Identify the caring concepts you feel guided your nursing from Roach’s 6 C’s or Mayeroff’s 8 Caring Ingredients. Describe the ways of knowing that guided your nursing, The text book have good descriptions of the various ways of knowing.

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Identify the caring concepts you feel guided your nursing from Roach’s 6 C’s or Mayeroff’s 8 Caring Ingredients. Describe the ways of knowing that guided your nursing, The text book have good descriptions of the various ways of knowing.

 

After reading the first four chapters from the Barry, Gordon & King text book, select another chapter to read about a nursing situation before you begin developing your own nursing situation. A nursing situation is the shared lived experience in which the caring between the nurse and the one nursed nurtures wholeness and well-being. Reflect on your own nursing situation from practice in which the caring between you and the one nursed nurtured wholeness and well-being. Post that nursing situation here. Identify the caring concepts you feel guided your nursing from Roach’s 6 C’s or Mayeroff’s 8 Caring Ingredients. Describe the ways of knowing that guided your nursing, The text book have good descriptions of the various ways of knowing.
This is a required post, which provides the foundation for your FINAL NURSING SITUATION SYNTHESIS PAPER

A 22-year-old female who adheres to a vegan diet has been diagnosed with iron-deficiency anemia.

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A 22-year-old female who adheres to a vegan diet has been diagnosed with iron-deficiency anemia.

Which of the following components of her diagnostic blood work would be most likely to necessitate further investigation? (Points : 0.4)

Decreased mean corpuscular volume (MCV)

Decreased hemoglobin and hematocrit

Microcytic, hypochromic red cells

Decreased erythropoietin levels

Question 2. 2. A child has been diagnosed with thalassemia. Which of the following other health problems is the child at risk for? (Points : 0.4)

Hypocoagulation

Iron and ferritin deficiencies

Splenomegaly and hepatomegaly

Neutropenia

Question 3. 3. A 24-year-old woman presents with fever and painful, swollen cervical lymph nodes. Her blood work indicates neutrophilia with a shift to the left. She most likely has: (Points : 0.4)

A mild parasitic infection

A severe bacterial infection

A mild viral infection

A severe fungal infection

Question 4. 4. A couple who are expecting their first child have been advised by friends to consider harvesting umbilical cord blood in order to have a future source of stem cells. The couple have approached their nurse practitioner with this request and are seeking clarification of exactly why stem cells are valuable and what they might expect to gain from harvesting them. How can the nurse practitioner best respond to the couple’s inquiry?

History of Gout Research

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Hyperuricemia is a biochemical defect distinguished by Serum uric acid (sUA) level greater than 6.8mg/dl (Sunkureddi

et al

. 2006). In majority of cases (90%), hyperuricemia arise due to reduced excretion of uric acid by kidneys, whereas in residual cases (10%), there is enlarged production of uric acid (Canella

et al

. 2005). .

Gout is an illness that is correlated to overload synthesis, and

deposition

of uric acid crystals. These crystals form secondary to hyperuricemia that is a serum urate concentration greater than 0.42 mmol/L

(

Eggebeen

et al

. 2007; Chen

et al

. 2008). Hyperuricemia and gout are significantly high risks for kidney or bladder stones (urolithiasis).The prevalence of gout and hyperuricemia among US adults in 2007–2008 was 3.9% (Zhu et

al

. 2011) while 18% observed in the German population (Mikuls

et al

. 2007). They are highly prevalent and have treatment preposition beyond the care of inflamed joints.

Gouty arthritis were amongst the initial disease to be documented in clinical entity, Identified by the Egyptians in 2640 BC (Nuki

et al

. 2006), podagra (acute gout stirring in the first metatarsophalangeal joint) was later on recognized by Hippocrates in the fifth century BC, who termed as ‘the unwalkable disease’. Some of Hippocrates’ outstanding clinical perception in relation to gout are potted in aphorisms, which are as accurate today as they were 2500 years ago (Hippocrates

et al

. 1886). Hippocrates also distinguished the connection between the disease and an unbalanced lifestyle referring to podagra as ‘arthritis of the rich’, as contrasting to rheumatism, an arthritis of the deprived people

There are the four differents stages that medical professionals use to classify for the gout. The Asymptomatic gout, The Acute gout ,The Chronic goutand The Interval or intercritical goutIn asymptomatic goutthere is increase in the level of uric acid with the complaint of increase in the pain in the joints and there is no more symptoms. In acute gout this patients have too much pain in their joints and there is a swelling and assiated with the redness of joints.90% of patients have attack on their big toe. Other joints involved are ankle,midfoot heel and knee but any joints can be involved. The attack with gout can be resolved within one or two days

.

