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Discussion: Pharmacokinetics and Pharmacodynamics NURS 6521

Pharmacokinetic and Pharmacodynamics

Pharmacokinetics (PK) and pharmacodynamics (PD) are two main branches of pharmacology that are essential for optimizing drug therapy and ensuring patient safety. PK studies the journey of a drug through the body, including its absorption, distribution, metabolism, and elimination while on the other hand, PD examines how a medication affects the physiological and biochemical functions of the body (Ernstmeyer & Christman, 2023). This paper explores the relationship of these principles with my real-world clinical experiences, emphasizing the importance of considering individualized factors that influence drug response.

Case Presentation

During my clinical experience, I came across a 65-year-old male patient with a history of chronic heart failure presented with worsening symptoms of dyspnea, fatigue, and edema. His current medications included furosemide, an aldosterone antagonist, and enalapril, an ACE inhibitor. Upon evaluation, the patient’s serum potassium level was found to be elevated, indicating potential hyperkalemia, which is a known adverse effect of aldosterone antagonists.

Factors Influencing Pharmacokinetic and Pharmacodynamic Processes

Several factors influenced the PK and PD processes in this patient, contributing to the development of hyperkalemia. According to Rosenthal and Burchum (2019), an advanced patient’s age increases the risk of impaired renal function. The patient’s age, being over 60 years old, could have slowed down the elimination of potassium from the body. Secondly, the patient’s concurrent use of enalapril, an ACE inhibitor, can further enhance potassium retention due to its mechanism of action. Additionally, the patient’s reduced physical activity may have contributed to decreased potassium excretion through sweat.

Personalized Plan of Care

Based on the influencing factors and patient history, a personalized plan of care was developed to address the hyperkalemia and optimize drug therapy. The aldosterone antagonist dosage was reduced to minimize potassium retention (American Geriatrics Society, 2019). Additionally, the patient was advised to monitor his potassium levels regularly and maintain a low-potassium diet. Furthermore, regular monitoring of renal function was recommended to ensure adequate potassium excretion.

Conclusion

This case study highlights the importance of considering PK and PD principles in patient care. Understanding these factors that influence drug absorption, distribution, metabolism, and elimination enables healthcare professionals to tailor drug regimens to individual patients, minimizing the risk of adverse effects and maximizing therapeutic efficacy.

Discussion: Pharmacokinetics and Pharmacodynamics NURS 6521 References

American Geriatrics Society. (2019). American geriatrics society 2019 updated AGS beers criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 67(4), 674–694. https://doi.org/10.1111/jgs.15767

Ernstmeyer, K., & Christman, E. (2023). Chapter 1 pharmacokinetics & pharmacodynamics. Www.ncbi.nlm.nih.gov; Chippewa Valley Technical College. https://www.ncbi.nlm.nih.gov/books/NBK595006/

Rosenthal, L. D. R., & Burchum, J. R. (2019). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants: Laura Rosenthal DNP ACNP, Jacqueline Burchum dnsc APRN BC: 9780323554954: Amazon.com: Books. Amazon.com. https://www.amazon.com/Pharmacotherapeutics-Advanced-Practice-Physician-Assistants/dp/0323554954

Discussion: Pharmacokinetics and Pharmacodynamics

As an advanced practice nurse assisting physicians in the diagnosis and treatment of disorders, it is important to not only understand the impact of disorders on the body, but also the impact of drug treatments on the body. The relationships between drugs and the body can be described by pharmacokinetics and pharmacodynamics.

Pharmacokinetics describes what the body does to the drug through absorption, distribution, metabolism, and excretion, whereas pharmacodynamics describes what the drug does to the body.

Photo Credit: Getty Images/Ingram Publishing

When selecting drugs and determining dosages for patients, it is essential to consider individual patient factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes. These patient factors include genetics, gender, ethnicity, age, behavior (i.e., diet, nutrition, smoking, alcohol, illicit drug abuse), and/or pathophysiological changes due to disease.

