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Capella University NURS-FPX4020 Assessment 4 Quality Improvement Initiative Tool Kit Essay Example Approach

Medication administration errors are undesirable in healthcare facilities. The safety improvement plan of interest will focus on introducing barcode medication administration technology and a staff education program. The focus is reducing medication administration errors’ prevalence, thus improving patient safety and ensuring quality patient outcomes.

This improvement plan kit is divided into four themes: Evidence-Based Medication Error Prevention Strategies, Utilization of Healthcare Technologies, Education and Training, Communication and collaboration. The tool kit provides and explains how various resources under these themes will help implement and sustain a safety improvement plan initiative in a medical unit in a healthcare facility.

Evidence-Based Medication Error Prevention Strategies Annotated Bibliography 

Manias, E., Kusljic, S., & Wu, A. (2020). Interventions to reduce medication errors in adult medical and surgical settings: a systematic review. Therapeutic Advances in Drug Safety, 11, 2042098620968309. https://doi.org/10.1177/2042098620968309

The article explores literature for interventions to reduce medication errors in healthcare facilities. The article supports the assertion that medication errors are the leading causes of death and harm globally, and the researchers compared the different activities in reducing medication errors with prescribing, administering, and supplying medication. The researchers analyzed results from six libraries and used statistical analysis to determine the success of these activities. The study results show that the most effective interventions include pharmacist-led reconciliations, prescriber education, medication reconciliation by trained mentors, and computerized physician order entry.

The study also showed that combined interventions such as CPOE and automated distribution systems have better outcomes than single technology interventions. Combining interventions is thus potentially effective, and thus, the result supports the safety improvement plan. The resource will help the nurses understand the importance and effectiveness of the chosen interventions in addressing medication errors and improving patient safety. The resource will also help the nurses select the best interventions to propose in addition to the selected safety improvement plan.

Salar, A., Kiani, F., & Rezaee, N. (2020). Preventing the medication errors in hospitals: A qualitative study. International Journal of Africa Nursing Sciences, 13, 100235. https://doi.org/10.1016/j.ijans.2020.100235

The study was conducted in Iran to identify the best interventions in medication error prevention in a hospital ward. The study was conducted using 16 nurses and one physician selected using purposive sampling, and data were collected using semi-structured interviews. The study results were categorized into acting professionally and presenting technical strategies.

In the ‘acting professionally theme,’ themes that appeared include reading the drug label, continuous training on medication administration, preventing errors, and awareness of the legal implications. Under the theme of ‘presenting technical strategies,’ themes most prominent were distinguishing high-risk drugs, medication safe-keeping, and skilled nurses administering drugs. The resource will help the nurses understand their responsibility and collaborative efforts in preventing medication errors. 

It will also help identify areas in their practices that require improvement and help them address these areas. It will also help them appreciate and select technical interventions to help reduce medication administration errors. The resource will also help us understand the importance of mixing technical strategies and professionalism in minimizing medication errors. The resource is vital to safety improvement because change begins with an individual, and understanding the basic activities that prevent errors can help nurses advance to better patient outcomes.

Ciapponi, A., Nievas, S. E. F., Seijo, M., Rodríguez, M. B., Vietto, V., García-Perdomo, H. A., Virgilio, S., Fajreldines, A. V., Tost, J., Rose, C. J., & Garcia-Elorrio, E. (2021). Reducing medication errors for adults in hospital settings. Cochrane Database of Systematic Reviews, (11). https://doi.org/10.1002/14651858.cd009985.pub2

This article evaluated the effectiveness of various interventions in preventing medication administration errors among adults admitted in a hospital setting. The researchers conducted a systematic review of studies investigating interventions aimed at medication error prevention. The study also evaluated other outcome measures such as adverse drug events, length of hospital stays, quality of life, mortality, and morbidity in all hospital care units. The research analyzed 65 studies and showed that medication reconciliation was the most common and effective intervention in medication administration error prevention. 

Other interventions with high efficacy included electronic prescribing systems, barcode medication administration, professional education, improved medication dispensing systems, and organizational policy changes. The study results show that interventions such as medication reconciliation, CPOE, CDSS, barcoding, and feedback and dispensing systems reduce medication administration errors and adverse drug events. The resource supports the safety improvement plans interventions, professional education, and BCMA are evidence-based interventions that are viable in preventing medication errors.

The resource compares the effectiveness of the various interventions in different studies. It helps determine their effectiveness based on the identified evaluation parameters. Using the information provided, nurses can analyze interventions and select the best intervention(s) based on their success in achieving the desired goals. This resource can be helpful to nurses who wish to evaluate an intervention to prevent medication administration errors in the hospital. The areas evaluated and discussed above can serve as a guideline to determine the impact of the intervention besides its effectiveness in medication administration error prevention. The resource can also be sued to help determine the compatible interventions required to produce quality outcomes among patients.

Utilization of Healthcare Technologies

Saleem, M. (2023). Barcode Medication Administration Technology to Prevent Medication Errors. Journal of the College of Physicians and Surgeons–Pakistan: JCPSP, 33(1), 107-108. https://doi.org/10.29271/jcpsp.2023.01.107

The study is a viewpoint proposing BCMA implementation to avoid adverse drug events. The resource gives an overview of BCMA, studies its effectiveness, and evaluates challenges associated with its implementation of BCMA. The article aims to improve BCMA awareness and oversee its implementation in care facilities. The literature review in the study shows that BCMA improves patient safety by decreasing the rate of adverse drug events and transcription errors.

BCMA requires the institution to implement supporting technologies, particularly CPOE, to ensure all medications are available in the system and any errors between prescription and administration are easily discovered. Barcode medication administration is a viable technology for reducing mortality and morbidity related to preventable medication administration errors.

The resource is crucial to the safety improvement plan. It has vast information on the state of the art of BCMA and its application to improve medication administration safety in healthcare facilities. The study depicts BCMA as a clinical decision support system that will assist nurses in administering medications flawlessly. One of the technology’s limitations is detecting errors that occurred before the entry of the CPOE.

The technology also requires a functional health information system and other medication error prevention technologies such as CPOE and CDSS. Given the protocol outlined in this study, the resource can be used to educate nurses on how to implement the BCMA technology in the facility. Thus, this resource is crucial to ensuring the successful implementation of the safety improvement plan.

Naidu, M. & Alicia, Y. L. (2019). Impact of barcode medication administration and electronic medication administration record system in clinical practice for an effective medication administration process. Health, 11(05): 511. https://doi.org/10.4236/health.2019.115044 .

The study notes that change interventions are directed toward creating a new norm in healthcare facilities. The study was implemented to determine the outcomes of using BCMA and electronic medication administration systems (e-MAR), as well as clinical practices, policies, and processes that affect nurses’ medication administration processes in clinical settings.

A literature review during the study revealed that provision guidelines increase compliance with BCMA implementation. Studies also reported significant improvement in medication error reduction during the period. In addition, adding e-MAR to BCMA increased its efficiency and efficacy in error prevention. The study also explores the advantages and disadvantages of BCMA and e-MAR, strategies for developing BCMA and e-MAR systems, and the implementation process and potential challenges and their management.

This resource will be crucial to the team in implementing the BCMA technology and considering other backup technologies for increased efficiency. The study supports implementing BCMA as a viable technology for preventing medication errors. The study will be an integral resource for the nurses as it will help them evaluate the BCMA critically before implementation. Reviewing the advantages and disadvantages and weighing them in the organizational context will help determine if it is a viable innovation for the healthcare facility.

In addition, the resource will provide nurses with a step-by-step process for developing, implementing, and evaluating the BCMA intervention. In addition, it will provide vital information that will help predict and identify challenges and address them for the successful implementation of the project. Thus, the resource supports the safety improvement plan and will help implement the plan.

