Describe and evaluate the differences between evidence based practice and research. Describe the importance and application of health care information, data mining, and importance to application in patient care outcomes.

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DISCUSSION QUESTION

Instructions
Describe and evaluate the differences between evidence based practice and research.
Describe the importance and application of health care information, data mining, and importance to application in patient care outcomes.
Discuss how data mining and interpretation influences case management and utilization
Describe participation in managed care and the importance of quality care initiatives and performance indicators (remember to use AHRQ as a resource)

Parameters:
1000-1500 words not including the cover page and references (total, not for each topic)
Follow the APA 7th edition for references and citations
Include a minimum of 6 scholarly references (does not include text or websites)
Demonstrate analysis, evaluation and synthesis of information

What is Will’s risk of schizophrenia? Would Will benefit from talking with a genetic counselor? Should Will have genetic testing to see if he will get schizophrenia?

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Module 15 GENETIC / Behavioral Disorders

  • -Label the answer to the question number or letter.
  • -Indicate the question you pick.

Cite at least 4 references no older than (2020) or 3 years relevant to the discussion topic/questions. APA 7. For all assignments: All assignments must be written in an academic tone. You are not to write in the first person. Instead, you need to use the third person. Large word-for-word quotes are not permitted. Direct quotes, if used, need to be only a sentence or two long. Instead, most cited material needs to be paraphrased. References should consist of scholarly journals. Web sources can be used, though they should come from credible sources such as government agencies, academics, and private agencies with a strong reputation within the community they serve. You will not be allowed to use web pages or web groups such as Wikipedia or Answers.com, as the information contained in these web pages is academically questionable. You cannot use web pages with a questionable background or academic source. Furthermore, you will not be permitted to cite encyclopedias, dictionaries, newspapers, or magazines. It is important to remember evidence-based.

Review these websites:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6774046/
http://www.cdc.gov/genomics/gtesting/EGAPP/recommend/CYP450.htm
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2743615/
https://www.nature.com/articles/gim2007123

 

PART A
1. Explain factors that have made our understanding of the genetic and environmental components to autism so challenging.

PART B
2. Case Study: Bob and Will are monozygotic (identical) twins. They are 18 years old and in their first year at the liberal arts college that their parents attended. They have always been excellent students. Bob plans to study law and wants to work with international corporations. Will is more interested in studying business and directing those corporations. Both Bob and Will have been experimenting with drugs at college. In the last month or so, Bob’s work has fallen off. He has not been completing assignments at his usual high level of quality. His thoughts seem to have become disorganized, and he mentions to Will that he has been hearing voices telling him that he should abandon school because the administration is working for an unfriendly foreign government. After much difficulty, Bob is diagnosed with schizophrenia.

1. What is Will’s risk of schizophrenia?
2. Would Will benefit from talking with a genetic counselor?
3. Should Will have genetic testing to see if he will get schizophrenia?

PART C
3. Describe three causes of population bottlenecks and the implications they would have on the species involved.

Identify the specific pattern of inheritance (if any) indicated for this family. Indicate what criteria the pedigree presents that support the correct pattern of inheritance for this health problem.

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Module 14

Genetics of Cancer Assignment:

  • Label the answer to the question number or letter.
  • Indicate the question you pick.

Cite at least 4 references no older than (2020) or 3 years relevant to the discussion topic/questions. APA 7. For all assignments: All assignments must be written in an academic tone. You are not to write in the first person. Instead, you need to use the third person. Large word-for-word quotes are not permitted. Direct quotes, if used, need to be only a sentence or two long. Instead, most cited material needs to be paraphrased. References should consist of scholarly journals. Web sources can be used, though they should come from credible sources such as government agencies, academics, and private agencies with a strong reputation within the community they serve. You will not be allowed to use web pages or web groups such as Wikipedia or Answers.com, as the information contained in these web pages is academically questionable. You cannot use web pages with a questionable background or academic source. Furthermore, you will not be permitted to cite encyclopedias, dictionaries, newspapers, or magazines. It is important to remember evidence-based.

1. Oncogene expression was first observed in cancer cells. Explain the role of oncogene products in normal, noncancerous cells.