For this Discussion, you reflect on a case from your past clinical experiences and consider how a patient’s pharmacokinetic and pharmacodynamic processes may alter his or her response to a drug.

To Prepare

Review the Resources for this module and consider the principles of pharmacokinetics and pharmacodynamics.

Reflect on your experiences, observations, and/or clinical practices from the last 5 years and think about how pharmacokinetic and pharmacodynamic factors altered his or her anticipated response to a drug.

Consider factors that might have influenced the patient’s pharmacokinetic and pharmacodynamic processes, such as genetics (including pharmacogenetics), gender, ethnicity, age, behavior, and/or possible pathophysiological changes due to disease.
Think about a personalized plan of care based on these influencing factors and patient history in your case study.

Post a description of the patient case from your experiences, observations, and/or clinical practice from the last 5 years. Then, describe factors that might have influenced pharmacokinetic and pharmacodynamic processes of the patient you identified. Finally, explain details of the personalized plan of care that you would develop based on influencing factors and patient history in your case. Be specific and provide examples.

Pharmacokinetics and Pharmacodynamics Example Solution

The human body and pharmacological agents interact in various fashions to cause desired pharmacological effects and adverse outcomes in undesired situations. I encountered a patient named Mrs. B (not her actual name) who was being treated for congestive heart failure in my training. Mrs. B is a 78-year-old black female who had been on treatment for heart failure two months ago. During that admission, she had been brought in because she had bilateral lower limb edema.

Mrs. B was put on furosemide for his edema and heart failure. She was ambulant and reported no leg pain. During the second day on furosemide, she started reporting dizziness. Her blood pressure measured that day was within the normal limits but borderline low. Her physician reassured her that her vitals were fine but there needed some adjustments in the doses of her medications. Her physician was also worried about her kidney function due to her conditions. Therefore, he ordered that Mrs. B be evaluated for serum creatinine, urea levels, and serum potassium and sodium levels.

Mrs. B’s body ad furosemide reacted in various ways to cause the improvement of the edema and the dizziness with lowered blood pressure. Furosemide is the commonest prescribed diuretic and has indications in cardiac, hepatic, pulmonary, and renal diseases (Rosenthal & Burchum, 2020). It has well documented pharmacokinetic profile and pharmacodynamics properties. The route of administration can be parenteral or enteral. Oral administration is usually through oral uncoated tablets or oral disintegrating films (Koh et al., 2021).

The route determines its bioavailability and onset of action after administration. The absorption happens in the gut after oral administration, and metabolism occurs in the liver, after which elimination will take place in the kidneys. This explains the physicians’ concerns about kidney functions. Poor elimination in kidney injury would lead to toxicity of this drug and more adverse events. Furosemide acts in the loop of Henle to promote the excretion of water and potassium.

Therefore, it reduces fluid overload and reduces cardiac output. In so doing, it can lower blood pressure and cause hypotension and dizziness. This explains the phenomenon that Mrs. B was experiencing on the second day of therapy (Khan et al., 2022). Therefore, the pharmacokinetics and pharmacodynamics of furosemide explain the entire phenomena Mrs. B had. This understanding provides the basis for the care plan for this patient.

Individualized Plan for Mrs. B

Mrs. would require rehydration despite still having fluid overload. This would prevent acute kidney injury and furosemide toxicity. Mrs. B is an elderly patient, and the administration of furosemide would require monitoring of sodium levels for this particular population, according to the American Geriatric Society (American Geriatrics Society, 2019). Decreased kidney function among the elderly population would lead to decreased drug elimination and thus toxicity. This plan would also include blood pressure monitoring to prevent orthostatic hypotension and dizziness.

The personalized plan for Mrs. B is based on what furosemide does to the body (pharmacodynamics) and what the body does to furosemide (pharmacokinetics) and the factors influencing these interactions. Age has stood out as a key factor in the pharmacodynamics and pharmacokinetics of furosemide. The diminished physiological capacity of the body in adults influences how they eliminate and metabolize medications. Therefore, nursing interventional adjustments and physical intervention adjustments would be justified in this case.