Broome, R. G., Thomas, M., Jones, C., & Sneha, S. (2020). Exploring BCMA compliance in an acute care community hospital. Nursing Management, 51(11), 32-38. https://doi.org/10.1097/01.NUMA.0000719412.67108.17

The researchers note that it has been established in earlier studies that BCMA is a viable technology for eliminating medication administration errors. However, few studies address the rates of care providers’ adherence to the technology or strategies to ensure adherence and ensure facilities reap the maximum benefits of the technologies. The study evaluated a BCMA implementation project developed to ensure that all six medication rights are appropriately implemented in medication administration. The project’s adherence rate was 99.77 compared to the 99 national benchmarks.

Many factors affect the adherence rate, and the rate varies significantly in other healthcare facilities. The researchers noted that the significant factors affecting adherence to the technology include unscannable QR codes, patients with several risk assessment wristbands, drained batteries, patient PIB removal or damage to the PIB, medications without barcodes, damaged barcodes, unreadable barcodes and improper barcode placement by the pharmacy department.

Recommended change interventions include adding drop-down menu options in the HER, implementing a handheld wireless scanner, improving maintenance of the AMU machine, and other strategies to address these issues. The study is thus resourceful and can help predict barriers to compliance success and present their management options. The resource provides vital information that can be used to help improve the proposed change interventions. The resource will enhance the nurses’ knowledge of barriers to BCMA technology compliance and success and strategies to address the barriers. The resource will thus help implement and comply with the safety improvement plan.

Nurses Education and Training

Marufu, T. C., Bower, R., Hendron, E., & Manning, J. C. (2022). Nursing interventions to reduce medication errors in pediatrics and neonates: Systematic review and meta-analysis. Journal of Pediatric Nursing, 62, e139-e147. https://doi.org/10.1016/j.pedn.2021.08.024

There are numerous organizational, systematic, technological and personal interventions to prevent medication errors. They all have varying degrees of success and compatibility based on the organization, unit, or need (causal factors). The study aimed to identify nursing interventions to reduce medication administration errors. The systematic review analyzed 18 studies that met the predetermined inclusion criteria. The studies analyzed were from various countries, the majority being from the US, thus providing a better representation of global perspectives and interventions in preventing medication errors.

An analysis of the studies showed that the primary interventions include education programs, medication information services, pharmacists’ involvement/medical reconciliation, double checking, and smart pumps. Education interventions were identified in 13 out of 18 of the studies, showing that they are the most common interventions in healthcare. A meta-analysis showed that education programs have an associated sixty-four percent reduction in medication administration errors after implementation.

The study notes that medication administration safety is a multifaceted problem, and medication safety education is essential to care interventions. According to the study, care providers must identify the causes of errors before implementing care interventions. The resource supports the implementation of a staff education program and the implementation of care interventions based on the causes of errors being addressed. The resource will allow nurses to compare the effectiveness of various care methods against staff education. It will also lead nurses to evaluate the causes of medication errors before implementing the best care interventions.

Alrabadi, N., Shawagfeh, S., Haddad, R., Mukattash, T., Abuhammad, S., Al-rabadi, D., Farha, R. A., AlRabadi, S., & Al-Faouri, I. (2021). Medication errors: a focus on nursing practice. Journal of Pharmaceutical Health Services Research, 12(1), 78-86. https://doi.org/10.1093/jphsr/rmaa025

Medication administration is a primary nursing role, and the government endeavors to ensure individuals remain healthy and free from physical and psychological suffering, such as that associated with medication administration errors. Thus, a deep understanding of medication errors and clinical practices is vital for their management/ prevention. The researchers reviewed studies on medication errors from Google Scholar and other search engines. The review explores various areas of medication errors, such as classification, types, outcomes, reporting processes, and strategies to prevent medication errors.

The study is instrumental to the staff education program because it highlights the factors vital to preventing medication errors. The study also explains the evidence-based strategies that can be used to address the problem, such as independent double checks, standardizing procedures, documentation, keeping communication lines open, patient engagement, avoiding distraction, creating a blame-free culture, and organizational support in error reporting.

This resource will be integral to informing the content of the educational program. The resource is extensive and covers many domains of medication administration and its interception with the nursing profession. The themes discussed. An analysis of the best practices provided in this study will help determine which practices to include in the safety improvement plan besides the proposed changes. The resource will also form a vital framework that will guide how the two interventions in the safety improvement plan will be implemented. The resource will also provide interventions for continuous organizational improvement.

Lilley, L. L., Collins, S. R., & Snyder, J. S. (2022). Pharmacology and the nursing process E-Book. (10th Ed.) Elsevier health sciences.

The book is a resourceful intervention that explores the state of the art of pharmacology in nursing. The book has a topic dedicated to medication error prevention and response. The book also explores medication administration for the various systems and also routes. The book explores the various types of errors and their detection. It also explores the use of healthcare technologies such as BCMA, CDSS, CPOE and e-MAR in detecting and correcting medication errors.

The chapter also explores the significance of interprofessional collaboration in medication error prevention. It discusses in depth the steps nurses can take to address medication errors in various circumstances, such as overdose and medication side effects. Unlike studies, the book examines the concepts in depth. For example, it explains stepwise interventions such as administering antidotes, including their doses.

The book also presents a stepwise implementation of a preventive intervention for preventing medication errors. The book also discusses the ethical and legal issues in medication administration and issues hardly addressed by studies. The book notes that medication errors are undesirable and have legal implications for the patients, care providers and the facility. It also presents best practices in medication administration, such as utilizing medication administration companions and proper documentation to avoid the legal and ethical issues associated with medication administration. Thus, this resource will be significant to the nurses and help implement the safety improvement plan.

Interprofessional Education and Collaboration

Grimes, T. C., & Guinan, E. M. (2022). Interprofessional education focused on medication safety: A systematic review. Journal of Interprofessional Care, 1-19. https://doi.org/10.1080/13561820.2021.2015301

The study’s main aim was to evaluate interprofessional collaboration interventions’ design, delivery, and evaluation. The systematic review describes medication safety-focused interprofessional education. The focus themes were the learners’ opinions, satisfaction, and attitude towards interprofessional work. The most common groups identified in the study were nurses, physicians, and pharmacists. These professionals view medication safety from different perspectives but with the patients’ interests and hearts. The study shows that learners accept and adopt early medication safety interventions focused on an interprofessional team.

The study recommendations could be used in the safety improvement plan. The recommendations include the development of a standard curriculum, learner engagement, and quality and drive development. The care professionals working together must also have the skill set necessary before engaging in the interprofessional team. In addition, the education program should have a learning outcome and assessment approach predefined pre-implementation.

The resource will help the role group in various ways. The nurses can utilize the recommendations of this resource to implement the desired safety improvement plan. It will also help them prepare to implement the desired interventions. For example, the outcomes of the education plan and the assessment plan should be determined before and well-curated to ensure they measure the effectiveness of the education intervention. Thus, this resource will help implement the interventions and meet the desired goals.

Irajpour, A., Farzi, S., Saghaei, M., & Ravaghi, H. (2019). Effect of interprofessional education of medication safety program on the medication error of physicians and nurses in the intensive care units. Journal of Education and Health Promotion, 8. https://doi.org/10.4103/jehp.jehp_200_19

Medication administration is a primary nursing role, but nurses are not the only professionals administering medications. Other care providers, such as pharmacists, physicians, and nurses, are also crucial in medication administration and error prevention. The study evaluated the effectiveness of an interprofessional education program on medication safety for nurses and physicians.

The study results showed a decrease in medication error rate post-implementation compared to pre-implementation. Interprofessional education helps improve interprofessional collaboration, which positively impacts care outcomes. Interprofessional teams bring different perspectives that ensure high-quality decisions, represent the interests of all healthcare professions, and holistically achieve patients’ needs. Thus, interprofessional education programs on medication safety can help reduce medication errors and improve patient safety.

