How to Approach the Clinical Encounter and Medical Ethics

How to Approach the Clinical Encounter and Medical Ethics

A 16-year-old male was brought to the emergency department (ED) in police custody for psychiatric evaluation. His girlfriend called 911 because he was hearing voices and threatening to shoot her. He reportedly had a history of schizophrenia and had stopped taking his medications. On arrival, he was attempting to leave the ED: “Let me go! I know my rights!” While in the ED, he stated that he did not want his mother or his psychiatrist to know that he threatened to shoot his girlfriend and did not want this to be in his medical record.

Reflect on how you would approach this dilemma.

DISCUSSION POST, SO 1 PAGE IS JUST FINE IN LEGTH, APA FORMAT, MUST HAVE AT LEAST  3 REFERENCES.NOTHING LESS.

Using Gordon’s Functional Health Patterns frameworkIn your community assessment, include the following:

Using Gordon’s Functional Health Patterns frameworkIn your community assessment, include the following:

  • Identify resources in your community that would enable you to complete a community assessment and submit a summary of your findings (1–2 paragraphs).
  • Refer to Table 8-3: Examples of Community Strengths and Concerns, and assess the strengths and concerns of your community (2–3 paragraphs).
  • Identify potential barriers to implementing community health plans in your community and brainstorm  ways of addressing these barriers (2–3 paragraphs).

Topic: Diagnostic Reasoning

Topic: Diagnostic Reasoning

Clinical decision making is the process by which we determine who needs what and when. While not exactly arbitrary, this exercise can be quite subjective. Each provider compiles their own data (hence the emphasis on learning to perform an accurate H&P) and then constructs an argument for a particular disease state based on their interpretation of the “facts.” The strength of their case will depend on the way in which they gather and assemble information. There may then be no single, right way of applying diagnostic and therapeutic strategies to a particular case. Medicine involves playing the odds, assessing the relative chance that a patient is/is not suffering from a particular illness. Codifying the way in which providers logically approach problems and deal with this uncertainty is a difficult task. Relying solely on the classic features of a disease may be misleading. That is because the clinical presentation of a disease often varies: the symptoms and signs of many conditions are non-specific initially and may require hours, days, or even months to develop.

Generating a differential diagnosis; that is, developing a list of the possible conditions that might produce a patient’s symptoms and signs, is an important part of clinical reasoning. It enables appropriate testing to rule out possibilities and confirm a final diagnosis.

This case portrays a poor patient outcome after a misdiagnosis.

Case scenario

A previously healthy 35-year-old lawyer presents to a primary care office with a chief complaint of chest pain and a non-productive cough. The pain started suddenly two hours prior to coming to the office while the patient was sitting at his desk. The patient describes the pain as sharp in nature, constantly present but made worse with inspiration and movement, and with radiation to the base of the neck. His blood pressure in the right arm and other vital signs are normal

On physical examination, the only findings of note are chest wall tenderness and a faint cardiac murmur. The ECG in the office is normal. The patient is observed for an hour in the office and assessed. He is diagnosed with viral pleurisy and sent home on non-steroidal analgesics.

The following day the patient collapses at home and cannot be resuscitated by the paramedic service. An autopsy reveals a Type 1 aortic dissection with pericardial tamponade.

Discussion Assignment:

Developing a list of possible conditions that might produce a patient’s symptoms and signs is an important part of clinical reasoning.

As an NP in primary care, what would you have done differently?

Discuss the importance of creating a list of differentials for this patient. How could it have changed this outcome?

If a serious diagnosis comes to mind based on a patient’s symptoms:

  • Ask yourself: Have you considered the likelihood of a serious diagnosis and whether it needs to be ruled out by testing or referral?
  • Because many serious disorders are challenging to diagnose, have you considered ruling out the worst-case scenario?
  • Ask yourself: Do you have a sufficient understanding of the clinical presentation to offer an opinion on the diagnosis?
  • What other diagnoses could it be? How might the treatment to date have altered the patient’s outcome?
  • What other diagnostic and laboratory or imaging was needed in order to make a complete differential list? What support tools would you consider using in helping to create a differential diagnosis list?
  • Are you familiar with the current clinical practice guidelines for the investigation of a suspected condition such as chest pain?
  • Please support with up-to-date evidence-based standard of care guidelines that are less than 5 years old.