References

American Geriatrics Society. (2019). American geriatrics society 2019 updated AGS beers criteria® for potentially inappropriate medication use in older adults: 2019 Ags beers criteria® update expert panel. Journal of the American Geriatrics Society, 67(4), 674–694. https://doi.org/10.1111/jgs.15767

Khan, T. M., Patel, R., & Siddiqui, A. H. (2022). Furosemide. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK499921/

Koh, S.-K., Jeong, J.-W., Choi, S.-I., Kim, R. M., Koo, T.-S., Cho, K. H., & Seo, K.-W. (2021). Pharmacokinetics and diuretic effect of furosemide after the single intravenous, oral tablet, and newly developed oral disintegrating film administration in healthy beagle dogs. BMC Veterinary Research, 17(1), 295. https://doi.org/10.1186/s12917-021-02998-4

Rosenthal, L., & Burchum, J. (2020). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). Saunders. https://evolve.elsevier.com/cs/product/9780323554954

Example Discussion 1 Approach 2

The patient case that I recall from my past experiences is about a 40-year-old male patient who was admitted following an amputation. The patient transferred to rehab just days after the surgery and was not medically stable to endure 3 hours of therapy. Some comorbidities include a kidney transplant, ESRD on peritoneal dialysis, hypertension, and diabetes. The patient was  chronically hypotensive, with normal systolic blood pressures in the 80s. Current medications included anti-hypertensives and alpha-adrenergic agonists. During therapy, the patient would experience orthostatic hypotension dropping down to the 60’s.  

Some factors might have influenced pharmacokinetic and pharmacodynamic processes in this patient. Pharmacokinetics involves absorption, distribution, metabolism and excretion. After the medication is ingested, it gets absorbed into the bloodstream, which moves from the blood into the cell.

The drug is then metabolized by the liver and excreted primarily by the kidneys. Drugs and their metabolites can exit the body in urine, bile, sweat, saliva, breast milk, and expired air (Rosenthal, 2021). Patients with chronic kidney disease will respond to drugs   differently than patients with normal kidney function. In patients with healthy kidneys, small molecules and drugs get filtered through the glomerulus. In the tubules, lipid-soluble drugs undergo passive reabsorption. Lastly, active transport systems can pump drugs into the tubule to be excreted with urine. 

For patients who have ESRD, the excretion of drugs is affected tremendously. Whether kidney disease is acute or chronic, drug clearance decreases, and the volume of distribution may remain unchanged or increase” (Roberts, et.al., 2018). Duration and intensity are factors to consider in these patients due to the increased number of free drugs in the blood. With patients who are taking multiple drugs, there is a delayed excretion of drugs if they use the same transport system, and the medication effects can be delayed. According to Sommer, Seeling, and Rupprecht, “70.4% of the residents with an estimated glomerular filtration rate (eGFR) < 60 mL/min take at least five drugs, with 17.7% of them taking > 10 drugs as long-term medication” (2020).  

The personalized care plan that I would implement for this patient included taking a full history of medications including herbal and over-the-counter drugs. Accurate documentation of medications prevents adverse drug-to-drug interactions, medication replication, and dosage errors. As the provider, we can adjust the dosage of medications accordingly. In the case of this patient, a decrease in the dosage of antihypertensive medications should be considered because the patient continues to have hypotension.

Renal dosage of these medications also must be taken into consideration, are these medications appropriate for patients with chronic kidney disease? I would monitor for signs and symptoms of toxicity including low blood pressure, dizziness, headaches, and feeling tired. Monitor blood pressure throughout the day, especially before and after taking blood pressure medications and when the patient reports symptoms of hypotension. The patient would benefit from education about the medications and what signs and symptoms to monitor for.