The resource will help oversee the safety improvement plan implementation. The resource will help incorporate change interventions in the safety improvement plan. It will help the nurses incorporate other care providers to ensure quality outcomes. The nursing profession cannot be independent and must rely on other professionals’ input. The resource will help the nurses seek input from other professionals and use it to improve and implement the safety improvement plan.

Kim, S., Kim, H., & Suh, H. S. (2022, March). Priorities in the Prevention Strategies for Medication Error Using the Analytical Hierarchy Process Method. In Healthcare (Vol. 10, No. 3, p. 512). MDPI. https://doi.org/10.3390/healthcare10030512

The study was conducted to prioritize medication error prevention strategies. Various strategies cut across various units and have varying effectiveness and compatibility with the organization/institution wishing to implement them. The hierarchy structure implemented had three stages;’ goals of decisions, criteria, and alternatives. Ten experts were involved in the process.

In the decision criteria, the most selected criteria were system improvement over cultural and system improvement in the counterplan. The preferred alternative was a counterplan by facilities and culture change from a blame culture to a safety and reporting culture. A sensitivity analysis shows that priorities are robust based on organizational needs. The study recommends an analytical hierarchy process in selecting and prioritizing preventive strategies to address current needs and implement evidence-based strategies and policies to improve patient safety.

The resource will be vital in prioritizing interventions that involve creating effective interventions to manage the medication administration problem. Organizational needs may differ based on the settings of interest and the services offered by a facility. For example, this safety improvement plan focuses on medical units, and the needs in the medical units may differ from those in intensive care units hence the need for prioritization. The analytic hierarchy process will help prioritize the two priorities based on organizational needs or available resources. Healthcare resources are scarce, and the tool will help the nurses prioritize implementing the safety improvement plan initiatives based on their effectiveness.

Conclusion

Medication safety is an essential concept in the nursing profession and healthcare. Medication administration errors occur at the point of care and are caused by various factors that should be promptly addressed. Medication administration errors can be prevented using various interventions, and the selected interventions in this safety improvement plan are BCMA and an education program. The above resources support the interventions selected in the safety improvement plan and will guide the nurses in designing, implementing, and evaluating them. Healthcare institutions should focus on such improvement interventions to improve patient safety, satisfaction and ensure quality care outcomes.

Capella University NURS-FPX4020 Assessment 4 Quality Improvement Initiative Tool Kit Essay References

Alrabadi, N., Shawagfeh, S., Haddad, R., Mukattash, T., Abuhammad, S., Al-rabadi, D., Farha, R. A., AlRabadi, S., & Al-Faouri, I. (2021). Medication errors: a focus on nursing practice. Journal of Pharmaceutical Health Services Research, 12(1), 78-86. https://doi.org/10.1093/jphsr/rmaa025

Broome, R. G., Thomas, M., Jones, C., & Sneha, S. (2020). Exploring BCMA compliance in an acute care community hospital. Nursing Management, 51(11), 32-38. https://doi.org/10.1097/01.NUMA.0000719412.67108.17

Ciapponi, A., Nievas, S. E. F., Seijo, M., Rodríguez, M. B., Vietto, V., García-Perdomo, H. A., Virgilio, S., Fajreldines, A. V., Tost, J., Rose, C. J., & Garcia-Elorrio, E. (2021). Reducing medication errors for adults in hospital settings. Cochrane Database of Systematic Reviews, (11). https://doi.org/10.1002/14651858.cd009985.pub2

Grimes, T. C., & Guinan, E. M. (2022). Interprofessional education focused on medication safety: A systematic review. Journal of Interprofessional Care, 1-19. https://doi.org/10.1080/13561820.2021.2015301

Irajpour, A., Farzi, S., Saghaei, M., & Ravaghi, H. (2019). Effect of interprofessional education of medication safety program on the medication error of physicians and nurses in the intensive care units. Journal of Education and Health Promotion, 8. https://doi.org/10.4103/jehp.jehp_200_19

Kim, S., Kim, H., & Suh, H. S. (2022, March). Priorities in the Prevention Strategies for Medication Error Using the Analytical Hierarchy Process Method. In Healthcare (Vol. 10, No. 3, p. 512). MDPI. https://doi.org/10.3390/healthcare10030512

Lilley, L. L., Collins, S. R., & Snyder, J. S. (2022). Pharmacology and the Nursing Process E-Book. (10th Ed.). Elsevier health sciences.

Manias, E., Kusljic, S., & Wu, A. (2020). Interventions to reduce medication errors in adult medical and surgical settings: a systematic review. Therapeutic Advances in Drug Safety, 11, 2042098620968309. https://doi.org/10.1177/2042098620968309

Marufu, T. C., Bower, R., Hendron, E., & Manning, J. C. (2022). Nursing interventions to reduce medication errors in paediatrics and neonates: Systematic review and meta-analysis. Journal of Pediatric Nursing, 62, e139-e147. https://doi.org/10.1016/j.pedn.2021.08.024  

Naidu, M., & Alicia, Y. L. Y. (2019). Impact of barcode medication administration and electronic medication administration record system in clinical practice for an effective medication administration process. Health, 11(05), 511.https://doi.org/10.4236/health.2019.115044

Salar, A., Kiani, F., & Rezaee, N. (2020). Preventing the medication errors in hospitals: A qualitative study. International Journal of Africa Nursing Sciences, 13, 100235. https://doi.org/10.1016/j.ijans.2020.100235

Saleem, M. (2023). Barcode Medication Administration Technology to Prevent Medication Errors. Journal of the College of Physicians and Surgeons–Pakistan: JCPSP, 33(1), 107-108. https://doi.org/10.29271/jcpsp.2023.01.107

Capella University NURS-FPX4020 Assessment 4 Quality Improvement Initiative Tool Kit Essay Instructions

For this assessment, you will develop a Word document or an online resource repository of at least 12 annotated professional or scholarly resources that you consider critical for the audience of your safety improvement plan, pertaining to medication administration, to understand or implement to ensure the success of the plan.

Communication in the health care environment consists of an information-sharing experience whether through oral or written messages (Chard, Makary, 2015). As health care organizations and nurses strive to create a culture of safety and quality care, the importance of interprofessional collaboration, the development of tool kits, and the use of wikis become more relevant and vital. In addition to the dissemination of information and evidence-based findings and the development of tool kits, continuous support for and availability of such resources are critical.

Among the most popular methods to promote ongoing dialogue and information sharing are blogs, wikis, websites, and social media. Nurses know how to support people in time of need or crisis and how to support one another in the workplace; wikis in particular enable nurses to continue that support beyond the work environment. Here they can be free to share their unique perspectives, educate others, and promote health care wellness at local and global levels (Kaminski, 2016).

You are encouraged to complete the Determining the Relevance and Usefulness of Resources activity prior to developing the repository. This activity will help you determine which resources or research will be most relevant to address a particular need. This may be useful as you consider how to explain the purpose and relevance of the resources you are assembling for your tool kit. The activity is for your own practice and self-assessment, and demonstrates course engagement.

DEMONSTRATION OF PROFICIENCY for Capella University NURS-FPX4020 Assessment 4 Quality Improvement Initiative Tool Kit Essay

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

• Competency 1: Analyze the elements of a successful quality improvement initiative.
  • Analyze usefulness of resources for role group responsible for implementing quality and safety improvements with medication administration.
• Competency 2: Analyze factors that lead to patient safety risks.
  • Analyze the value of resources to reduce patient safety risk or improve quality with medication administration.
• Competency 3: Identify organizational interventions to promote patient safety.
  • Identify necessary resources to support the implementation and sustainability of a safety improvement initiative focusing on medication administration.
• Competency 5: Apply professional, scholarly, evidence-based strategies to communicate in a manner that supports safe and effective patient care.
  • Present compelling reasons and relevant situations for resource tool kit to be used by its target audience.
  • Communicate in a clear, logically structured, and professional manner, using current APA style and formatting.

References

Chard, R., Makary, M. A. (2015). Transfer-of-care communication: Nursing best practices. AORN Journal, 102(4), 329-342.