2. Some newer cancer therapies inhibit the activity of tyrosine kinases (TKs). How would this mechanism affect tumors?

3. What would be the potential outcome of a procedure that could stop the expression (turn off) of all oncogenes?

4. Case Study A: Barbara is 56 and has two daughters and one son. She has just been diagnosed with a ―recurrence‖ of the lobular breast cancer treated by lumpectomy and radiation 4 years ago. Her father (Aaron) is still living at age 82, and her mother (Ann) died of ovarian cancer at age 36 (diagnosed at age 34). Her sister, Bonnie, was diagnosed with breast cancer 6 years ago at age 32 and died 2 years after diagnosis. She was married and has no children. Her brother, Brett, now age 45, underwent surgery and chemotherapy last year for breast cancer. He has one son and one daughter who are teenagers.
Her mother had one sister, Amy, who died of ―abdominal‖ cancer when she was 34, and one brother, Allen, who died of bone cancer at age 41. Her father’s twin brothers died at Bergen-Belsen during World War II. Barbara’s daughter Connie is 30 and was recently diagnosed with breast cancer. She has two sons ages 1 year and 3 years. Barbara’s other daughter, Catherine, is 32. Barbara’s son, Carl, is 26. Neither Catherine nor Carl have any evidence of disease.
a. Draw the pedigree
b. Identify the specific pattern of inheritance (if any) indicated for this family.
c. Indicate what criteria the pedigree presents that support the correct pattern of inheritance for this health problem.
d. Identify who in this kindred could benefit from genetic testing at this time, and provide a rationale for your choice.
e. If genetic testing is pursued, who would be the best person to test first?

5. Case Study B: Martin is 68 and diagnosed with colon cancer. His sister (age 65) was diagnosed with colon cancer last year. They have one maternal aunt (age 90) and one paternal aunt (age 75) with breast cancer. One maternal uncle (age 72) had colorectal cancer, and one paternal uncle has prostate cancer (age 75). A maternal great-aunt died of childhood leukemia (age 12). A second maternal great-aunt died of breast cancer (age 69). A maternal great-uncle died of lung cancer (age 64).
a. Draw the pedigree
b. What is the pattern of inheritance, if any?
c. Indicate what criteria the pedigree presents that support the correct pattern of inheritance for this health problem?
d. Identify who in this kindred could benefit from genetic testing at this time, and provide a rationale for your choice.

What precautions should be taken when caring for a woman of childbearing age who is homozygous for the factor V Leiden allele?

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Module 13

• Label the answer to the question number or letter.
• Indicate the question you pick. Cite at least 4 references no older than (2020) or 3 years relevant to the discussion topic/questions. APA 7. For all assignments: All assignments must be written in an academic tone. You are not to write in the first person. Instead, you need to use the third person. Large word-for-word quotes are not permitted. Direct quotes, if used, need to be only a sentence or two long. Instead, most cited material needs to be paraphrased. References should consist of scholarly journals. Web sources can be used, though they should come from credible sources such as government agencies, academics, and private agencies with a strong reputation within the community they serve. You will not be allowed to use web pages or web groups such as Wikipedia or Answers.com, as the information contained in these web pages is academically questionable. You cannot use web pages with a questionable background or academic source. Furthermore, you will not be permitted to cite encyclopedias, dictionaries, newspapers, or magazines. It is important to remember evidence-based.

Cardiovascular Assignment:
Additional resources:
General Physical Activities Defined by Level of Intensity: http://www.cdc.gov/nccdphp/dnpa/physical/pdf/PA_Intensity_table_2_1.pdf

Genetics of Heart Disease
https://www.cdc.gov/heartdisease/risk_factors.htm

1. What precautions should be taken when caring for a woman of childbearing age who is homozygous for the factor V Leiden allele?

2. Case Study: Edgar is 56 years old. His father died of a stroke at age 76. His mother had hypertension and died of a myocardial infarction at age 64. Edgar has three siblings; two have hypertension and are smokers. One had a stroke at age 54. Edgar’s uncle Pete died of a stroke at age 64. Edgar does not smoke and has normal blood pressure. He wants to know what his genetic risk is for having a stroke because he has seen a TV special on genetics and is considering having genetic testing.

a. What could you tell Edgar about the genetics of stroke?
b. Would Edgar benefit from genetic counseling?
c. Should Edgar’s children (ages 36 and 30) have genetic testing?

