursery. Your next admission is a term newborn born at 3.5 kg, and all maternal labs are negative. The infant’s exam is normal.

  1. What vaccine(s) should she receive and why?
  2. … would you do if the mother tested positive for Hepatitis B?
  3. What would you do if the mother’s Hepatitis B status was unknown?

Case # 2
Your first patient in primary care clinic is a healthy 2-month-old. She received Hep B #1 in the nursery. She is a term infant and parents have no concerns. Her exam is normal and there are no contraindications to giving her vaccines.

  1. Which vaccines should the child receive at this visit?
  2. When should she return and which ones would you administer at the next visit?
  3. Which vaccination combinations can … to minimize the number of needle injections, if available?

Case # 3
A healthy 5-year-old comes in with her mother for a well-child check in November. Her routine vaccines are up to date through 2 years old, but she has never received a vaccine for influenza. Her exam is normal.

  1. Which vaccines do you recommend at this visit?
  2. What anticipatory guidance should … given for a child receiving a flu vaccine at this age?
  3. Are there any contraindications for the vaccines that you recommended today?

Case # 4
An 11-year-old girl presents for a routine well-child check. Her immunizations are up to date. Her exam is normal and there are no contraindications to giving her vaccines.

  1. Which vaccine(s) do you recommend at this visit?
  2. The mother is states that she only wants her daughter to have “the one … for school this year but not the others”. How should the Nurse Practitioner counsel the mother and the patient?
  3. The mother is agreeable to proceed with vaccine administration today. Are additional doses needed? If yes, state which ones and when.

Maternal Child

Purpose of Assignment

This assignment will help to identify the normal growth and development by topic for each age group. In the final column of the assignment you need to observe a child and apply the information you gathered and document your findings in comparison by the particular age of that child.

Competency

Apply the foundations of pediatric nursing when caring for clients with health alterations.

Scenario

You are working in a large urban pediatric clinic after-hours.
A mother brings her 6-month-old daughter, Vivi Mitchell, to the clinic for rhinorrhea, congestion, fever, and cough. Upon assessment, you identify the child has wheezing upon auscultation and on inspection, you identify retractions.

  • The child is in less than 10th percentile of weight and has a cardiac history of Patent Ductus Arteriosus (PDA).
  • Born at 36 weeks gestation.
  • Mother states this child doesn’t go to day care but her two other children ages 2 and 3 do attend daycare.
  • T- 102.1 HR 140 RR 40 BP 83/58 Pulse ox 96%
  • A swab for respiratory syncytial virus (RSV) is positive.

Doctor orders – Nasal bulb suction and saline drops PRN, Tylenol 15mg/kg Q4 PRN for fever, Albuterol nebulizer in office and push po fluids as tolerated.
After the albuterol neb treatment, respirations are 36 and oxygen saturation is 100%. Wheezing has diminished. Mom is an ER nurse and the doctor feels comfortable that she has a nebulizer at home and can return to pediatric afterhours or ER if needed.
Client is discharged with these orders:

  • methylprednisolone 0.4 mg/kg oral BID for 3
  • Albuterol Q4 hours for 24 hours, then Q 6 hours for 24 hours, and Q6 as needed.
  • Call if needed prior to the Q4 dose.
  • Manage fever with Tylenol and continue hydration and nasal bulb suction Q6 while awake.
  • Return for re-evaluation in 3 days

Trends and Issues in Health care 

APA Format
 1) Minimum 4 full pages and  4 slides with speaker notes (No word count per page)- Follow the 3 x 3 rule: minimum three paragraphs per page
           Part 1: minimum 1 page
           Part 2: minimum 1 page
           Part 3: minimum 4 slides
          Part 4: minimum 1 page
           Part 5: minimum 1 page
   Submit 1 document per part
2)¨******APA norms
All paragraphs must be narrative and cited in the text- each paragraph
         Bulleted responses are not accepted
         Don’t write in the first person 
Don’t copy and paste the questions.
Answer the question objectively, do not make introductions to your answers, answer it when you start the paragraph
 