ITS A DISCUSSION POST. ONE PAGE IN LENGTH IS JUST FINE. APA STYLE AND MUST HAVE 3 REFERNECES PLEASE.

Step 1 Select a favorite dish from your culture ( VENEZUELA) that you would like to makeover. Find a picture of this food (online is okay). Write down the main ingredients and how it is prepared/cooked.

Step 1 Select a favorite dish from your culture ( VENEZUELA) that you would like to makeover. Find a picture of this food (online is okay). Write down the main ingredients and how it is prepared/cooked.

Step 2 Review the guidelines for a heart-healthy diet in your reading.

Step 3 Identify how you can make your favorite dish more heart-healthy. This could include the ingredients or preparation/cooking method.

Step 4 Submit your initial post with the following information included:

  • Name of your favorite dish and what culture it represents.
  • Include a photo of the traditional dish.
  • Description of the traditional ingredients and cooking method.
  • Please explain how you would make it more heart-healthy. Provide a thorough rationale for the reason why these changes make it more heart-healthy. Be specific to at least 3 ingredients and/or cooking techniques you can change. You do not have to make it (unless you want to). The explanation is enough for this post.
  • Minimum of 250 words for the first post.

System Disorder Paper Grading Rubric

System Disorder Paper Grading Rubric

 

Required Information Not present or included Not acceptable Needs improvement Satisfactory Excellent Earned Points
Introduction/Pathophysiology 0 1-5 6-10 11-14 15  
Risk Factors 0 1-5 6-10 11-14 15  
Expected Findings 0 1-5 6-10 1-14 15  
Laboratory Tests 0 1-3 4-7 8-9 10  
Diagnostic Procedures 0 1-3 4-7 8-9 10  
Complications 0 1-5 6-10 11-14 15  
Summary 0 1 2-3 4 5  
Grammar/Spelling 0 1 2-3 4 5  
APA format (does not exceed page limit) 0 1 2-3 4 5  
Minimum 2 Reference citations in APA format 0 1 2-3 4 5  
Total         100  

 

 

Comments/Feedback

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Excellent:

Introduction/Pathophysiology Concise, clear intro that covers the pathophysiology of disease
Risk Factors Provides risk factors tied to pathophysiology without just listing
Expected Findings Expected findings tied to pathophysiology that are not just listed
Laboratory Tests Covers the critical lab results and rationale
Diagnostic Procedures Covers critical diagnostic procedures and rationale
Complications Addresses at least 3 complications of the disorder
Summary Summarizes content in 3 sentences
Grammar/Spelling No grammar or spelling errors
APA format (does not exceed page limit) No APA errors
Minimum 2 Reference citations in APA format More than 2 references used and formatting correct

 

Satisfactory:

Introduction/Pathophysiology

Clear intro that covers the pathophysiology of disease
Risk Factors Provides risk factors that are not just listed
Expected Findings Expected findings that are not just listed
Laboratory Tests Covers the critical lab results
Diagnostic Procedures Covers critical diagnostic procedures
Complications Addresses at least 3 complications of the disorder
Summary Summarizes content in more than 3 sentences
Grammar/Spelling Less than 5 grammar and/or spelling errors
APA format (does not exceed page limit) Less than 5 APA errors
Minimum 2 Reference citations in APA format 2 references used and formatting correct

 

Needs Improvement:

Introduction/Pathophysiology Intro disorganized or does not clearly address the pathophysiology
Risk Factors Risk factors are just listed
Expected Findings Expected findings only listed
Laboratory Tests Does not include all critical labs or includes irrelevant labs
Diagnostic Procedures Does not include all critical labs or includes irrelevant labs
Complications Addresses less than 3 complications of the disorder
Summary Summary is disorganized or lengthy
Grammar/Spelling 6 – 10 grammar and/or spelling errors
APA format (does not exceed page limit) 6 – 10 APA errors
Minimum 2 Reference citations in APA format 2 references used but formatting is incorrect

 

Not present or included:

Introduction/Pathophysiology Not included or included beyond page 2
Risk Factors Not included or included beyond page 2
Expected Findings Not included or included beyond page 2
Laboratory Tests Not included or included beyond page 2
Diagnostic Procedures Not included or included beyond page 2
Complications Not included or included beyond page 2
Summary Not included or included beyond page 2
Grammar/Spelling 11 or more grammar and/or spelling errors
APA format (does not exceed page limit) 11 or more APA errors
Minimum 2 Reference citations in APA format Less than 2 references

Chronic Renal Failure -The handout should include the following:

Chronic Renal Failure -The handout should include the following:

TWO pages plus a reference page (see below for detailed directions about your references)

Written as a handout (short sections with limited verbiage and including bullet points, columns, or tables.