In the interval gout stage there is acute gouty flares and the patients has no symptoms.there is increase in the number of gouty attack if the uric acid level below 6 mg/dl .the most of patients have attack but they have never exprinced another attack of gout, Chornic gout develops because of high level of uric acid in their body for many years.firm nodular swelling is called tophi.the tophi can occurs anywhere the most common location are antihelix and helix of ear,digits of feet and hands. (Hench

et al

.1936; Nakayama

et al

. 1984).

It is estimated that the incidence and prevalence of gout and hyperuricemia in the USA are over 6 and 42 million, respectively, with a progressively increasing pattern and affecting mainly men over the age of 40 years (Lawrence

et al

. 2008).

The rate of gout in African living in America is generally about 13% of the US population, and is double in comparison with Caucasians to develop gout. In a prospective cohort study, young men 571 Caucasian and 352 African living in America were followed for a mean duration of 29 years. The growing incidence of gout in these 2 cohorts was 5.8% and 10.9%, correspondingly. Yet, African living in America represent only 10% of the patients treated for gout.(Alvin

et al

2012)

All the way through history gout has been linked with rich foods and extreme alcohol consumption. Because it is evidently connected with a way of life that, at least in the past, could only be afforded bythe rich, gout has been referred to as the ‘disease of kings’. In some eras gout was apparent as publicly desirable because of its occurrence among the politically and socially influential people. In his typical monograph on the history of gout (Copeman

et al

. 1964), Copeman refers to a comment in the London Timesin 1900, “The common cold is well named, but the gout seems right away to lift up the patient’s social status”, and to another in Punch in 1964, “In observance with the spirit of moredemocratic times, gout is becoming less upper-class and is now open to all. It is preposterous that a man should be barred from enjoying gout because he went to the wrong school.”

In history, gout has been well thought-out to be primarily a male disease, But actuality that women can also develop gout was first documented through the reign of Nero (AD 54–68) by Seneca, who observed, in this age, women competitor men in every kind of lasciviousness. Why require we then be astonished at considering so many of the female sex afflicted with the gout (Froster

et al

1979). In the current era, although gout remains first and foremost a disease of men in middle age, it has turn out to be more and more frequent in women, predominantly after the menopause.( Hench

et al

.1936; Nakayama

et al.

1984).

The ancestral connection of gout was documented hundreds of years ago but important the exact genetic mechanisms weren’t achievable until the arrival of modern genetic tools. Gout was incorporated as an inherited disorder in the seminal work of Archibald E. Garrod in his 1931 publication on inborn errors in metabolism. Garrod well thought-out gout to be a dominantly inherited trait.(Gray

et al

2012)

In earlier times, attacks of gout were also seen as a prophylactic against more serious diseases. According to the writer Horace Walpole gout “prevents other illnesses and prolongs life might I treat that gout, should not I have a fever, palsy (Lewis

et al

. 1873),.

In recent decades, however, the diet and lifestyle that predispose persons to hyperuricemia and gout have become all the time more common. The role of excess nutritional purines (derived from meat, seafood, and beer) in the progress of gout is illustrated by the difference between the incidence of gout in Asia and Europe. Traditional Asian diets, based on rice and vegetables, are small in dietary purines, and gout has been moderately rare in these cultures. In contrast, European and American diets, which are high in meat and definite sea foods, are linked with hyperuricemia and gout (Choi

et al

. 200; Zollner

et al.

1973). Rising affluence has also led to an increase in the figure of people following a westernized diet and lifestyle, and this has been paralleled by an increase in the occurrence and incidence of gout throughout the world.

Purines are machinery of nucleosides, the structure blocks of DNA and RNA. Purine nucleosides are used in the formation of other metabolically significant factors as well, such asadensosinetriphosphate, S-adeneosylmethione, and nicotineadeninedinucleotide. Given the significance of purine-containing molecules for continued existence, vertebrates, including humans, have developed robust mechanism for producing enough purine nucleosides for their metabolism using willingly available materials (such as glucose, glycine, and glutamine), as well as recycling purine nucleosides from all through the body or from the diet (Richette

et al

; Wilson

et al

. 2010).