3. Case Study: Karen’s brother (Charlie) has a genetic cardiac disorder that puts him at high risk for sudden cardiac death. He has had one episode and is now being treated with medications and an implanted cardioverter defibrillator. This disorder is transmitted in families in an autosomal dominant pattern, and genetic testing is available. Karen and Charlie’s dad died at age 39 of a single car crash. The family always assumed that it was suicide because he had been depressed, but the family doctor suggested that he may have had a cardiac arrest, just as Charlie did. Karen drives a school bus and has not talked to her brother in 10 years. The last time they saw each other was at their father’s funeral. Charlie is asked to inform his sister of her genetic risk, but he refuses.
a. What is Karen’s risk of being affected with this disorder?
b. What ethical principles are involved in this case?
c. What would you do if you were Charlie’s health-care provider?

4. One form of polycystic kidney disease (PKD) has an autosomal dominant transmission pattern. Explain why a 60-year-old man with the disease still has about 25% kidney function remaining but his monozygotic twin daughters had such severe disease that they each had to have a kidney transplant by age 18 (assuming that all three of them had very good care and were very adherent to their medical regimens).

The mother of a child who was just diagnosed with type 1 diabetes turns to the child’s father and says “This is all your fault. Your father has type 2 diabetes”. Is she correct in her assumption that the child inherited diabetes from his father’s family? Explain your response.

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Module 12

Maternal Child & Children Assignment:

• Please label the answer to the question number or letter.
• Please indicate the question you pick. Cite at least 4 references no older than (2020) or 3 years relevant to the discussion topic/questions. APA 7. For all assignments: All assignments must be written in an academic tone. You are not to write in the first person. Instead, you need to use the third person. Large word-for-word quotes are not permitted. Direct quotes, if used, need to be only a sentence or two long. Instead, most cited material needs to be paraphrased. References should consist of scholarly journals. Web sources can be used, though they should come from credible sources such as government agencies, academics, and private agencies with a strong reputation within the community they serve. You will not be allowed to use web pages or web groups such as Wikipedia or Answers.com, as the information contained in these web pages is academically questionable. You cannot use web pages with a questionable background or academic source. Furthermore, you will not be permitted to cite encyclopedias, dictionaries, newspapers, or magazines. It is important to remember evidence-based.

Review vocabulary of dysmorphology
There is an acronym “Family GENES” that is designed to help make a decision to do further evaluation or not.
F-Family history is pretty obvious.
G-Groups of anomalies (3 or more)
E-Extreme presentation (eg: early onset or abnormally severe)
N-Neurologic abnormalities (includes delays or degeneration)
E-Exceptional pathology (rare findings)
S-Surprising lab values (hypocalcemia, severe anemia, abnormal chromosomes etc.)

Dysmorphology is a search for recognizable patterns. It is useful if it gives us information that can guide further evaluation or management, or if a specific diagnosis is found that eliminates the need for additional studies. Some families take comfort in knowing the answer. Others do not but may benefit if they or their child receive better care because the caretakers know what they are dealing with.
It is important to pay attention to the way we talk about dysmorphology. Genetic disease is different from other health problems because it is part of who we are not something that happened to us. So while it is not always possible to know the technical terms it is important to describe specific features using terms that will not be offensive. So terms like FLK or toaster head (description of dolicocephaly – literally “long head” – often used in some newborn intensive care units) are generally avoided. While terms like hypertelorism or widely spaced eyes are both acceptable.

Assignment Questions:
1. The mother of a child who was just diagnosed with type 1 diabetes turns to the child’s father and says “This is all your fault. Your father has type 2 diabetes”. Is she correct in her assumption that the child inherited diabetes from his father’s family? Explain your response.
2. John is a 16-year-old who loves to play soccer. His 18-year-old brother, Andre, passed out while playing basketball and has now been diagnosed with long QT syndrome (LQT1). The cardiologist involved suggests that all Andre’s siblings should have a cardiac examination, including an electrocardiogram (ECG), before they play sports. John’s ECG shows a borderline QT prolongation during activity, so the cardiologist recommends genetic testing. John tests positive for the same mutation in the gene KCNQ1 (LQT1) that Andre has, and he is told that he must stop playing soccer. He is counseled to take up a less intense sport, like golf. John is clearly upset and wants to know why this is happening to him. He feels just fine and does not understand why he cannot play his favorite sport
a. What is the connection between sports restrictions and long QT syndrome?
b. How can understanding genetics help to predict who might be affected by long QT syndrome if someone in the family is already affected?
c. How and with what terms will you explain to John why these modifications in exercise are necessary?