**** ******APA norms- PPP
          Don’t use images.
          Use the speaker note briefly to provide substantial and objective information
          Do not repeat the same information on slides in speaker notes
You should include speaker notes on all slides that expand and deepen the information. Therefore the information must be relevant and complementary.
All paragraphs must be narrative and cited in the text- each paragraph
         Bulleted responses are not accepted
         Don’t write in the first person 
Don’t copy and paste the questions.
All paragraphs must be answered objectively, do not make introductions to your answers, answer them when you start the paragraph
       Use the speaker note briefly to provide substantial and objective information
Submit 1 document per part
3)****************************** It will be verified by Turnitin (Identify the percentage of exact match of writing with any other resource on the internet and academic sources, including universities and data banks)
********************************It will be verified by SafeAssign (Identify the percentage of similarity of writing with any other resource on the internet and academic sources, including universities and data banks)
4) Minimum 3 references (APA format) per part not older than 5 years  (Journals, books) (No websites)
Part 3:   Minimum 5 references (APA format) per part not older than 5 years  (Journals, books) (No websites)
All references must be consistent with the topic-purpose-focus of the parts. Different references are not allowed.
5) Identify your answer with the numbers, according to the question. Start your answer on the same line, not the next
Example:
Q 1. Nursing is XXXXX
Q 2. Health is XXXX
6) You must name the files according to the part you are answering: 
Example:
Part 1.doc 
Part 2.doc
__________________________________________________________________________________
Part 1:  Trends and Issues in Health care
1. Discuss a formal role where a nurse is in a position of leadership.
2. Outline the essential responsibilities of that role and the educational preparation required.
3. Explain what leadership traits, styles, or qualities are required to be successful in this role and why.
Part 2:  Trends and Issues in Health care
The influence of leadership can be far-reaching in practice and improving patient outcomes even when not in a formal role.
1. Describe advocacy strategies that you can use as a leader to create positive change in your current workplace.
Place: Hialeah Hospital
Population: Hispanic
Focus: Community
2. Describe a time when you provided leadership and the outcome.
a.  Was there anything that you would do differently?
Part 3:  Trends and Issues in Health care
1. Summarize: Authoritarian, Autocratic Leadership style. Also, include:
a. Traits
b. Practices
c. 2 advantages over other Leadership styles
2. Summarize: Democratic, Participative  Leadership style. Also, include:
a. Traits
b. Practices
c. 2 advantages over other Leadership styles
3. Summarize:  Delegating, “Laissez Faire” Leader. Also, include:
a. Traits
b. Practices
c. 2 advantages over other Leadership styles
4. Compare the three  Leadership styles. Also, include:
a. Commonalities Leadership styles strengths
b. Commonalities Leadership styles weaknesses.
 
Part 5: Health Care Policy
1. Describe the key concepts underlying community activism:
a. Social justice
b. Community
c. Consciousness-raising
d. Critical reflection
e. Praxis
f. Empowerment
a.give examples of how each of these concepts applies to a specific context.
2. Examine how Advanced Practice Nurses can engage in community activism to limit further negative health impacts from Big Tobacco in their respective health communities.
Attached below is an additional resource, an article, that details various ways by which nursing professionals can engage in community activism.
Patient Advocacy in the Community and Legislative Arena:
http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-17-2012/No1-Jan-2012/Advocacy-in-Community-and-Legislative-Arena.html?css=print
Part 6: Nursing Research
1. What type of analysis you are conducting in your research studies? (Inferential data analysis)
2. What are the advantages and disadvantages of both inferential analysis and qualitative analysis?