Purines can be divided into two types Endogenouspurines are manufactured within human cells. And exogenouspurines are obtained from foods. In mammals, surplus purine nucleosides are detached from the body by collapse in the liver and excretion from the kidneys. For most mammals, the purines are first transformed into the transitional uric acid, which is then metabolized by the enzyme

uricase

into the compound

allantoin

. Allantoin is a very soluble compound that can without difficulty pass through the bloodstream, become clean by the kidneys, and be excreted from the body. In dissimilarity to other mammals, humans and other primates lack a serviceable uricase enzyme, and can only break purines down into uric acid.

The procedure of breaking down purines results in the configuration of uric acid in the humans body is not as easy to detached, because human body lack uricase, and that can build up in body tissues.

The levels of uric acid in the blood depend on 2 factors. The first is the rate of uric acid synthesis in the liver. While uric acid consequences from purine degradation, its levels are influenced by both the amount of purines synthesized in the body, as well as the amounts of purines absorbed from the diet The second determinant of blood uric acid levels is the rate of uric acid excretion from the kidneys. The residual uric acid travels all the way through the intestines, where bacteria help break it down (Richette

et al.

2010).

Excretion has the maximum effect on blood uric acid levels, with about 90% of hyperuricemia cases attributed to impaired renal excretion (Choi

et al

. 2005). Impaired excretion is most often due to abnormality in the kidney urate carrier or organic ion transporter, both of which control the movement of uric acid out of proximal kidney tubules and into urine (Enomoto A

et al

. 2002).

The treatment of gout consists of controlling the pain

,

Reducing the serum urate levels

,

changing unhealthy life styles

,

preventing the complications of chronic gout. (Schumacher

et al

2008)

By changing the life style because unhealthy life style will result increase hypertension,hyperlipidemia and obesity,by controlling diet of purine consumption causes significant decrease in the serum urate level but the greater decrease is seen in those patients who have stop the alcohol consumption in their diet (choi

et al

2005)

There are number of ways to reduced the sUA level.the best way is too control the diet,but sometime along with the drugs.sometime these drug are very effective and reduced the sUA very quickly. (choi hk

et al

2008)

Following drugs are also used to lower sUA level urate levels:

  1. Uricosuric agents (ii) Allopurinol and Febuxostat:


Uricosuric agents:

Two drugs that belong to this group are benzbromane and probencid.these two are weal organic acid and lower the sUA level,by inhibition of tublar rebsorptionof urate in the renal tubular system and increasing uric acid in the urine

.

These agents are indicated when the renal execration of urate are decreased.it is contraindicated in patient with renal calculi(Alvin

et al

2012).

Two drugs that belong to xanthine oxidiase inhibitor are Allopurinol and Febuxostat. Xanthine oxidase inhibitor along with uricosuric agent are used to increase the urinary execration of urate .The two drugs Febuxostat and Allopurinolare used to lower the sUA level and their


Xanthine oxidase

xanthine oxidase is the only enzyme that break down the purine bases and catalyze the conservation of hypoxanthine to xanthine and the xanthine to uric acid .then uric acid normally excerated .this enzyme deficiency is may be due to the gentic factor, sometime more consumtion of purine food and less production of enzyme.If any drug that is metabolized by xanthine oxidased,its action is increased by Allopurinol drug llike mercaptopurine


FEBUXOSTAT

: Febuxostatis a

urate

decreasing drug and inhibitor of

xanthine oxidase

so that is used in the treatment of

hyperuricemia

and chronic

gout

(Grosser T

et al

. 2011). Febuxostat was approved by the

European Medicines Agency

on April 21, 2008and after one year it was approved by the

U.S. Food and Drug Administration

on February 16, 2009 Febuxostat lowers sUA concentrations by acting on the purine catabolism, the mechanism of action is oxidation of hypoxanthine to xanthine and xanthine to uric acid(Becker

et al

. 2005).

. it is structurally quite different from Allopurinol, has an different mechanism of action on enzyme inhibition, and is more potent.Unlike Allopurinol, that undergoes oxidation to the active metabolite oxypurinol and interacts chemically with the molybdenum center of xanthine oxidase, Febuxostat remains unchanged and inhibits xanthine oxidase by binding in a narrow channel leading to the molybdenum center of the enzyme. By this mechanism, Febuxostat is able to inhibit both the reduced and oxidized form of xanthine oxidase to produce sustained reductions in sUA levels. (Beckar

et al

2010)

The capability of humans and primates to protect blood levels of uric acid (due to slow kidney filtration and lack of a uricase enzyme) was probably useful to our evolution, by increasing antioxidant capacity of the blood (Alvarez-Lario

et al

. 2011).