Discussion 1 Schizophrenia and Diabetes Example 3

My patient is an incarcerated 43-year-old Hispanic male with schizophrenia, currently being treated with 20mg of olanzapine once at nighttime. This treatment has effectively treated the positive and negative symptoms of his mental health illness. However, his blood sugar levels have become elevated lately He has no reported history of diabetes nor other known medical conditions. He has a history of methamphetamine and alcohol use. He has gained approximately twenty pounds over the past three months while incarcerated. 

It is well documented that patients undergoing treatment with antipsychotics are at an increased risk of gaining weight and developing diabetes mellitus (DM) in comparison to the general population, an approximate eight to ten-fold increased risk according to Jaworski et al. (2021). Holt (2019) noted that among atypical (second generation) antipsychotics, olanzapine has been associated with the highest rate of weight gain and DM (71%) when compared to first generation antipsychotics (p.4).

Among the atypicals, olanzapine is closely followed by risperidone and quetiapine in causing these adverse effects, with the least likely being ziprasidone and aripiprazole (Khandker et al., 2022, p.2). However, the possible causational mechanism of developing DM associated with initiating antipsychotics is still being studied. There is the general belief that it correlates with weight gain, but there is also evidence that suggests that it may be due to a direct decrease in insulin sensitivity and insulin secretory capacity (Holt, 2019, p. 5).  

To determine the best course of treatment to take with this patient, it is important to review and balance the control of symptoms, risk of side effects, and the risk of relapse (Khandker et al., 2022, p. 9). Our patient has a history of taking other antipsychotics including Haldol and risperidone, but the patient experienced most benefit of his symptoms with olanzapine. He does not recall having received treatment with either ziprasidone or aripiprazole.

In this case, I would recommend that we adjust his antipsychotic medication to aripiprazole, monitor for therapeutic response, and continue monitoring his blood sugars. We want to avoid having to treat another disease process if it can be avoided which might be accomplished with this adjustment. It is also important to note that it may be necessary to treat him with olanzapine if it is discovered that he is not responded favorably to other treatments or if the patient wishes to continue with his current treatment after being given the risks of benefits of his options. 

NURS 6521 Week 1 Assignment Ethical and Legal Implications of Prescribing Drugs 

Please be mindful of plagiarism and APA format, I have included the rubric. Please use my course resources as one of my references as instructed. Please include Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier in the references.

Assignment 2: Ethical and Legal Implications of Prescribing Drugs

What type of drug should you prescribe based on your patient’s diagnosis? How much of the drug should the patient receive? How often should the drug be administered? When should the drug not be prescribed? Are there individual patient factors that could create complications when taking the drug? Should you be prescribing drugs to this patient? How might different state regulations affect the prescribing of this drug to this patient?

These are some of the questions you might consider when selecting a treatment plan for a patient.

Photo Credit: Getty Images/Caiaimage

As an advanced practice nurse prescribing drugs, you are held accountable for people’s lives every day. Patients and their families will often place trust in you because of your position. With this trust comes power and responsibility, as well as an ethical and legal obligation to do no harm. It is important that you are aware of current professional, legal, and ethical standards for advanced practice nurses with prescriptive authority.

Additionally, it is important to ensure that the treatment plans and administration/prescribing of drugs is in accordance with the regulations of the state in which you practice. Understanding how these regulations may affect the prescribing of certain drugs in different states may have a significant impact on your patient’s treatment plan. In this Assignment, you explore ethical and legal implications of scenarios and consider how to appropriately respond.

To Prepare

Review the Resources for this module and consider the legal and ethical implications of prescribing prescription drugs, disclosure, and nondisclosure.

Review the scenario assigned by your Instructor for this Assignment.

Search specific laws and standards for prescribing prescription drugs and for addressing medication errors for your state or region, and reflect on these as you review the scenario assigned by your Instructor.

Consider the ethical and legal implications of the scenario for all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.