Nursing Research, Pathophysiology, Health Care Policy And Nursing Research

APA Format
 1) Minimum  6  full pages (No word count per page)- Follow the 3 x 3 rule: minimum three paragraphs per page
           Part 1: minimum 1 page
           Part 2: minimum 1 page
           Part 3: minimum 1 page
           Part 4: minimum 1 page
           Part 5: minimum 1 page
           Part 6: minimum 1 page
   Submit 1 document per part
2)¨******APA norms
All paragraphs must be narrative and cited in the text- each paragraph
         Bulleted responses are not accepted
         Don’t write in the first person 
Don’t copy and paste the questions.
Answer the question objectively, do not make introductions to your answers, answer it when you start the paragraph
Submit 1 document per part
3)****************************** It will be verified by Turnitin (Identify the percentage of exact match of writing with any other resource on the internet and academic sources, including universities and data banks)
********************************It will be verified by SafeAssign (Identify the percentage of similarity of writing with any other resource on the internet and academic sources, including universities and data banks)
4) Minimum 3 references (APA format) per part not older than 5 years  (Journals, books) (No websites)
All references must be consistent with the topic-purpose-focus of the parts. Different references are not allowed.
5) Identify your answer with the numbers, according to the question. Start your answer on the same line, not the next
Example:
Q 1. Nursing is XXXXX
Q 2. Health is XXXX
6) You must name the files according to the part you are answering: 
Example:
Part 1.doc 
Part 2.doc
__________________________________________________________________________________
Part 1: Nursing Research
1. Discuss the characteristics and requirements that research tools should have on quantitative research to give validity to the study.
2. Give 2 examples
Part 2: Nursing Research
Sample:
The population of interest in this project is school-going adolescent habitual smokers. School-going adolescents are the focus because it is between the age of 12 and 18 that most of them start to engage in smoking and substance abuse.
Method:
Convenience sampling is a non-probability and non-random sampling
1. Describe why you were to choose a specific method to select a sample over other methods.
a. Defend the method you preferred.
Part 3: Pathophysiology
 
You are caring for a patient who has been admitted to the coronary care unit for chest pain unrelieved by nitroglycerin and to rule out myocardial infarction. He is placed on a continuous electrocardiogram (ECG) monitor, and there are orders for him to have 12-lead ECGs every 12 hours for the next 48 hours.
1. Discuss the type of information that can be yielded from continuous monitoring ECG versus a 12-lead ECG.
2. What factors should you consider in selecting the electrode placement and lead (electrical view of the heart) for continuous ECG monitoring?
3. What is the purpose of ordering 12-lead ECGs every 12 hours in this patient?
Part 4: Pathophysiology
 
A 56-year-old patient with newly diagnosed stage 1 hypertension has been referred to you for counseling regarding lifestyle modifications. He is married, with four children—two in high school, two in college. His job as a senior vice-president for a major retail chain requires that he work long hours and frequently eat at restaurants. He smokes two packs of cigarettes a day, has a body mass index (BMI) of 29 kg/m2, and a waist–hip ratio of 1.6. He usually drinks one to two dry martinis to relax after he gets home from work.
1. How would you develop a realistic plan to help this patient reduce his blood pressure and prevent complications?
2. Which risk factors would be among your top two or three priorities for this patient and why
3. What interventions or recommendations would you provide for modifying these?
Part 5: Health Care Policy
 
1. Describe the key concepts underlying community activism:
a. Social justice
b. Community
c. Consciousness-raising
d. Critical reflection
e. Praxis
f. Empowerment
a.give examples of how each of these concepts applies to a specific context.
2. Examine how Advanced Practice Nurses can engage in community activism to limit further negative health impacts from Big Tobacco in their respective health communities.
Attached below is an additional resource, an article, that details various ways by which nursing professionals can engage in community activism.
Patient Advocacy in the Community and Legislative Arena:
http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-17-2012/No1-Jan-2012/Advocacy-in-Community-and-Legislative-Arena.html?css=print
Part 6: Nursing Research
 
1. What type of analysis you are conducting in your research studies? (Inferential data analysis)
2. What are the advantages and disadvantages of both inferential analysis and qualitative analysis?