Vitamin.C

Humans and primates are one of the few mammals that cannot produce their own vitamin c( vit.c), and may have evolve the capability to protect uric acid to reimburse for this (Hediger MA

et al.

2002). For example, blood uric acid levels in humans are in general about 6 times that of vit.c, and about ten times the levels in other mammals (Roch-Ramel F

et al

. 1999). Like vit.c, uric acid has a principle role in shielding high-oxygen tissues (like the brain) from spoil, and low blood uric acid levels have been linked with the succession or greater than before risk of more than a few neurological disorders, including Amyotrophic Lateral Sclerosis (Keizmann D

et al

. 2009), Multiple sclerosis (Rentzos M

et al.

2006), and Huntington’s (Auinger P et al. 2010), Parkinson’s (Andreadou E

et al

. 2009), and Alzheimer’s diseases (Kim TS

et al

. 2006).

Evaluation of Healthcare Policies in Canada

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Summary of Healthcare Policies in Canada

In Canada, the healthcare system is under the control of both the federal and provincial governments.  The federal government provides funding and places conditions that the provincial government must meet to receive that funding.  The federal government’s responsibilities towards the health of Canadians, and the conditions and responsibilities placed on the provincial government are laid out in the Canada Health Act of 1984. The Healthcare act describes these responsibilities as establishing “criteria and conditions in respect of insured health services and extended health care services provided under provincial law that must be met before a full cash contribution may be made.”  These criteria and conditions fall into five areas: public administration, comprehensiveness, universality, portability and accessibility.  For example, under the heading of public administration, provincial healthcare must be non-profit and be run by an administration that has the legal authority to administer a part of public life. Under universality, the Healthcare Act demands that healthcare services be available to all people in the province that qualify.


The Effect of Canada’s Healthcare Policies on The Province of Ontario

In the Province of Ontario, healthcare is greatly affected by the policies of the federal government.  Primarily in that the province must function within the conditions of the Canada Healthcare Act to receive federal funding.  Unfortunately the funding is inadequate.  The transfer payments to the province do not take into account our aging population, who will have increased healthcare needs as they grow older.  The Premiers of Canada agree that the federal government needs to provide sustainable funding at an increase of 5.3% annually, however, the province of Ontario itself is not providing sustainable levels of funding.   In the 2019 provincial budget they have only increased healthcare spending by 1.6%, which does not reach the level of inflation, let alone provide additional funding for increased needs.  Just like the federal funding, the provincial funding does not take into account the aging population.  The demand for new technologies and advanced procedures are also not accounted for at the current funding level.


Obstacles and Challenges Facing Ontario

In January of 2019, the Premier’s Council on  Improving Healthcare and Ending Hallway Medicine released its first report.  The report discusses a multitude of factors that challenge the province when trying to improve healthcare.  The primary factor is that there are not enough long term care beds available.  When there are no beds to move to, patients remain in the emergency department, and other patients end up on extra beds in the hallways.  When elderly patients are ready to be released from the hospital, there are not enough long term care spaces for them to move into and not enough home supports available so that they can return to their homes.  A lack of mental health services in the community, where they are best dealt with, is also a factor.  Mental health patients also clog up the emergency departments and beds in Ontario.

It is unlikely that  healthcare in the province will improve in the near future, as Doug Ford  has already made multiple cuts to the healthcare budget.  In July of 2018, he cut planned mental health funding  by $330 million.   Funding to the College of Midwives of Ontario was cut in December of 2018 and two long term care home funds were cut by $34 million in June of 2019. This funding would have  provided programs, services and equipment that would allow seniors to stay in their homes longer, which is less expensive than having them in long term care facilities. These cuts are just a few examples of the many cuts to healthcare already made by the Ford government.


Proposals to Improve Healthcare in Ontario

The Federal Liberal government has made proposals to improve healthcare in the form of promises they will keep if elected again. They have committed to a family doctor for every Canadian, as well as increased mental health services.  If elected they will work further on a national pharmacare program to reduce prescription drug costs.  Trudeau used the announcement of his healthcare plan to plug for a Liberal Federal Government by commenting “ the question becomes for Canadians, ‘Who do you want negotiating with Doug Ford when it comes to your health?”

In June of this year, The Premiers Council on Improving Healthcare and ending Hallway Medicine released its second report.  The report discusses four areas in which the Provincial Government should focus its resources to develop solutions..  First, the system should be better integrated to provide user friendly service that provides easy access to medical services for patients.  Second, the homecare system should be improved and flexible and telemedicine opportunities increased.  Third, partnerships between medical and social services need to be strengthened, and digital information should be easier to access.  Finally, capacity must be increased.