Think about two strategies that you, as an advanced practice nurse, would use to guide your ethically and legally responsible decision-making in this scenario, including whether you would disclose any medication errors.

By Day 7 of Week 1

Write a 2- to 3-page paper that addresses the following:

1. Explain the ethical and legal implications of the scenario you selected on all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.
2. Describe strategies to address disclosure and nondisclosure as identified in the scenario you selected. Be sure to reference laws specific to your state.
3. Explain two strategies that you, as an advanced practice nurse, would use to guide your decision making in this scenario, including whether you would disclose your error. Be sure to justify your explanation.
4. Explain the process of writing prescriptions, including strategies to minimize medication errors.

SCENARIO:

You see another nurse practitioner writing a prescription for her husband, who is not a patient of the nurse practitioner. The prescription is for a narcotic. You can’t decide whether or not to report the incident.

Give examples. For example, say it was Dilaudid (hydromorphone) tablets. Talk about the drugs effects on patient (kinetics & dynamics briefly), use highest level pharmacological information, since you are doing advanced pharmacology. Talk about Ethical Moral & Legal aspects of this error & how you will rectify the issue. Talk about long term consequences of opioid prescriptions. Give information as short paragraphs, not big blobs.

NOTE:
PLEASE INCLUDE A TITLE PAGE, INTRODUCTION AND SUMMARY.
MY STATE IS PENNSYLVANIA.

Use peer reviewed scholarly reference articles, provider/clinician based, not patient based, from peer reviewed, current US based journals. Within 5 years.

NURS 6521 Week 2 Pharmacotherapy for Cardiovascular Disorders

Please be mindful of plagiarism and APA format, I have included the rubric. Please use my course resources as one of my references as instructed. Please include Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier in the references.

Learning Resources

Required Readings (click to expand/reduce)

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

Chapter 33, Review of Hemodynamics (pp. 285-289)
Chapter 37, Diuretics (pp. 290-296)
Chapter 38, Drugs Acting on the Renin-Angiotensin-Aldosterone System (pp. 297-307)
Chapter 39, Calcium Channel Blockers (pp. 308-312)
Chapter 40, Vasodilators (pp. 313-317)
Chapter 41, Drugs for Hypertension (pp. 316-324)
Chapter 42, Drugs for Heart Failure (pp. 325-336)
Chapter 43, Antidysrhythmic Drugs (pp. 337-348)
Chapter 44, Prophylaxis of Atherosclerotic Cardiovascular Disease: Drugs That Help Normalize Cholesterol and Triglyceride Levels (pp. 349-363)
Chapter 45, Drugs for Angina Pectoris (pp. 364-371)
Chapter 46, Anticoagulant and Antiplatelet Drugs (pp. 372-388)

Assignment: Pharmacotherapy for Cardiovascular Disorders

…heart disease remains the No. 1 killer in America; nearly half of all Americans have high blood pressure, high cholesterol, or smoke some of the leading risk factors for heart disease

Despite the high mortality rates associated with cardiovascular disorders, improved treatment options do exist that can help address those risk factors that afflict the majority of the population today.

Photo Credit: Getty Images/Science Photo Library RF

As an advanced practice nurse, it is your responsibility to recommend appropriate treatment options for patients with cardiovascular disorders. To ensure the safety and effectiveness of drug therapy, advanced practice nurses must consider aspects that might influence pharmacokinetic and pharmacodynamic processes such as medical history, other drugs currently prescribed, and individual patient factors.

Reference: Murphy, S. L., Xu, J., Kochanek, K. D., & Arias, E. (2018). Mortality in the United States, 2017. Retrieved from https://www.cdc.gov/nchs/products/databriefs/db328.htm

To Prepare

Review the Resources for this module and consider the impact of potential pharmacotherapeutics for cardiovascular disorders introduced in the media piece.
Review the case study assigned by your Instructor for this Assignment.

Select one the following factors: genetics, gender, ethnicity, age, or behavior factors.
Reflect on how the factor you selected might influence the patient’s pharmacokinetic and pharmacodynamic processes.