Health Care Policy, Nursing Research And Nursing Theory

APA Format
 1) Minimum  3  full pages (No word count per page)- Follow the 3 x 3 rule: minimum three paragraphs per page
           Part 1: minimum 1 page
           Part 2: minimum 1 page
           Part 3: minimum 1 page
      
   Submit 1 document per part
2)¨******APA norms
All paragraphs must be narrative and cited in the text- each paragraph
         Bulleted responses are not accepted
         Don’t write in the first person 
Don’t copy and paste the questions.
Answer the question objectively, do not make introductions to your answers, answer it when you start the paragraph
Submit 1 document per part
3)****************************** It will be verified by Turnitin (Identify the percentage of exact match of writing with any other resource on the internet and academic sources, including universities and data banks)
********************************It will be verified by SafeAssign (Identify the percentage of similarity of writing with any other resource on the internet and academic sources, including universities and data banks)
4) Minimum 3 references (APA format) per part not older than 5 years  (Journals, books) (No websites)
All references must be consistent with the topic-purpose-focus of the parts. Different references are not allowed.
5) Identify your answer with the numbers, according to the question. Start your answer on the same line, not the next
Example:
Q 1. Nursing is XXXXX
Q 2. Health is XXXX
6) You must name the files according to the part you are answering: 
Example:
Part 1.doc 
Part 2.doc
__________________________________________________________________________________
Part 1: Health Care Policy
1. Describe the key concepts underlying community activism:
a. Social justice
b. Community
c. Consciousness-raising
d. Critical reflection
e. Praxis
f. Empowerment
b.give examples of how each of these concepts applies to a specific context.
2. Examine how Advanced Practice Nurses can engage in community activism to limit further negative health impacts from Big Tobacco in their respective health communities.
Attached below is an additional resource, an article, that details various ways by which nursing professionals can engage in community activism.
Patient Advocacy in the Community and Legislative Arena:
http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-17-2012/No1-Jan-2012/Advocacy-in-Community-and-Legislative-Arena.html?css=print
Part 2: Nursing Research
1. What type of analysis you are conducting in your research studies? (Inferential data analysis)
2. What are the advantages and disadvantages of both inferential analysis and qualitative analysis?
Part 3: Nursing Theory
The Community Nursing Practice Model and  Rozzano Locsin’s Technological Competency as Caring in Nursing
Topic:  Support capacity building focused on client strengths and client participation
1. How do you see using both of these theories in today’s nursing environment?

Collaboration In Patient Education And Compliance With Older Adults

Topic 4 DQ 2
What part does negotiation play in patient education?
Unlike in the ancient days, patients in modern society have a role and control over their health because they can address their views and opinions. Thus, in the contemporary world, physicians do not act like small ‘gods’ who know and have the final say about a patient’s health; instead, they involve the patients in effective communication and negotiation to discuss patients’ health and possible medication (Orchard, n.d). Patient education involves establishing medication decisions that will work effectively for the patient, physician, and family of the patients. Negotiation helps in patient education because it allows physicians to learn about their culture, beliefs, and values before prescribing any medication. Negotiation identifies areas of agreement and disagreement and provides a forum for discussing solutions. While some health care professionals do not agree with negotiation, patient education can only be as effective as a patient’s willingness and ability to carry out the prescribed recommendations.
For instance, while making and teaching patients about important health decisions, such as quitting smoking, negotiation and face-to-face communication prove more effective (Eisemann, Wagner, & Reece, 2018). Unlike public awareness through platforms, such as awareness campaigns and mass media, negotiation and effective communication prevent and encourage the victims to quit smoking. Nurses’ main role and aim in the health sector is to provide quality and patient-centered healthcare. This is possible upon understanding the patient; therefore, negotiation and effective communication help patient education and provide quality healthcare minimize hospital readmissions (Contributor, 2019). Moreover, during the negotiation processes, the patient’s family also learns some of the essential activities to undertake, especially in the case of genetic diseases, to reduce the probability of contracting such diseases.
 