Concluding Remarks

The Ontario Medical Association supports the recommendations made in The Premier’s Council on Healthcare and ending Hallway Medicine, however, The Ontario Nurses Association understands that these plans will cost millions of dollars and provide no assurances that there will be any improvement in patient care for Ontarians.


References

  • “2nd Report from the Premier’s Council on Improving Healthcare and Ending Hallway Medicine.”
  • Canada, Health. “Government of Canada.”

    Canada.ca

    , Government of Canada, 27 Dec. 2018, https://www.canada.ca/en/health-canada/services/health-care-system/canada-health-care-system-medicare/canada-health-act.html.
  • Guyatt, Gordon. “Doug Ford Failing to Keep His Health Care Promises.”

    Thestar.com

    , 24 July 2019, https://www.thestar.com/opinion/contributors/2019/07/24/doug-ford-failing-to-keep-his-health-care-promises.html.
  • . “Hallway Health Care: A System Under Strain.”

    First Interim Report from the Premier’s Council on Improving Healthcare and Ending Hallway Medicine

    , Government of Ontario, Ministry of Health and Long-Term Care, http://www.health.gov.on.ca/en/public/publications/premiers_council/report.aspx.
  • “How Will Doug Ford Change the Health-Care System? Here Are Some Answers | CBC News.”

    CBCnews

    , CBC/Radio Canada, 31 Jan. 2019, https://www.cbc.ca/news/canada/toronto/ontario-premier-doug-ford-health-care-rueben-devlin-1.4997601.
  • “Liberals Promise to Build National Pharmacare Program – but Offer Few Details | CBC News.”

    CBCnews

    , CBC/Radio Canada, 23 Sept. 2019, https://www.cbc.ca/news/politics/liberal-health-care-pharmacare-2019-1.5293645.
  • “OMA Welcomes Premier’s Council Recommendations to Improve Health Care and End Hallway Medicine.”

    Ontario Medical Association

    , https://www.oma.org/sections/news-events/news-room/all-news-releases/oma-welcomes-premiers-council-recommendations-to-improve-health-care-and-end-hallway-medicine/.
  • “OMA Welcomes Premier’s Council Recommendations to Improve Health Care and End Hallway Medicine.”

    Ontario Medical Association

    , https://www.oma.org/sections/news-events/news-room/all-news-releases/oma-welcomes-premiers-council-recommendations-to-improve-health-care-and-end-hallway-medicine/.
  • “ONA Launches New Ad Campaign ‘Priorities and Promises’; Calls on Ford Government to Stop Unravelling Health Care, Consult with Experts.”

    ONA

    , https://www.ona.org/news-posts/ona-launches-new-ad-campaign/.
  • “Ontario’s Government for the People Taking Immediate Action to End Hallway Health Care.”

    News.ontario.ca

    , https://news.ontario.ca/opo/en/2018/10/ontarios-government-for-the-people-taking-immediate-action-to-end-hallway-health-care.html.
  • “Premier’s Council on Improving Healthcare and Ending Hallway Medicine Releases First Report.”

    News.ontario.ca

    , https://news.ontario.ca/ihehm/en/2019/01/premiers-council-on-improving-healthcare-and-ending-hallway-medicine-releases-first-report.html.
  • “Premier’s Council on Improving Healthcare and Ending Hallway Medicine Releases Second Report.”

    News.ontario.ca

    , https://news.ontario.ca/ihehm/en/2019/06/premiers-council-on-improving-healthcare-and-ending-hallway-medicine-releases-second-report.html.
  • “Premiers Committed to Healthcare Sustainability, Call on Federal Government to Be Full Partner.”

    Canada’s Premiers

    , 11 July 2019, http://www.canadaspremiers.ca/premiers-committed-to-healthcare-sustainability-call-on-federal-government-to-be-full-partner/.
  • Russell, Andrew. “How the Ontario 2019 Budget Will Affect Families across the Province.”

    Global News

    , 12 Apr. 2019, https://globalnews.ca/news/5157528/ontario-2019-budget-families/.
  • “The People’s Health Care Act, 2019.”

    Legislative Assembly of Ontario

    , https://www.ola.org/en/legislative-business/bills/parliament-42/session-1/bill-74.
  • “UPDATE: Mounting Health Care Cuts.”

    Ontario Health Coalition

    , https://www.ontariohealthcoalition.ca/index.php/mounting-health-care-cuts/.
  • “Your Government in Action.”