Kaminski, J. (2016). Why all

CAPS 400 The Deadly Bloom Sample Paper

Abstract

Alzheimer’s patients are suspected to have an increase level of Beta-methyl-amino-L-alanine (BMAA). BMAA is an environmental toxin produced by cyanobacteria and is linked to algae blooms. Found in sea creatures such as sharks, fish and shellfish that ingest algae, the neurotoxin is believed to trigger the neurodegenerative disease Alzheimer’s. The examiners performed an autopsy and removed the entire bran from forty deceased bodies. The deceased were separated into a control and experimental group. The experimental group consisted of twenty of the deceased who had diagnoses of Alzheimer’s while living and the remaining twenty had not victims of Alzheimer’s disease.

The brains were then placed in a cylinder filled with fluid to distinguish the average volume between the control and experimental group. The results came back to the experimental group suffering from brain atrophy and the control group having no brain atrophy. Medical examiners also used an enzyme-linked immonosorbent assay (ELISA) to disclose the presence of the toxin in the brain tissue of Alzheimer’s patients. The ELISA test proved that BMAA was present in eighteen of the brains of the deceased diagnosed with Alzheimer’s while living.

The findings also showed that BMAA was present in three of the healthy brains. To further understand the relation between Alzheimer’s and BMAA scientist should further investigate BMAA. More funding will go towards investigation. The safety information for seafood will contain both a safety summary and a complete toxicological profile. Exposure to BMAA should also decrease to reduce the cost of health care cost to Alzheimer’s.

Literature Review

Alzheimer’s disease is an illness that affects the brain and includes memory loss causing individuals to forget about loved ones and interfering with social skills. The disease attacks nerve cells of the brain, which then weakens a person’s ability to recall certain aspects of lives (Alzheimer’s Association, n.d). Having this complex illness interferes with daily routines, eating and taking medications have to be reminded by an aid or a family member. Impaired judgments, personality changes, annoyance are some of the symptoms (Web Md, n.d). Pictures, sticky notes are placed on items for remembrance.

Ranked number sixth leading cause of death in the United States, Alzheimer’s is irreversible (National Institute on Aging, 2016). Early onset Alzheimer’s occurs in people as young as thirty years old. Late onset Alzheimer’s occurs after sixty years old (NIH Senior Heath, 2015). The disease progresses slowly for some and faster for others. Mental abilities become compromised. Conversations are challenging as a result of compromised mental abilities (Alzheimer’s Association, n.d). It is categorized into three stages, mild, moderate and severe Alzheimer’s.

Individuals are diagnosed with the illness during mild Alzheimer’s. Driving and working are capable, however, during this stage a person is experiencing memory lapses. Family members start to take notice of struggles (Alzheimer’s Association, n.d). Close relatives notice difficulties with paying bills handling money and personality changes (National Institute on Aging, 2016). Doctors also detect problems in concentration and memory in this stage (Alzheimer’s Association, n.d).

The second stage is moderate Alzheimer’s. “Damage occurs in areas of the brain that control language, reasoning, conscious and sensory processing” (National Institute on Aging, 2016). Individuals require more help than the previous stage. There is an increase in memory loss, an urgency and uncontrollable time use the bathroom. Remembering names, faces and multitasking worsens. “At this stage people have hallucinations, delusions and paranoia” (National Institute on Aging, 2016). More time is spent with family members and not alone.

The final stage called severe Alzheimer’s is where assistance is needed at all times. Memory is compromised; people do not remember where they live or family member names, most times are spent in bed  “Plaques and tangles spread throughout the brain and brain tissue shrinks” (National Institute on Aging). Joining in conversations does not happen and personalities change dramatically (Alzheimer’s Association, n.d).

The ultimate way to diagnose Alzheimer’s is to perform an autopsy. Doctors look at the brain tissues of the deceases to out find whether plaques and tangles exist (NIH Senior Health, 2015). Neurologists can make a diagnosis by asking patients and family members a series of questions about past health; conduct a test to measure memory and a brain scan to look for any abnormalities in the brain (NIH Senior Health, 2015).

A person diagnosed with Alzheimer’s can live between ten or twenty years. Depending on the severity some can remain alive for less than three years (Holland, 2016). The cause of Alzheimer’s is genetic for most and idiopathic for others. . “Late-onset Alzheimer’s arises from a complex series of brain changes that occur over decades” (National Institute on Aging, 2016). Alzheimer’s can be inherited from a parent. A child with one parent carrying the gene has a 50/50 chance of inheriting the mutation and develop early onset Alzheimer’s (National Institute of Aging, n.d).

A major determinant for late onset Alzheimer’s is the apoliprotein E gene (APOE). “APOE is a cholesterol carrier that supports lipid transport and injury repair in the brain” (Nature Reviews Neurology, 2013). Patients who carry copies of APOE e4 have a higher risk of developing Alzheimer’s disease than patients who are carry APOE 3 (UC Irvine Institute n.d). “APOE lipoproteins bind to several cell-surface receptors to deliver lipids and also to hydrophobic amyloid-B peptide which is thought to initiate toxic events that lead to synaptic dysfunction and neurodegeneration in Alzheimer’s disease” (Nature Reviews Neurology, 2013).

Health and lifestyle factors induce the risk of Alzheimer’s. “Researcher suggests that a host of factors beyond genetics may play a role in the development of Alzheimer’s disease” (National Institute on Aging, 2016). Researchers mention that heart disease, stroke, high blood pressure and diabetes could play a role in increasing the risk of developing Alzheimer’s disease (National Institute on Aging, 2016).

Beta-methyl-amino-L-alanine (BMAA) can also increase the risk of Alzheimer’s disease. BMAA is an amino acid produced by cyanobacteria (Ethno Medicine, n.d). The toxin is found in sea creatures such as sharks, fish and shellfish that ingest algae. “BMAA is inserted into human proteins, causing them to misfold replaces amino acid serine in the protein sequence” (Ethno Medicine, n.d). Beta-methyl-amino-L-alanine replaces the amino acid serine. Serine is an amino acid that is important in the functioning of the brain and central nervous system (Vitamins stuff, n.d). Replacing serine causes protein aggregation and apoptosis (Ethno Medicine, n.d). BMAA is a trigger for Alzheimer’s in some people.

An estimated 5.5 million Americans are diagnosed with Alzheimer’s in 2017 (Alzheimer’s Association, n.d). 200,000 are estimated to be under the age of 65 and 5.3 million are 65 and over (Alzheimer’s Association, n.d). Two thirds of Alzheimer’s patients are women (Alzheimer’s Association, n.d). African Americans are twice as likely to have Alzheimer’s as Caucasians (Alzheimer’s Association, n.d). Hispanics are one and one-half as likely to have Alzheimer’s as older Caucasians (Alzheimer’s Association, n.d). “Today, someone in the United States develops Alzheimer’s every 66 seconds” (Alzheimer’s Association, n.d).

Alzheimer’s disease does not have a cure, however, individuals can take medications and participate in non-drug therapy (Alzheimer’s Association, n.d). Cholinesterase and memantine are used to stabilize the symptoms of Alzheimer’s temporarily (Alzheimer’s Association, n.d).

Cholinesterase inhibitors are used to help delay mild to moderate Alzheimer’s (National Institute on Aging, 2016). These medications include donespezil and galantamine. These medicines help reduce the symptoms and prevent them from getting worst for an amount of time (National Institute on Aging, 2016). Although taking inhibitors is helpful, cholinesterase may lose effects as a result of the disease progressing (National Institute on Aging, 2016).

To help moderate to severe Alzheimer’s doctors prescribe Namenda (memantine) (National Institute on Aging, 2016). These medications help maintain functions longer. While this can be helpful for most, medications and non-drug therapy do not reverse the damage Alzheimer’s has caused in the brain. The prescriptions provide a temporary relief from the symptoms (Alzheimer’s Association, n.d).