Consider how changes in the pharmacokinetic and pharmacodynamic processes might impact the patient’s recommended drug therapy.

Think about how you might improve the patient’s drug therapy plan based on the pharmacokinetic and pharmacodynamic changes. Reflect on whether you would modify the current drug treatment or provide an alternative treatment option for the patient.

Write a 2- to 3-page paper that addresses the following:

1. Explain how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned.
2. Describe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples.
3. Explain how you might improve the patient’s drug therapy plan and explain why you would make these recommended improvements.

Here is the Case for your Study!

Patient JJ has a history of strokes. The patient has been diagnosed with type 2 diabetes, hypertension, and hyperlipidemia.

Drugs currently prescribed include the following:

Glipizide 10 mg po daily
Metformin 500 mg po daily
HCTZ 25 mg daily
Atenolol 25 mg po daily
Hydralazine 25 mg qid
Simvastatin 80 mg daily
Verapamil 180 mg CD daily

Facilitator/Professor help:

INFORMATION AS SHORT PARAGRAPHS, READABLE. All information & presentation have to be at advanced clinician level.

1. Discuss pharmacology of existing agents briefly, molecular mechanism of action, therapeutic & adverse effects, & relevant kinetics, all as short paragraphs, readable.
2. Talk about what modifications are needed, what drugs are not at the best interest.
3. Follow a guideline, preferably JNC 8 and its current modifications (also ACC/AHA 2019 guidelines).
4. Talk about the drugs you have substituted or added, & their key pharmacology.
5. Address any specific questions that you are asked for in this case.

Example, here are some questions you may want to address in your assignment:

Does this patient need both verapamil & atenolol at the same time, since both have similar actions?

Recent guidelines do not recommend beta blockers for hypertension. But it was possibly added for the best therapeutic outcome? Why beta blockers? (example, he had strokes?).

Is there a drug to be added for stroke prevention?

What are the major adverse effects of Statins (muscle related), Hydralazine (many, lupus like syndrome), glipizide (hypoglycemia) HCTZ (hypokalemia) etc.

Why can’t this patient be a candidate for metformin, the best used diabetes drug, efficacious, no hypoglycemic attacks etc.?

Please include a title page, an introduction with a purpose statement, and a summary.

NURS 6521 Week 3 Asthma and Stepwise Management 

Please be mindful of plagiarism and APA format, I have included the rubric and a template. Please use my course resources as one of my references as instructed. Please include Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier in the references.

Asthma and Stepwise Management

Asthma is a respiratory disorder that affects children and adults. Advanced practice nurses often provide treatment to patients with these disorders. Sometimes patients require immediate treatment, making it essential that you recognize and distinguish minor asthma symptoms from serious, life-threatening ones. Since symptoms and attacks are often induced by a trigger, advanced practice nurses must also help patients identify their triggers and recommend appropriate management options. Like many other disorders, there are various approaches to treating and managing care for asthmatic patients depending on individual patient factors.

Photo Credit: Photo Library / Getty Images

One method that supports the clinical decision making of drug therapy plans for asthmatic patients is the stepwise approach, which you explore in this Assignment.

To Prepare

Reflect on drugs used to treat asthmatic patients, including long-term control and quick relief treatment options for patients. Think about the impact these drugs might have on patients, including adults and children.

Consider how you might apply the stepwise approach to address the health needs of a patient in your practice.

Reflect on how stepwise management assists health care providers and patients in gaining and maintaining control of the disease.

Create a 5- to 6-slide PowerPoint presentation that can be used in a staff development meeting on presenting different approaches for implementing the stepwise approach for asthma treatment. Be sure to address the following:

1. Describe long-term control and quick relief treatment options for the asthma patient from your practice as well as the impact these drugs might have on your patient.
2. Explain the stepwise approach to asthma treatment and management for your patient.
3. Explain how stepwise management assists health care providers and patients in gaining and maintaining control of the disease. Be specific.