    Ontario.ca

    , https://www.ontario.ca/page/your-government-action.

Compare and Contrast: LVNs and RNs

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The nursing standards of practice and nursing scope of practice are rules and regulations for the given state, that promote competent nursing actions are being performed during clinical practice. Although LVNs and RNs work closely together, they have different nursing scope of practices. The nursing scope of practices promotes client and nurse’s safety, competent nursing practices, and quality client care (Henry. 2016). As LVNs and RNs perform their daily duties, the nursing standards of practice and nursing scope of practice are kept in mind to prevent harm, breaking moral and ethical principles, and legal actions. Both LVNs and RNs provide client care using clinical skills, knowledge, and judgement (Henry. 2016). However, an RN has more in-depth clinical knowledge and experience, and is able to perform more complex duties in comparison to the LVN. For example, the RN initiates and supervises the nursing process, developing client care plans, client teaching, and so forth. There are many differences in the nursing scope of practice between LVNs and RNs (Russell, 2012). Two standards that interest me are assessment and education.

Assessment is the first step of the nursing process. This phase is a vital component of the nursing process because it is a continuous collection of client health information gathered by the LVN and RN. The information may be objective or subject data regarding the client’s medical history, family history, psychological history, and psychosocial history (Toney-Butler, Thayer, 2019). After the information is gathered, the RN will use clinical judgement and thinking to verify, analyze, and interpret the collected health information to form the client’s plan of care, develop a care plan, and to address other factors affecting the client (Toney-Butler, Thayer, 2019). RNs work independently while LVNs work under the supervision of the registered nurse and physician. Although both LVNs and RNs participate in the assessment phase, the RN is responsible for overseeing and supervising the entire nursing process (Mahuron. 2016). During the assessment phase the LVN’s role is data collection and assisting the RN collect subjective and objective health information. The LVN will also participate in client care and assist with the on-going assessment (Mahuron. 2016). The nursing process consists of five phases, assessment, nursing diagnosis, planning, intervention, and evaluation. Each phase is a key component to the client’s care (Toney-Butler, Thayer. 2019). However, without the efforts of the license vocational nurses and registered nurses during the assessment phase, the other phases of the nursing process would not be possible.

For inspiring registered nurses and licensed vocational nurses, there are differences in the academic requirements and clinical experience. License vocational nurse programs are shorter in length in comparison to a registered nurse program, varying from eleven months to two years. Enrollment requirements consist of a high school diploma or equivalent and no previous medical experience is necessary (RegisteredNursing.org. 2019). The License vocational nursing program will focus on the fundamentals of nursing, pharmacology, an introductory course to health care, and receive clinical experience under the supervision of a registered nurse at various facilities, such as long-term facilities (Writers, 2019). During clinical rotations, students are expected to perform physical assessments, injections, participate in wound care and medication administration. Prior to entering into a registered nursing program, there are a few factors to consider. Depending if the potential student is a license vocational nurse, meets academic and medical requirements, has earned an Associates of science degree, and so forth, the program may range from eight months to a few years. The registered nurse didactic curriculum will focus on advanced med-surg, pathology, and leadership management (Writers. 2019). Clinical rotations may be at acute facilities or hospitals, and over time the student will care for multiple clients. During clinical rotations, nursing students provide care for clients using clinical knowledge, clinical skills, while learning the standards of practice and scope of practice of a registered nurse under the supervision of the clinical instructor. Both nursing programs require in-class lectures, online courses, and supervised clinical experiences at various sites. After the completion of either program, the graduate must apply and pass either the NCLEX-PN or NCLEX-RN to be recognized as a license vocational nurse or registered nurse in their given state.

License vocational nurses and registered nurses both strive to provide competent care for clients. Yet, they have different roles, nursing scopes of practice, responsibilities, and may work in different health care settings (Writers. 2019). As an LVN transitioning into a RN, it is important to understand the differences and similarities of both roles and their nursing scope of practice and to be able to decipher between the two. The nursing scope of practices are implemented to protect clients and nurses by ensuring prudent and competent nursing actions. These rules and regulations separate the LVN’s from the RN’s responsibilities, allowing both nurses to perform their expected duties without confusion. All nurses are assigned clients to provide care by using clinical knowledge and abilities (Henry, 2016). However, RNs possesses in-depth knowledge, clinical experience, understands how to apply clinical judgment and thinking, they are most suitable to be assigned complex tasks and manage the on-going care for acute clients independently. Nurses must understand the rules and regulations regarding client care and how these guidelines affect both the nurse and the client. Nurses practicing outside their scope of practice may lead to negligence, malpractice, legal action, and harm (RegisteredNursing.org. 2018). As a nurse, preforming safe and competent nursing actions is not only in the best interest of the client, it will also ensure nurses are providing quality client care, competent, morally responsible, and perform ethical nursing practices.