Using 200-300 words APA format with at least two references. Sources must be published within the last 5 years. There should be a mix between research and your reflections. Add critical thinking in the posts along with research. Apply the material in a substantial way.

Health Assessment

IN ORDER TO ANSWER THE QUESTIONS YOU HAVE TO READ ENTIRED CASE STUD.
You are required to answer all the DISCUSSION QUESTIONS listed below in each domain.
DOMAIN: HISTORY
1a) Identify two (2) additional questions that were not asked in the case stud and should have been?
1b) Explain your rationale for asking these two additional questions.
1c) Describe what the two (2) additional questions might reveal about the patient’s health.
DOMAIN: PHYSICAL EXAMM
For each system examin in this case;
2a) Explain the reason the provider examin each system.
2b) Describe how the examm findings would be abnormal based on the information in this case. If it is a wellness visit, based on the patient’s age, describe what examm findings could be abnormal.
2c) Describe the normal findings for each system.
2d) Identify the various diagnostic instruments you would need to use to examin this patient.
DOMAIN: ASSESSMENT (Medical Diagnosis)
Discuss the pathophysiology of the:
3a) Diagnosis and,
3b) Each Differential Diagnosis
3c) If it is a Wellness, type ‘Not Applicable’
DOMAIN: LABORATORY & DIAGNOSTIC TESTS
Discuss the following:
4a) What labs should be ordered in the case?
4b) Discuss what lab results would be abnormal.
4c) Discuss what the abnormal lab values indicate.
4d) Discuss what diagnostic procedures you might want to order based on the medical diagnosis. 
4e) If this is a wellness visit, discuss what the U.S. Preventive Taskforce recommends for patients in this age group.
I HAVE ATTACHED THE CASE STUD TO THIS POST. PLEASE USE APA STYLE REFERENCES AND NO LATER THEN 5 YEARS AGO.
  • attachment

    WK4HEALTHASSESSCASESTUDY.docx

Microsystem Assessment Of A Healthcare Practice

Conduct a microsystem analysis of a particular practice setting (current or a specific potential practice setting where you desire to work in your new graduate practice role). If you are currently practicing, doing an actual assessment of your microsystem is the most beneficial approach to learning this process. You cannot begin this assignment until you have reviewed the appropriate Microsystem workbook  (Links to an external site.)and completed the readings in Nelson.
If you are currently in a role that is accountable for a macro system then you may choose to complete this assignment from that lens and you should clearly identify that you are doing so and that you understand the difference. Make a recommendation for change to promote effective outcomes and ensure safety for individuals. Please include a reflection on how you are living nursing as caring by proposing this change. Develop a potential evaluation processfor your proposal.
Please note that you must first conduct the assessment before you develop your interventions or response to the assessment. The assessment drivesthe recommendation for change. How did your 5-P assessment drive your Global Aim and the need for change? Assignment Directions and Grading Grid (maximum 20 points):
1. Utilize the 5-P Process to complete your assessment. You must begin by defining the Purpose of your Microsystem.(4 points)
2. Present evidence for your recommended change. Remember that the change should evolve from your 5-P assessment.(4 points)
3. Develop a P-D-S-A for your proposed change. (4 points)
4. Suggest an evaluation plan. (4 points)
5. What do you expect to be the results of this plan? What other resources might be needed to hard wire the desired results? (2 points)
6. APA, spelling, grammar and syntax do count! (2 point)
**Extra Credit: Up to 2 Extra credit points are available to students who choose to step it up and enhance their MicrosystemAssessment by using tools such as fishbone diagrams, flow charts, bar charts, pareto charts, line graphs, and run charts.