Word templates for brochuresLinks to an external site. 

Article on how to make brochure in PagesLinks to an external site. (Mac) – make sure you convert to PDF before you submit (directions are in the article)

A minimum of two graphics – used to enhance the content

Sections of the handout should address the following:

Summary of the condition. i.e., How does the condition develop? What is the effect on the body? Why is it a serious health condition?

The lifestyle factors (and other risk factors) leading to the condition.

General nutrition recommendations. 

Foods allowed and not allowed. i.e., the foods that should be limited/reduced or encouraged (normally in a table or columns). This must be a detailed list of foods on both sides. They must be in the students’ words (i.e., graphics should NOT replace the content you are being graded on).

Medications/supplements that are commonly used to treat the condition (can include necessary vitamins); and which should be avoided.

Hypertension, Diet & Lifestyle

Hypertension, Diet & Lifestyle

The circulatory system is the “highway” of our bodies. It delivers nutrients and moves wastes to be moved out of our bodies. The pressure of blood flowing against the walls of your arteries is blood pressure. Normally, blood pressure will rise and fall throughout the day, however if it remains elevated for a long time it can damage the heart and other parts of our body. Uncontrolled blood pressure can ultimately cause stroke, heart attack, kidney failure, heart failure and sexual disfunction. Hypertension occurs when the blood pressure is higher than normal.

Blood Pressure Levels: Blood Pressure Category

Systolic mm Hg (Upper Number)

Diastolic mm Hg (lower number)

Normal Less than 120 and Less than 80 Elevated 120-129 and Less than 80 High Blood Pressure- Stage 1

130-139 or 80-89

High Blood Pressure- Stage 2

140 or higher or 90 or higher

Hypertensive Crisis

Higher than 180

And /or

Higher than 120

Risk Factors for hypertension include: Modifiable Risks Non-Modifiable Risks Smoking, second-hand smoke, Diabetes, Being obese or overweight, high cholesterol, poor diet, and inactivity

Family history, race/ethnicity, sleep apnea, male gender, chronic kidney disease and advancing age.

General Nutrition Guidelines:  Consuming a healthy diet high in fruits and vegetables, whole grains, and low-fat dairy products but low

in saturated fats and trans fats is helpful to improve blood pressure levels.  Salt intake, specifically sodium consumption should be limited. 1,500 mg/day of Na/Salt is a good goal

to work toward, but limiting to 1,000mg/day may be even more helpful to regulate blood pressure. Limiting processed foods which tend to be high in salt is a good way to start. Check with your doctor and dietitian for the level that is best for you.

 Increasing potassium intake to 3,000 to 5,000 mg per day is also beneficial.  Speak with your doctor regarding alcohol consumption. Generally, it is advised for men to limit

consumption to drinks per day and one drink per for women.

 

 

Foods to Choose Foods to Limit/Avoid Breads: whole wheat breads, unsalted breads, and rolls

Breads or rolls with salted tops, packaged stuffing, biscuits, corn bread, bread crumb mixes

Cereals: regular cooked cereals, puffed wheat, puffed rice and shredded wheat cereals

Instant cereals, regular ready to eat cereals

Crackers& snacks: unsalted crackers and snacks and unsalted peanut butter

Salted crackers and snacks, party spreads & dips, regular peanut butter

Pasta, rice & potatoes: all types Pre-made, processed, canned, frozen Dried beans& peas: all types Pre-made, processed, canned Meats& alternatives: fresh or frozen, low Na canned varieties

Salted, smoked, canned, spiced, pickled, flavored, marinated, processed, frozen dinners, cold cuts, luncheon meats, meat pies.