References:

Provide a summary of a psychometric instrument focusing on personality assessment (objective or projective), one that is commercially available or published in a reputable psychology journal.

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 Provide a summary of a psychometric instrument focusing on personality assessment (objective or projective), one that is commercially available or published in a reputable psychology journal.

 

Prepare a two-page, single-spaced summary of a psychometric instrument focusing on personality assessment (objective or projective), one that is commercially available or published in a reputable psychology journal. The summary should include the name of the test, its author(s), its publisher, copyright year, number of forms, appropriate age level, and costs; description; administration, scoring, and interpretation; reliability; validity; and applicability and evaluation. You may use the online resources listed above (e.g., Buros Institute of Mental Measurements, the Science Directorate of the APA) and/or reference materials available through Milner Library (e.g., Mental Measurements Yearbook, Tests in Print, PsycINFO) to identify a suitable test and report on its properties and uses. I have provided a sample summary. The summary is worth 10 points and will be evaluated on its accuracy, clarity, coherence, and thoroughness. The test summary is due on 5/15/14

The cost-control mechanism instituted two years ago, based on patient cost sharing and managed competition

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The cost-control mechanism instituted two years ago, based on patient cost sharing and managed competition

You are the President of the United States and your first term ends in a year. The cost-control mechanism you instituted two years ago, based on patient cost sharing and managed competition, has not worked, and the American people are upset about persistent health care inflation. You are preparing a major television address on health care costs. What will you propose? Can you convince the public that yours is a painless cost control strategy? Be sure to site references used in developing your address to the nation.

Specialty Nursing Certification & Return on Investment (ROI) Cost Analysis

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Specialty Nursing Certification & Return on Investment (ROI) Cost Analysis

Paper , Order, or Assignment Requirements

Your organization is interested in applying for Magnet status and will be required to submit data on the percentage of nurses who are certified in a nursing specialty. The nursing specialty certifications rates at your entity are low. You have been asked by your Chief Nursing Officer (CNO) to submit a summary of the impact of nursing specialty certification. The CNO will present this information to the Executive Leadership Team in a proposal to reimburse nurses for obtaining and maintaining certification.

Create a 1-2 page proposal for your CNO summarizing the following:
Step 1: Locate published evidence (2-4 primary research articles and national/state web references) that supports the concept that certification improves overall nursing care.
Step 2: Identify at least two nursing sensitive outcomes and/or quality outcomes you can realistically audit to evaluate the impact of certification.
Step 3: Select one specialty certification and summarize the projected cost for a staff of 60 RNs to become certified.
Step 4: Perform a cost and benefit analysis and return on investment of certifying 60 RNs
Part 2: Note: The Impact of the Nursing Specialty Certification Proposal Assignment will be given to your CNO. It should (1) be written in bullet points -whenever possible; (2) must not exceed 2 pages and (3) Include a cost/benefit analysis and ROI (4) List key references at the bottom of the proposal.

Identify an effective health care organization that utilizes information technology.

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Identify an effective health care organization that utilizes information technology.

Identify an effective health care organization that utilizes information technology.

Analyze the components and requirements of its information systems technology program.
Explain the requirements for health care information technology systems to comply with federal, state, and local laws governing patient information security.
Assess the risks and affected stakeholders in the event of a system breach or failure, and recommend approaches that can be used to safeguard confidential information.

Identify an effective health care organization that utilizes information technology.

Analyze the components and requirements of its information systems technology program.
Explain the requirements for health care information technology systems to comply with federal, state, and local laws governing patient information security.
Assess the risks and affected stakeholders in the event of a system breach or failure, and recommend approaches that can be used to safeguard confidential information.

Rheumatoid Arthritis: Etiology- Symptoms and Management

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Rheumatoid Arthritis

Rheumatoid arthritis is an autoimmune disorder that affects about 1% of the population


(Hubert & VanMeter, 2018). It results in a chronic inflammatory condition, primary in older women. An autoimmune disease means that the body is attacking itself. Rheumatoid arthritis (RA) typically affects the joints, making them distorted and aching. However, it can cause discomfort in other bodily systems as well.