Doctors’ usually prescribed three different types of cholinesterase inhibitors; donespezil, is used to treat all stages of Alzheimer’s, Rivastigmine is used to treat mild to moderate Alzheimer’s and finally Galantamine is used to treat mild to moderate Alzheimer’s (Alzheimer’s Association, n.d).

Caring for someone with Alzheimer’s is estimated to be $60,000 a year. Depending on the family of the patients, a nursing home or private care is used. The cost of living in a nursing home is around $82,000 per year. Coverage is not always covered by insurance. Family members cover some of the cost (Hanes, 2012).

Alzheimer’s causes damage between the nerve cells in the brain and death of the nerve cells (National Institute on Aging, n.d). In the brain of a person with Alzheimer’s, the cortex and hippocampus shrink which injures the part of the brain that controls memory and thinking and the ventricles enlarge (Alzheimer’s Association, n.d). A magnetic resonance imaging (MRI) shows on average 0.44 percent of whole brain volume is lost in Alzheimer’s patients (ALZFORUM, n.d).

In a brain of an Alzheimer’s patient, amyloid plaques are piled up between the nerve cells. “Amyloid is a general term for protein fragments that the body produces normally” (Bright Focus Foundation, n.d). Someone with a healthy brain can eliminate them, however, in a brain of an Alzheimer’s person, these fragments become insoluble plaques (Bright Focus Foundation, n.d).

The brains also contain nerve cells containing tangles. “They primarily consist of a protein called tau, which forms part of a structure called microtubule” (Bright Focus Foundation, n.d). These proteins are not normal and the microtubule die out where tangles form (Bright Focus Foundation, n.d). Plaques do not stay in one place as Alzheimer’s progresses; they spread throughout the brain’s cortex. Depending on the stage at which a person is, the changes in the brain’s cortex very. (Alzheimer’s Association, n.d)

Methods and Materials

BMAA is a neurotoxin that has been linked to Alzheimer’s and other neurological diseases. To investigate the presence of BMAA and its correlation to Alzheimer’s diagnosis a research study was conducted. With the permission of family members doctors at the National Institute of Neurological Disorders and Stroke gathered forty brain tissue samples to complete their experiment. Twenty of the samples came from people that had been diagnosed with Alzheimer’s, were deceased and were named the experimental group the other twenty who died of other causes, were named the control group. To find out if BMAA is an underlying cause of Alzheimer’s autopsy was performed to the forty patients who were diagnosed with Alzheimer’s as well as the controls.

Standard procedures were used to remove the brains, which include “cutting the nerves to the blood vessels to the brain, the fibrous attachment to the skull and the nerves to the eyes,” (Encyclopedia, n.d). Twenty of the deceased had diagnoses of Alzheimer’s while living and the remaining twenty had not victims of Alzheimer’s disease. After obtaining the brains, pilling the lining of the surface of the brain from both the experimental and control group, data collection for both was obtained.

To confirm a correlation between the presence of BMAA and Alzheimer diagnoses medical examiners performed an autopsy and removed the entire brain from forty deceased bodies. Examining the external features of the brain to identify atrophy. The brains were then placed in a cylinder filled with fluid to distinguish the average volume between the control and experimental group. Using a knife, the examiner cut each brain in half to evaluate the difference between a healthy brain and an Alzheimer brain. Each brain was cut into smaller pieces to identify any similarities and differences (Gentleman, 2012).

The medical examiners used enzyme-linked immunosorbent assay (ELISA), which are used to detect the presence of antigen antibody in a sample (ELISA-antibody, n.d). The first step the examiners took in determining the presence of BMAA in the brain tissue was the use of standard solution. The medical providers added fifty microliters of solutions to the control and experimental group’s wells of the test strips. Secondly, the medical attendant added fifty microliters of enzyme conjugate to each wells using a pipette. Following, the addition of the enzyme conjugate, addition of fifty microliters of antibody solution was added to the individual wells. After the solution was added, tape was used to cover the wells then mixture of the contents was done, along with incubation for sixty minutes.

The fourth step in determining the presence of BMAA was removing the tape and disposing the contents into a sink. 250 microliters of washing buffer was used to clean the wells. Next, 100 microliters of substrate color solution was added to each wells. During this step, the examiners covered the wells with tape and mixed the contents together, then incubated for thirty minutes. The sixth step for the examiners was adding 100 microliters of stop solutions using a multi-channel pipette. The final step in determining the presence was to calculate the results” (Abraxis, n.d).

Health examiners were able to determine if BMAA was truly present in the brain of the experimental group. Also if its present in the brains of some of the control group.

Results

Upon Medical examiners could see obvious brain atrophy in the experimental group and the brains of the control group remained with no atrophy. “Neurofibrillary tangles and B-amyloid plaques are the neurological hallmarks of Alzheimer’s” (Cox, 2016). The doctors concluded that BMAA replaced the amino acid serine in human proteins and it led to the death of motor neurons (Ethno Medicine, n.d). The control group brain maintained the average length and volume associated with normal size while the experimental group had a decrease in brain volume.

Once the doctors placed the healthy brains in the cylinder, the liquid in rose approximately to 2800 centimeters cube on one of the tries. Using this number, examiners were able to subtract the brain volume, which is 1500 from 2800 (Shcupak, 2001). The lowest the water rose up to be 2600 cm3. The highest the fluid elevated to be 2900 cm3, which gave examiners the highest number.

The medical examiners used the same method to determine the volume of the experimental group. Since the brains of the experimental group were smaller, than those of the control group, the fluid in the cylinder did not rise as high. The health providers simply took the volume of a healthy brain and subtracted the level at which the fluid reached. The water rose up to 800 cm3 on the first try and the doctor subtracted 1500 from 800 to determine the volume. On the second try the water rose up to 770 cm3, on another try the water raised to 599 and the highest the fluid and brain rose up to 2501

Capstone Experience Assignment 4

Being a global health concern, nosocomial infection is a relevant topic. Factors contributing to its relevance include its impact on the general quality of life, mortality and morbidity (Ban et al., 2017). Despite various attempts to reduce the infections, the prevalence and incidences are still overwhelming. Recently, the World Health Organization projected that about 10% and 7% of all patients in developed and developing countries, respectively, will acquire at least one health-associated infection (HAI) in their lifetime (Meng et al., 2019).

The statistics have spurred worldwide efforts to reduce the occurrences of the infections. A common preventative intervention towards infections includes hand washing. Technology has been used to improve the efficacy of hand washing, such as through behavior monitoring systems (Meng et al., 2019). The paper addresses the main issue (HAI), interventions and expected outcomes in a PICO format.

Impact of Topic on Nursing Practice and Profession

Due to limited surveillance systems, the epidemiology of nosocomial infections is not well established. However, existing studies provide estimates of the burden of the infections, indicating a global health concern. The impact of the infections on nursing practice and the profession is evident. Studies have shown nearly the same 30-day mortality rate of about 10% in patients with the infections (Sikora & Zahra, 2020). Further, Sikora and Zaha (2020) note that critically ill patients tend to have an even greater mortality rate of 25% compared to other patients. The deaths cause dysphoria and demoralization of healthcare workers (Zheng et al., 2017).

Additionally, studies in German hospitals have confirmed that patients with HAI spend a lot more time in hospitals as compared to other patients (Sikora & Zahra, 2020). The prolonged hospital stay causes an increased burden on the healthcare sector and increased associated costs in managing infections (Sikora & Zahra, 2020). In the United States adult inpatient hospitals, circa $9.8 billion is estimated to be incurred in managing the infections. In addition to the associated complications, it is evident that the infections impact the nursing practice negatively. However, the subtle positive impact cannot be undermined since the burden of the infections has inspired increased efforts in the search for effective preventative strategies.