Fruits & Vegetables: fresh or low sodium canned or frozen, low Na canned varieties

Canned products, frozen products with sauces or flavoring

Dairy products: milk, cream sour cream, yogurt, low Na cottage cheese, low Na cheeses

Buttermilk, processed cheeses, slices and spreads, regular cheeses and cottage cheeses

Fats & oils: unsalted margarine, regular butter, or mayonnaise, cooking oils, salt free gravies, low Na salad dressings and sauces * limit for healthy eating

Bacon fat/grease, salt pork, gravies and commercial salad dressing and sauces

Soups: salt free soup and low sodium bouillon cubes Regular canned or prepared soups, stews, broths, bouillon and packaged frozen soups

Desserts: sherbet, fruit ices, gelatin, pudding, ice cream, marmalade, jelly, jam and honey *limit for healthy eating

Commercially prepared and packaged baked goods and chocolate candies

Beverages: coffee, tea, soft drinks, fruit flavored drinks without Na

Carbonated beverages with Na or salt added; softened water

Condiments: fresh & dried herbs, low Na products, vinegar, lemon, lime, seasoning blends without salt

Table salt and any form of salt, bouillon cubes, MSG, meat extra, Worcestershire Sauce, tarter sauce, ketchup, chili sauce

 

Exercise: Physical activity and losing weight with diet and movement may help reduce blood pressure. 150 minutes of moderate intensity physical activity or at least 75 minutes of vigorous per week or a combination of both may be helpful for overall health. Check with your doctor before beginning an exercise regimen.

Medications: Sometimes medications will be prescribed to help control your blood pressure. It is important to take medications as directed. These may include ones that diuretics, which help eliminate sodium and water from the body, ACE inhibitors (Angiotensin-converting enzyme) & ARBs (Angiotensin II receptor blockers), which relax the blood vessels and decrease narrowing, and Calcium channel blockers which work on the muscle of the blood vessels. (Grapefruit should be avoided with Calcium channel blockers) Other medication may be added if blood pressure does not improve.

 

 

References

(2018, February 5). Verywell Health. https://www.verywellhealth.com/high-blood-pressure-diagnosis-

4158432

Https://whitakerwellness.com/wp-content/uploads/2017/07/shutterstock_161938103.jpg.

Https://www.heart.org/-/media/Files/Health-Topics/Answers-by-Heart/What-Is-High-Blood-Pressure.pdf.

(2021, January 16). High blood pressure (hypertension) – Diagnosis and treatment – Mayo Clinic.

Mayo Clinic – Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/high-blood-

pressure/diagnosis-treatment/drc-20373417

Tips to enhance exercise adherence. (2017, February 8). Women

Fitness. https://www.womenfitness.net/enhance-exercise-adherence/

What is high blood pressure? (n.d.). www.heart.org. https://www.heart.org/en/health-topics/high-blood-

pressure/the-facts-about-high-blood-pressure/what-is-high-blood-pressure

 

To assess a clinical issue that is the focus of the Quality Improvement Project.

Goal:

  • To assess a clinical issue that is the focus of the Quality Improvement Project.
  • Evaluate the clinical project.
  • Create an outline of the action plan for the project.

Bullying: Prevalence and Impact 

Module 11 Discussion

by  Yaquelin Lamar Febles – Tuesday, November 14, 2023, 10:08 AM

Number of replies: 0

Bullying prevention is an increasingly vital field of research, addressing the multifaceted nature and consequences of bullying behavior, particularly its complex relationship with suicide. This essay draws upon recent studies to explore strategies for bullying prevention and support for affected individuals.

Bullying: Prevalence and Impact

Recent research indicates that bullying remains a significant issue. A 2023 study revealed that approximately 49% of students in grades 4-12 reported experiencing bullying. Alarmingly, about 31% of adults also reported being bullied, underscoring the widespread nature of this problem. This prevalence highlights the urgent need for effective bullying prevention and intervention strategies, as bullying’s reach extends beyond school environments, impacting individuals of all ages in various settings, including digital spaces (PolicyLab, 2023).

Intervention Strategies in Educational Settings

One notable intervention is the “Be-Prox” program, a bullying intervention study conducted in Norwegian kindergartens. This program focuses on child bullying and employs behavioral strategies to mitigate its impact. The involvement of educational institutions like kindergartens in such interventions is crucial, as early childhood experiences significantly influence long-term psychological development (PolicyLab, 2023).