Briefly define advance nursing practice and the roles in advanced practice nursing pertaining to clinical practice, primary care, education, administration, and health information.

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Week 5 Project – Final Paper Outline (300 points)

Introduction

  1. Distinguish between Advanced Nursing Practice (ANP) and the Advanced Practice Nurse (APN). (25 points)
  2. Briefly define advance nursing practice and the roles in advanced practice nursing pertaining to clinical practice, primary care, education, administration, and health information. (25 points)
  3. Describe the advance nursing practice role you aspire and briefly share the experiences and/or qualities you have that have influenced your decision. (25 points)
  4. Describe your personal nursing philosophy and the model that helped you describe it.(25 points)
  5. Examine regulatory and legal requirements for the state in which you plan to practice/work. (20 points)
  6. Identify the required competencies (domains) and certification requirements for your selected role. (20 points)
  7. Describe what is required to obtain certification in your selected role. (20 points)
  8. Define Transformational Leadership and as it relates to your identified leadership attributes that you possess or need to develop. (20 points)
  9. Apply the leadership style you will embrace as an APN in primary care. (20 points)
  10. Describe the current policy or trends related to your APN role in primary care and determine if policy or trend needs to change–if opposed to change state why. (20 points)
  11. If determine above policies or trends requires change, proposes how APN can lead changes. (20 points)
  12. Conclusion: Summarize your role paper by highlighting key points made in your paper. (25 points)
  13. Paper was written in a clear, concise, and organized manner, demonstrating ethical scholarship in appropriate and accurate representation and attribution of sources; and displayed accurate spelling, grammar, and punctuation. Proper APA format was used. (35 points)

 

Analyze the increased complexity of care among older adults. Compare care models for nursing practice specific to the older adult. Design plans for care specific to the older adult.

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DISCUSSION ESSAY

Purpose of Assignment:

It is important for nurses to reflect on experiences and new knowledge gained in order to promote professional growth.

Course Competencies:

  • Analyze the increased complexity of care among older adults.
  • Compare care models for nursing practice specific to the older adult.
  • Design plans for care specific to the older adult.
  • Identify local, state, and national resources which facilitate safe and effective transitions of care for older adults.
  • Incorporate professional values, attitudes, and expectations regarding ageism when caring for the older adult.
  • Outline the importance of advocating for older adults in management of their care.

Transferable Skill:

• Information Literacy: Discovering information reflectively, understanding how information is produced and valued, and using information to create new knowledge and participate ethically in communities of learning.

Instructions:
Reflect on your development as a nursing professional and address the following in a 1-2 page paper:

1. Describe how you achieved each of the course competencies and the transferable skill.

2. Provide at least one example of new knowledge gained related to each competency and explain how this new knowledge will impact your nursing practice.

Describe the organization’s overall readiness based on your findings. Prepare a strategic plan to address issues pertaining to network growth, nurse staffing, resource management, and patient satisfaction.

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Assessment Description

Research a health care organization or network that spans several states within the United States (United Healthcare, Vanguard, Banner Health, etc.). Assess the readiness of the health care organization or network you chose in regard to meeting the health care needs of citizens in the next decade.

Prepare a 1,000-1,250 word paper that presents your assessment and proposes a strategic plan to ensure readiness. Include the following:

  • Describe the health care organization or network.
  • Describe the organization’s overall readiness based on your findings.
  • Prepare a strategic plan to address issues pertaining to network growth, nurse staffing, resource management, and patient satisfaction.
  • Identify any current or potential issues within the organizational culture and discuss how these issues may affect aspects of the strategic plan.
  • Propose a theory or model that could be used to support implementation of the strategic plan for this organization. Explain why this theory or model is best.

You are required to cite a minimum of three sources to complete this assignment. Sources must be appropriate for the assignment and relevant to nursing practice.

 

Within the case study, describe the reasons why J.D. might be presenting constipation and or dehydration. Why Vitamin B12 and folic acid are important on the erythropoiesis? What abnormalities their deficiency might cause on the red blood cells?