PICO Format

            The probable PICO question in this case is as follows: Does the contribution of behavior monitoring systems in hand washing, compared to direct observation methods, reduce nosocomial infections in a critical adult care unit among healthcare workers and patients? PICO is an evidence-based practice format used in framing and answering clinical questions. The P refers to the population or the problem. In this case, the issue is nosocomial infections, while the populations at risk are the healthcare workers and the patients.

I refer to the intervention in place to treat or mitigate the problem. The use of behavior monitoring innovations to improve hand hygiene adherence is the intervention studied. C is the comparison or the control intervention. In this case, a direct observation method is compared with the behavior monitoring systems. Further, O refers to the expected outcome. The intent of the interventions is to reduce the rate of nosocomial infections within the critical care unit. In this case, the PICO question helps explore the advantage behavior monitoring systems have over directly observed hand washing techniques.

According to Meng et al. (2019), direct observation is the gold standard for hand hygiene monitoring. However, it is costly and biased and the adherence or compliance rates are underwhelming. Therefore, technological innovations that are aimed at improving the adherence rates, such as behavior monitoring devices, are crucial. An example of such behavior monitoring systems include electronic sensors that counts, observe, and report hand hygiene adherence actions (Meng et al., 2019). Various studies have also proven the impact of technology in improving hand hygiene adherence and, ultimately, patient outcomes.

Conclusion

The quest for preventative interventions towards HAI is in progress. A commonly practiced preventative intervention includes hand washing; however, reports of adherence rates are underwhelming. To increase the efficacy of hand washing in the prevention of HAI, technology can be applied. Currently, addressed in the study are the behavior monitoring systems to improve hand washing adherence in a bid to increase the fight against nosocomial infections.

References

• Ban, K., Minei, J., Laronga, C., Harbrecht, B., Jensen, E., Fry, D., Itani, K., Dellinger, E., Ko, C., & Duane, T. (2017). American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update. Journal Of The American College Of Surgeons, 224(1), 59-74. https://doi.org/10.1016/j.jamcollsurg.2016.10.029
• Meng, M., Sorber, M., Herzog, A., Igel, C., & Kugler, C. (2019). Technological innovations in infection control: A rapid review of the acceptance of behavior monitoring systems and their contribution to the improvement of hand hygiene. American Journal Of Infection Control, 47(4), 439-447. https://doi.org/10.1016/j.ajic.2018.10.012
• Sikora, A., & Zahra, F. (2021). Nosocomial Infections. Ncbi.nlm.nih.gov. Retrieved 19 January 2021, from https://www.ncbi.nlm.nih.gov/books/NBK559312/#_NBK559312_pubdet.
• Zheng, R., Lee, S., & Bloomer, M. (2017). How nurses cope with patient death: A systematic review and qualitative meta-synthesis. Journal Of Clinical Nursing, 27(1-2), e39-e49. https://doi.org/10.1111/jocn.13975

Capstone Experience Topic Sample Paper

Capstone Experience Topic (Nosocomial Infections)

            Infections and infectious diseases are some of the common conditions healthcare professionals deal with on a day-to-day practice. Within the hospital, patients can acquire infections that were not present during admission. Similarly, in the course of their work, healthcare providers can also contract infections. These infections are known as nosocomial infections or health associated infections (HAI). Sikora and Zahra (2020) define HAI as the infections that are acquired after admission and typically manifest 48-hours post hospitalization. The settings where the infections are acquired include hospitals, ambulatory settings and long-term care facilities (Sikora & Zahra, 2020). In modern care, the risk factors associated with the infections are indwelling devices, invasive surgical procedures, prosthetic devices and susceptible host such as immune compromised patients. Various pathogens implicated in the etiology of HAI are broadly classified into bacterial, viral and fungal.

Significance of the Topic

            The infections affect a massive number of patients worldwide making it a global healthcare concern. Healthcare settings in both the developed and developing countries face the burden of the HAI. Due to its associated prolonged hospital stay, morbidity, mortality and financial burden, it remains an unresolved predicament. A study by Khan, Baig and Mehboob, (2017) report that huge number of patients, approximately 15% of all hospitalized individuals, end up acquiring the infections. The infections cause adverse consequences particularly in neonates, with a mortality rate of 4%-56% (Khan et al., 2017). Studies from South East Asia and Sub Saharan Africa indicate an incidence rate of 75% among the neonates (Khan et al., 2017).

Further studies on the economic burden of HIA provide evidence that management of the infections is expensive. For instance, a study in the United States reveal that medical costs incurred towards management of surgical site infections due to Vancomycin resistant enterococci are about $12,766 (Puchter et al., 2018). Even though the statistics are available, worldwide burden is unknown due to the unavailable surveillance systems for nosocomial infections. The worldwide prevalence is however likely to be higher with greater burden as compared to the impact on the specific countries. The burden of the HAI is an adequate impetus for the quest of preventive strategies spearheaded by the World Health Organization.

References

• Khan, H., Baig, F., & Mehboob, R. (2017). Nosocomial infections: Epidemiology, prevention, control and surveillance. Asian Pacific Journal Of Tropical Biomedicine, 7(5), 478-482. https://doi.org/10.1016/j.apjtb.2017.01.019
• Puchter, L., Chaberny, I., Schwab, F., Vonberg, R., Bange, F., & Ebadi, E. (2018). Economic burden of nosocomial infections caused by vancomycin-resistant enterococci. Antimicrobial Resistance & Infection Control, 7(1). https://doi.org/10.1186/s13756-017-0291-z
• Sikora, A., & Zahra, F. (2020). Nosocomial Infections. NCBI. Retrieved 15 January 2021, from https://www.ncbi.nlm.nih.gov/books/NBK559312/#_NBK559312_pubdet

Capstone Reflection Scoring Guide Rubric

CRITERIANON-PERFORMANCEBASICPROFICIENTDISTINGUISHEDReflect on use of evidence and the literature to plan and implement a capstone project, and compare project outcomes to initial predictions based on a review of the literature.Does not reflect on use of evidence and the literature to plan and implement a capstone project nor compare project outcomes to initial predictions based on a review of the literature.Reflects on use of evidence and the literature to plan and implement a capstone project, or compares project outcomes to initial predictions based on a review of the literature but not both.Reflects on use of evidence and the literature to plan and implement a capstone project, and compares project outcomes to initial predictions based on a review of the literature.Reflects on use of evidence and the literature to plan and implement a capstone project, and compares project outcomes to initial predictions based on a review of the literature. Explains how evidence-based practice principles informed this aspect of the capstone project.Reflect on the degree to which health care technology was leveraged successfully to improve outcomes or communication to relevant stakeholders in a capstone project.Does not reflect on the degree to which health care technology was leveraged successfully to improve outcomes or communication to relevant stakeholders in a capstone project.Identifies, but does not reflect on success of, health care technology leveraged to improve outcomes or communication to relevant stakeholders in a capstone project.Reflects on the degree to which health care technology was leveraged successfully to improve outcomes or communication to relevant stakeholders in a capstone project.Reflects on the degree to which health care technology was leveraged successfully to improve outcomes or communication to relevant stakeholders in a capstone project. Notes opportunities to improve health care technology use in personal practice.Reflect on how organizational and governmental health policy influenced the planning and implementation of a capstone project, as well as any contributions of the project to policy development.Does not reflect on how organizational and governmental health policy influenced the planning and implementation of a capstone project, nor on any contributions of the project to policy development.Identifies but does not reflect on how organizational and governmental health policy influenced the planning and implementation of a capstone project, nor on contributions of the project to policy development.Reflects on how organizational and governmental health policy influenced the planning and implementation of a capstone project, as well as any contributions of the project to policy development.Reflects on how organizational and governmental health policy influenced the planning and implementation of a capstone project, as well as any contributions of the project to policy development. Notes specific observations related to the BSN-prepared nurse’s role in policy implementation and development.Reflect on personal and professional growth throughout the capstone project and the BSN program, addressing the provision of ethical care and demonstration of professional standards.Does not address personal and professional growth throughout the capstone project and the BSN program.Describes but does not reflect on personal and professional growth throughout the capstone project and the BSN program or does not fully address the provision of ethical care and demonstration of professional standards.Reflects on personal and professional growth throughout the capstone project and the BSN program, addressing the provision of ethical care and demonstration of professional standards.Reflects on personal and professional growth throughout the capstone project and the BSN program, addressing the provision of ethical care and demonstration of professional standards. Notes specific growth areas of personal or professional pride.Communicate professionally in a clear, audible, and well-organized presentation, with correct grammar, spelling, and use of APA style.Does not communicate professionally in a clear, audible, and well-organized presentation, with correct grammar, spelling, and use of APA style.Communicates in a presentation that is unclear or inaudible, poorly organized, and/or contains errors in grammar, spelling, and/or use of APA style.Communicates professionally in a clear, audible, and well-organized presentation, with correct grammar, spelling, and use of APA style.Communicates professionally in an exceptionally clear, audible, and well-organized presentation, with flawless grammar, spelling, and use of APA style.