Digital Approaches to Bullying Prevention

In response to the increasing incidence of cyberbullying, innovative programs like “BullyDown” have been developed. This text messaging-based program is designed for middle school-aged youth and aims to prevent bullying through digital means. Given the rise of technology and social media in young people’s lives, such digital interventions are critical in addressing bullying in its modern forms (PolicyLab, 2023).

Conclusion

The ongoing research in bullying prevention is a testament to the seriousness of its impact on mental health and well-being. These studies not only highlight the prevalence of bullying among both children and adults but also emphasize the importance of multifaceted approaches to effectively address this issue. As bullying evolves with technological advancements, so must our strategies to combat it, ensuring the safety and well-being of individuals across all age groups.

References

1. PolicyLab (2023). 2023 Bullying Clinical Trials, Research & Treatment. Retrieved from  http://policylab.us/clinical-trials/bullying/

2. NORCE Norwegian Research Centre AS; University of Tromso; Bjørnafjorden municipality; Narvik municipality (2023). Be-Prox. An Effectiveness Study of Bullying Intervention in Norwegian Kindergartens. Retrieved from  http://policylab.us/clinical-trials/bullying/

3. Center for Innovative Public Health Research; University of North Carolina, Chapel Hill (2023). BullyDown, a Text Messaging-based Bullying Prevention Program for Middle School-aged Youth. Retrieved from  http://policylab.us/clinical-trials/bullying/

Statistics can be beneficial to nursing practice

Statistics can be beneficial to nursing practice

by  Luis Mathison  – Monday, November 13, 2023, 2:06 PM

Number of replies: 0

Understanding the fundamentals of nursing from its foundations, development, and subsequent performance of the profession, statistics have been indispensable in decision-making within what is known in nursing as evidence-based practice. We know that statistical aid in how data is collected and interpreted, analyzing it in a positive or negative way, is essential for the profession in decision-making always aimed at our patients

One of the benefits from statistics in the daily practice of nursing gives us the advantage of how to use the study results, interpret data found and how to apply  in the medical field to be used and applied to our patients. These investigative studies guide and provide much information within the parameters of validity, reliability, always based on evidence and previous experience. Relating these results to the clinic and preferences of our patients is crucial for future decision-making. Grove, S. K., & Cipher, D. J. (2019).

Consequently, the use of statistics in nursing has taken an important turn in terms of professionally taken improvements to obtain adequate healthcare and obtain information on strengths and weaknesses applicable to the patient for better results. An example could be the use of charts and data control that gives us valuable information to modify or improve applicable treatments and make the best decisions focused on the patient’s well-being (American Nurses Association, 2019).

It is noteworthy that over time, advances have been made through statistical research widely used in nursing, allowing visionary nurses to promote improvements in the individualized care of our patients and their health benefits. Statistical analysis, interpretation of data, and evidence-based experiences are significant for practicing the profession. We can also note that monitoring laboratories, vital signs, response to medications, behavior patterns, among others, can be of great importance in individual management, or with studied general patterns, we can compare and provide the best care. We can also identify any early alterations within the patterns and anticipate their timely attention. Grove, S. K., & Cipher, D. J. (2019).

Finally, it is worth mentioning that within the nursing profession, the everyday use of statistics has maintained a close and strict evaluation of the guidelines and development of the profession, always oriented towards improving patient-centered treatments. The nurse’s knowledge in this area is essential to understand and analyze the benefits and improvements applicable to the health and well-being of our patients.

References

American Nurses Association. (2019). Nursing informatics: Scope and standards of practice (2nd ed.). Silver Spring, MD: American Nurses Association.

Grove, S. K., & Cipher, D. J. (2019). Statistics for Nursing Research – E-Book: Statistics for Nursing Research – E-Book. In Google Books. Elsevier Health Sciences. https://books.google.com/books?hl=en&lr=&id=gt3WDwAAQBAJ&oi=fnd&pg=PP1&dq=+using+statistics+can+be+beneficial+to+nursing+practice+recent+articles&ots=thgK0gWuir&sig=-QFHYL0N9xiF3bISrnQmIizM1OE