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CASE STUDY

Hematopoietic:

J.D. is a 37 years old white woman who presents to her gynecologist complaining of a 2-month history of intermenstrual bleeding, menorrhagia, increased urinary frequency, mild incontinence, extreme fatigue, and weakness. Her menstrual period occurs every 28 days and lately there have been 6 days of heavy flow and cramping. She denies abdominal distension, back-ache, and constipation. She has not had her usual energy levels since before her last pregnancy.

Past Medical History (PMH):

Upon reviewing her past medical history, the gynecologist notes that her patient is a G5P5with four pregnancies within four years, the last infant having been delivered vaginally four months ago. All five pregnancies were unremarkable and without delivery complications. All infants were born healthy. Patient history also reveals a 3-year history of osteoarthritis in the left knee, probably the result of sustaining significant trauma to her knee in an MVA when she was 9 years old. When asked what OTC medications she is currently taking for her pain and for how long she has been taking them, she reveals that she started taking ibuprofen, three tablets each day, about 2.5 years ago for her left knee. Due to a slowly progressive increase in pain and a loss of adequate relief with three tablets, she doubled the daily dose of ibuprofen. Upon the recommendation from her nurse practitioner and because long-term ibuprofen use can cause peptic ulcers, she began taking OTC omeprazole on a regular basis to prevent gastrointestinal bleeding. Patient history also reveals a 3-year history of HTN for which she is now being treated with a diuretic and a centrally acting antihypertensive drug. She has had no previous surgeries.

Case Study Questions

  1. Name the contributing factors on J.D that might put her at risk to develop iron deficiency anemia.
  2. Within the case study, describe the reasons why J.D. might be presenting constipation and or dehydration.
  3. Why Vitamin B12 and folic acid are important on the erythropoiesis? What abnormalities their deficiency might cause on the red blood cells?
  4. The gynecologist is suspecting that J.D. might be experiencing iron deficiency anemia.
    In order to support the diagnosis, list and describe the clinical symptoms that J.D. might have positive for Iron deficiency anemia.
  5. If the patient is diagnosed with iron deficiency anemia, what do you expect to find as signs of this type of anemia? List and describe.
  6. Labs results came back for the patient. Hb 10.2 g/dL; Hct 30.8%; Ferritin 9 ng/dL; red blood cells are smaller and paler in color than normal. Research list and describe for appropriate recommendations and treatments for J.D.

 

What would you expect to see on Mr. W.G. EKG and which findings described on the case are compatible with the acute coronary event?

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CASE STUDY

Cardiovascular

Mr. W.G. is a 53-year-old white man who began to experience chest discomfort while playing tennis with a friend. At first, he attributed his discomfort to the heat and having had a large breakfast. Gradually, however, discomfort intensified to a crushing sensation in the sternal area and the pain seemed to spread upward into his neck and lower jaw. The nature of the pain did not seem to change with deep breathing. When Mr. G. complained of feeling nauseated and began rubbing his chest, his tennis partner was concerned that his friend was having a heart attack and called 911 on his cell phone. The patient was transported to the ED of the nearest hospital and arrived within 30 minutes of the onset of chest pain. In route to the hospital, the patient was placed on nasal cannula and an IV D5W was started. Mr. G. received aspirin (325 mg po) and 2 mg/IV morphine. He is allergic to meperidine (rash). His pain has eased slightly in the last 15 minutes but is still significant; was 9/10 in severity; now7/10. In the ED, chest pain was not relieved by 3 SL NTG tablets. He denies chills.

Case Study Questions

  1. For patients at risk of developing coronary artery disease and patients diagnosed with acute myocardial infarct, describe the modifiable and non-modifiable risk factors.
  2. What would you expect to see on Mr. W.G. EKG and which findings described on the case are compatible with the acute coronary event?
  3. Having only the opportunity to choose one laboratory test to confirm the acute myocardial infarct, which would be the most specific laboratory test you would choose and why?
  4. How do you explain that Mr. W.G temperature has increased after his Myocardial Infarct, when that can be observed and for how long? Base your answer on the pathophysiology of the event.
  5. Explain to Mr. W.G. why he was experiencing pain during his Myocardial Infarct. Elaborate and support your answer.