 

Resources:

Inter-professionalism

• Consider exploring the interprofessional collaboration video scenarios in this resource:
  • Interprofessional Professionalism Collaborative. (2018). IPA tool kit. Retrieved from http://www.interprofessionalprofessionalism.org/toolkit.html

Critical Reflection

• This article presents a framework for incorporating theory and evidence-based practice into reflection activities:
  • Kuennen, J. K. (2015). Critical reflection: A transformative learning process integrating theory and evidence-based practice. Worldviews on Evidence-Based Nursing, 12(5), 306–308.

Program and Library Resources

·         Writing Resources

Refer to the writing resources in the NHS Learner Support Lab, linked in the courseroom navigation menu, as you prepare your assessment.

APA Style and Format

The Writing Center’s APA Module can help you cite your references in correct APA style and format.

Library Resources

• BSN Program Library Research Guide.
• Databases A-Z: Nursing & Health Sciences.
• Evidence-Based Practice in Nursing & Health Sciences.
• Get Critical Search Skills.
• Library Research and Information Literacy Skills.

Cardiovascular and Cardiopulmonary Pathophysiologic Process

Cardiovascular and Cardiopulmonary Pathophysiologic Process

Cardiovascular and cardiopulmonary pathophysiologic process

Scenario 3: 11-year-old boy complains of wheezing and difficulty “getting enough air.” Notices it more when he is playing baseball and symptoms improve when exercise activity stops.

He says that the symptoms are getting worse and the symptoms are even occurring at rest. Mother says the child is allergic to cat dander and his next-door neighbor in their apartment building recently began sheltering cats for the local humane society. Auscultation demonstrates wheezes on forced expiration throughout all lung fields. ( must be included in paper)

Cardiovascular and Cardiopulmonary Pathophysiologic Process Assignment (1- to 2-page case study analysis)

In your Case Study Analysis related to the scenario provided, explain the following

The cardiovascular and cardiopulmonary pathophysiologic processes that result in the patient presenting these symptoms.

Any racial/ethnic variables that may impact physiological functioning.

How these processes interact to affect the patient.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The sample paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates). All papers submitted must use this formatting.

ORDER THROUGH BOUTESSAY

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized.

Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12-point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting a hard copy, be sure to use white paper and print it out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

Pathophysiologic Process of Cardiovascular Diseases Example

Understanding the pathophysiologic process of diseases is a critical component of being a nursing practitioner. It provides a better understanding of why symptoms occur in a certain manner, consequently providing a better understanding of how diseases progress. This constitutes a critical part of initiating early and effective treatment options to provide quality, safe and appropriate care. This paper aims to describe the pathophysiologic process behind cough and shortness of breath in a patient with COPD, highlighting any racial/ ethical factors that may be coming into play and understanding the interrelationship between these disease processes, resulting in the outcome observed.

Pathophysiologic Processes

The link between COPD and cardiovascular pathophysiologic processes primarily depends on hyperinflation and hypoxemia, among other processes. Hyperinflation is primarily a result of an increase in the residual gas in the alveoli after the process of breathing out. This hyperinflation can either be static or dynamic. Static entails the destruction of the lung parenchyma, resulting in the loss of the elastic recoil of the lung. The dynamic phase occurs on inhalation before full exhalation, consequently resulting in the retention of air molecules. This whole process greatly disrupts the muscles involved in respiration, resulting in the observed shortness of breath (McCance & Huether, 2019). Limitations in the airflow due to hyperinflation have been attributed to elevated pressures, right ventricular dysfunction, impaired left ventricular filling, and impaired cardiac output.

COPD results in excess mucus production by the lungs. The consequent impairment in the mucus-clearing mechanisms, in conjunction with the impairment of the ciliary structure, leads to the cough as a mechanism of clearing out the excess mucus (Radovanovic et al., 2018). The green sputum is due to an acute bacterial infection, most likely pneumonia. Elevated levels of myeloperoxidase enzyme during acute infections are the leading cause of the green color in the sputum. The fever is mostly a result of the upward surge of the set point of the thermoregulatory center as a result of cytokines (Santos et al., 2019). This is particularly common in infections and is believed to boost the immune system’s functioning while hindering the pathogen’s proliferation.

Cardiovascular and Cardiopulmonary Interaction

It is a common occurrence to experience cardiovascular complications and COPD coexisting. As highlighted earlier, the critical pathophysiological links between these two systems are lung hyperinflation, systemic inflammation, and exacerbations associated with COPD. This cardiovascular and cardiopulmonary interaction dramatically increases mortality rates and significantly affects the overall quality of life due to prolonged episodes of shortness of breath and exercise intolerance (Cheyne et al., 2020). Prolonged and frequent hospitalization as a result of COPD exacerbations dramatically reduces the patient’s productivity and increases the overall cost of healthcare.

Racial/Ethical Variables

Race is a crucial determinant in occupation types since most occupations are racially patterned (Wolf et al., 2020). In most instances, jobs, where there is exposure to smoke, dust, and other hazardous chemicals, tend to be reserved for certain racial groups. These factors greatly influence the disease process, consequently playing a significant role in the overall health of the individuals. Racially determined factors such as poverty and level of education determine an individual’s lifestyle, including physical exercise and diet. These are key to the overall physiologic functioning of an individual. These factors also influence health-seeking behaviors, which also affect normal physiologic functioning.

Conclusion.

The cardiopulmonary and cardiovascular systems are greatly affected by conditions affecting either of these systems, with symptoms manifesting in relation to the pathophysiologic processes involved. Understanding these processes is critical to offering quality care to patients. Factors such as race and ethnicity should be taken into consideration as they greatly impact the normal physiologic functioning of the body and, consequently, the disease process.

References

Cheyne, W. S., Harper, M. I., Gelinas, J. C., Sasso, J. P., & Eves, N. D. (2020). Mechanical cardiopulmonary interactions during exercise in health and disease. Journal of Applied Physiology (Bethesda, Md.: 1985), 128(5), 1271–1279. https://doi.org/10.1152/japplphysiol.00339.2019

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.