The initial encounter with RA causes inflammation in small joints, like finger and toes. Other joints can be attacked, like the knee and pelvic joints. Inflammation to the joints cause increased permeability, vasodilation, and exudate formation. The subsequent occurrences of the disease show signs of cell proliferation (synovitis) and Pannus formulation. Pannus is granulated tissue that activates inflammatory mediators in the cartilage (Hubert & VanMeter, 2018).

Synovitis occurs when too many leukocytes are present due to activation of endothelial cells and adhesion molecules


(Aletaha & Smolen, 2018). The disorder will result in sore, swollen, red, and painful joints. The inflammation in the synovial joint will cause Pannus-filled erosion in the joints. This will cause deformed joints and bones. A person with RA will have Rheumatoid factor (RF) in the blood and synovial fluid. RF increases the inflammation activation, along with other factors. Autoantibodies can formulate 10 years before signs and symptoms occur (Aletaha & Smolen, 2018). There is no known reason why people get RA, but the environment and genetics play a large role.


Etiology




and




risk




factors

Rheumatoid arthritis can happen to anyone since there are no exact causes. However, certain factors put a person more at risk than others. For instance, women are more prone to this disease than males. About 70% of RA cases are women (Belleza, 2017). Some research find that women get RA and other autoimmune diseases at higher incidences than males due to their increase in hormone levels. RA can happen at any age, but it tends to develop in middle-aged adults. People exposed to asbestos and other harmful chemicals are at an increased risk due to poor environment. Being overweight also puts someone at a higher risk of developing RA (Mayo Clinic, 2019). Cigarette smoke and air pollution are other contributions in getting RA. Genetics are a consideration because people with the “HLA shared epitope have an increased chance of developing RA.” (Belleza, 2017).


Clinical Manifestations and Complications

The most common physical sign of rheumatoid arthritis is having swollen, red, warm, and painful joints. Upon palpation, the joints would feel spongy and bouncy. Joints would also be difficult to move. In response to inflammation, the joints may have deformities. This is another reason for the difficulty in mobility of the joints and bones. Other signs and symptoms include: fatigue, edema, morning stiffness, eye sensitivity, and mouth dryness. Rheumatoid nodules are another sign and a complication. This nodule can even occur in the lung and can further complicate the bodily systems. Many medications people with RA take cause complications like: osteoporosis, anemia, bone marrow suppression, and gastrointestinal disturbances. If left untreated permanent damage can occur to the joints. Cardiovascular, lung, and eye function can also be at stake. RA can increase the risk of having blocked arteries and inflammation of the pericardium. In addition, it usually puts a person at risk for Sjogren’s syndrome (Mayo Clinic, 2019). This syndrome decreases the moisture in the mucus membranes inside the mouth and in the eyes.


Pathophysiological Processes

The autoimmune responses to the cells cause inflammation in the joints. This causes Pannus build up around the joints. Adhesive cells and endothelial cells are activated and leukocytes respond. The WBC’s accumulate in the surrounded area causing edema and pain. This can be aggravated by certain things, such as an increase in pressure to the joint, smoking, and stress. Inflammation from the leukocyte’s reaction will make signs and symptoms appear and in different severity levels.


Diagnostics

There are quite a few ways to tell whether or not a person has rheumatoid arthritis. Although the signs and symptoms are quite profound and evident, certain diagnostic tests can confirm that the person has RA. One test is called the antinuclear antibody titer, which appears elevated in RA patients. However, this test typically has to be repeated to specify which rheumatoid issue it is. The Rose-Waaler test is used to check the rheumatoid factor, which is positive in 80% of RA patients. CBC’s are usually low, resulting in anemia. On the other hand, the WBC tends to be high during the inflammatory process or an acute episode. The ESR, C3 and C4 levels will also be increased during an acute episode.  Most of the tests are non-evasive, but there are tests, like the synovial-membrane biopsy. This just checks the changes in fluids and leukocytes (Belleza, 2017).


Conclusion

To finalize, rheumatoid arthritis has no known cause. There are factors that may trigger it, as well as pathophysiological trends to follow. Common signs and symptoms that are present are joint pain, swelling, redness, and edema. This disease can affect other systems, as well. Since RA is an autoimmune disease, there is an attack on the body. This can cause other complications, such as pulmonary and cardiovascular issues. Fortunately, there are plenty of non-evasive diagnostic tests to confirm rheumatoid arthritis. It is important to confirm this disorder as soon as possible so that it can be treated. Reoccurring events will only result in worsening of the symptoms and possibly permanent damage.

References