Radovanovic, D., Pecchiari, M., Pirracchio, F., Zilianti, C., D’Angelo, E., & Santus, P. (2018). Plethysmographic Loops: A Window on the Lung Pathophysiology of COPD Patients. Frontiers in Physiology, 9, 484. https://doi.org/10.3389/fphys.2018.00484

Santos, C., Oliveira, R. C., Serra, P., Baptista, J. P., Sousa, E., Casanova, P., Pimentel, J., & Carvalho, L. (2019). Pathophysiology of acute fibrinous and organizing pneumonia – Clinical and morphological spectra. Pathophysiology: The Official Journal of the International Society for Pathophysiology, 26(3-4), 213–217. https://doi.org/10.1016/j.pathophys.2019.04.001

Wolf, S. T., Jablonski, N. G., & Kenney, W. L. (2020). Examining “race” in physiology. American journal of physiology. Heart and Circulatory Physiology, 319(6), H1409–H1413. https://doi.org/10.1152/ajpheart.00698.2020

Also Read: NURS 6501 Module 1 Assignment: Case Study Analysis

CARE OF A PATIENT WITH BREAST CANCER Sample Paper

Breast cancer is the most common cancer in women and the leading cause of death. Thus, the burden of this disease is overwhelming. Identification of women at risk for breast cancer and prompt evaluation of these women is important to diagnose and treat this condition early. Physical assessment proves to be an important tool in the diagnosis of breast cancer. The management of breast cancer is a holistic approach involving the nurse, the doctor, the oncologist and the surgeon. The nurse plays a major role in the entire treatment process of a cancer patient

Ms. Williams has several factors exposing her to breast cancer. She had her first pregnancy at an age above 30. Ms. Williams is taking birth control pills. Oral contraceptives are known to increase the risk of developing breast cancer. She also has a family history of breast cancer- a maternal aunt who had breast cancer. She is taking an over-the-counter antihistamine. In a study by Bens (2020) in the British Journal of Cancer, the use of antihistamines has been associated with breast tumor proliferation and thus the development of cancerous growths.

A detailed physical assessment of Ms. Williams has to be done for diagnostic purposes. The nurse should check the color of the skin of the breast and the nipple and note any discharge from the nipple. The discharge in breast cancer is mostly bloody. She should observe for changes in the size of the affected breast. Redness and warmth of the breast area would denote an inflammatory process. After palpation of the breast; the nurse should denote the quadrant in which the lump is, determine its size and shape (regular or irregular). The nurse should also try to move it to feel if it is attached to the chest or the skin. Palpation also reveals tenderness. Normally lumps are painless. The nurse should also assess the respiratory and cardiovascular systems state as there could be metastatic spread into the lungs and heart in the event of breast cancer. Palpation of the supraclavicular nodes for tenderness and enlargement should be done.

The management of Ms. Williams shall require a team approach by the health care providers. The doctor is necessary for the diagnosis of the disease and referral to an oncologist. The oncologist, after his assessment, determines the best treatment method. Tumors with regular edges can be removed by surgical excision. The surgeon and his teams prepare for the surgery and advice on post-operative care.  The nurse carries out the pre-operative and post-operative care required by this patient. The psycho-oncologist is very important in arraying anxiety and teaching life coping mechanisms. Sometimes, radiation might be the best option and the radiological team may need to be informed about Ms. Williams’s case.

Breast cancer can cause anxiety, fear and worry. The nurse should explain to Ms. Williams that a breast lump is not definitive that she has cancer. It could also be caused by local inflammation and blockage of the ducts. The nurse should reassure her. The nurse should teach Ms. Williams the disease process and how to cope effectively. The nurse should advise her to go for mammography.

As seen above, the diagnoses and management of breast cancer require a multidisciplinary team. Evaluation of risk factors should be taken into account during the care of this patient. Patient education and also public awareness are important preventive measures.

References

• Bens, A., Dehlendorff, C., Friis, S., Cronin-Fenton, D., Jensen, M. B., Ejlertsen, B., … & Mellemkjær, L. (2020). The role of H1 antihistamines in contralateral breast cancer: a Danish nationwide cohort study. British Journal of Cancer, 122(7), 1102-1108.
• https://www.nature.com/articles/s41416-020-0747-4
• Engmann, N. J., Golmakani, M. K., Miglioretti, D. L., Sprague, B. L., & Kerlikowske, K. (2017). Population-attributable risk proportion of clinical risk factors for breast cancer. JAMA oncology, 3(9), 1228-1236.
  https://jamanetwork.com/journals/jamaoncology/article-abstract/2599991
• Zardavas, D., Irrthum, A., Swanton, C., & Piccart, M. (2015). Clinical management of breast cancer heterogeneity. Nature reviews Clinical oncology, 12(7), 381.
• https://www.nature.com/articles/nrclinonc.2015.73.pdf?origin=ppub

Carolyn Cross V2VE Case Study SOAP Note and Differential Diagnoses for iHuman Case

Carolyn Cross V2VE Case Study SOAP Note and Differential Diagnoses for iHuman Case

Name: Carolyn Cross

Age: 41 years

Sex: F

Height: 5? 3?

Weight: 155 pounds (BMI 27.5)

Temperature: 98.4 F (oral) Pulse: 76 bpm – regular

Blood pressure: 134/74 mmHg122/72 upon standing

Respiratory rate: 16 bpm SpO2: 98% on room air Carolyn Cross

Chief complaint: Well-woman evaluation SOAP Note and Differential Diagnoses for iHuman Case.

Use this week’s iHuman case titled “Carolyn Cross V2VE” and create a SOAP note with a treatment plan (located at the bottom of the SOAP note.

Provide a subjective, objective, assessment, and plan (SOAP) note on this patient and your treatment plan using the SOAP note template provided Carolyn Cross V2VE Case Study SOAP Note and Differential Diagnoses for iHuman Case. Remember to keep the patient’s identity private; use the minimal amount of information possible to get the idea across.

Provide a reference for your treatment plan (in APA format). The reference may come from a journal, a book, etc. Cite all sources using APA format.

Include three differential diagnoses and support your diagnoses with supporting literature.

Skin: Warm, dry

Ms. Cross is a healthy 41-year-old G2P2 Hispanic-American female who presents for a well-woman examination. She has no active medical complaints, but is concerned about her risk of breast cancer as both her mother (age 63) and maternal first cousin (age 44) have been recently diagnosed with intraductal breast cancer.

Additional risk factors include menarche age 10.5; first pregnancy age 33; she breast fed each of her two infants for only four months each. The patient, reports a normal baseline mammogram at age 40, (report not available) and a history of fibrocystic breast disease. She is overweight (BMI 27.5) with a FH of hypertension, hyperlipidemia (father) and type 2 diabetes (mother).

She is concerned about her risk for breast cancer and does this fact increase her risk of breast cancer, her mother at 63 years old and first cousin 44 year old was recently diagnosed with breast cancer. She performs self-breast examines, no lumps or bumps or discharged noted by patient. She reports breast tenderness around her menstrual cycle.

Denies any health problems past or present. Immunizations are up to date. She gardens and does house work for exercise Carolyn Cross V2VE Case Study SOAP Note and Differential Diagnoses for iHuman Case. She reports later she takes vitamin E for fibro cystic breast disease, she had a mammogram 18 months ago.

Father has hyperlipidemia and HTN and mother is a type 2 DM and just diagnosed at 63 with breast cancer. Pt has a glass of wine every night with supper her diet is traditional Hispanic diet. Both breast is irregular lump and bump bilateral with slight diffuse tenderness. She has two boys and a husband no reported siblings

Labs

• Name
• Value
• Units
• Reference
• Range
• Cholesterol

239 mg/dL low risk <200, moderate 200-239, high >239 High-density lipoprotein (HDL) 45 mg/dL maj risk <40, neg risk >59 Low-density lipoprotein (LDL) 159 units/L low risk <130, moderate 130-159, high >159 Triglycerides 40 mg/dL (?) 35-135, (?) 40-16 Name Value Units Reference Range Glucose, 8 hour fasting 122 mg/dL <126 Name Value Units Reference Range Hemoglobin A1c 6.4 % normal 4-5.6, elevated risk 5.7-6.4, diabetes >6.7 Her papsmear was normal.

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
I encourage you to incorporate the readings from the week (as applicable) into your responses.

Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

APA Format and Writing Quality

Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
I highly recommend using the APA Publication Manual, 6th edition.

Use of Direct Quotes

I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
It is best to paraphrase content and cite your source.

LopesWrite Policy

For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
I do not accept assignments that are two or more weeks late unless we have worked out an extension.
As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

Communication is so very important. There are multiple ways to communicate with me:
Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.