PLEASE USE THE TEMPLATE
5-6 SLIDES

Concepts of Cardiovascular and Respiratory Disorders Knowledge Check

QUESTION 1

1. Scenario 1: Myocardial Infarction

CC: “I woke up this morning at 6 a.m. with numbness in my left arm and pain in my chest. It feels tight right here (mid-sternal).” “My dad had a heart attack when he was 56-years-old and I am scared because I am 56-years-old.” 

HPI: Patient is a 56-year-old Caucasian male who presents to Express Hospital  Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states this started this morning and has been getting worse, pointing to the mid-sternal area, “it feels like an elephant is sitting on my chest and having a hard time breathing”. He rates the pain as 9/10. Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, or lightheadedness. Nitroglycerin 0.4 mg tablet sublingual x 1 which decreased pain to 7/10.

Lipid panel reveals Total Cholesterol 424 mg/dl, high density lipoprotein (HDL) 26 mg/dl, Low Density Lipoprotein (LDL) 166 mg/dl, Triglycerides 702 mg/dl, Very Low-Density Lipoprotein (VLDL) 64 mg/dl

His diagnosis is an acute inferior wall myocardial infarction.

Question:

Which cholesterol is considered the “good” cholesterol and what does it do?

QUESTION 2

1. Scenario 1: Myocardial Infarction

CC: “I woke up this morning at 6 a.m. with numbness in my left arm and pain in my chest. It feels tight right here (mid-sternal).” “My dad had a heart attack when he was 56-years-old and I am scared because I am 56-years-old.” 

HPI: Patie

Discussion Pharmacokinetics and racial differences

Discussion Pharmacokinetics and racial differences

Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas.

Use proper APA format to cite and reference sources.

** Separate the two topics into two separate documents,

1: Astrid is an 18-year-old Asian female. She is a college freshman and recently went to a party where she had alcohol for the first time. She describes to you the “horrible” side effects of facial flushing, nasal congestion, and dizziness. She is convinced she was “drugged.” With what you know about pharmacokinetics and racial differences, how can you help her understand the reaction she had to alcohol? What important education points do you need to provide and why?

2: Jana, a 36-year-old single mother of three children, has a 15-year history of asthma. For the past month, she has been using albuterol every day. Previously, she had been using the inhaler every 3 to 4 months. She is in the office for a refill. What further information is needed to treat this patient and why? What clinical guidelines should you refer to for her medication management and why?

Requirements: explained in the assignment description

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.

Discussion: Problem of Practice Chronic Absenteeism

Discussion: Problem of Practice Chronic Absenteeism

PROBLEM OF PRACTICE

In your EdD program, you will identify a professional problem or opportunity found in your professional context. The Carnegie Project on the Education Doctorate (CPED) defines this special problem, called a problem of practice, as:

A persistent, contextualized, and specific issue embedded in the work of a professional practitioner, the addressing of which has the potential to result in improved understanding, experience, and outcomes. (n.d., Design-Concepts Upon Which to Build Programs section)

CPED (n.d.) further explains that scholarly practitioners (or professional practitioners):

…blend practical wisdom with professional skills and knowledge to name, frame, and solve problems of practice. They use practical research and applied theories as tools for change because they understand the importance of equity and social justice. They disseminate their work in multiple ways and they have an obligation to resolve problems of practice by collaborating with key stakeholders, including the university, the educational institution, the community, and individuals. (Design-Concepts Upon Which to Build Programs section)

As a professional practitioner, you will identify a problem of practice within the context of your professional setting. Over the course of your program, you can expand your knowledge of the scholarly literature related to the problem or issue. Your understanding of this problem of practice will develop through further study.

Read the Problems of Practice [PDF] document.

Read the EdD Doctoral Program Manual [PDF] and specialization-specific information to consider possible problems of practice to study further. The EdD program at Capella requires you to complete an inquiry project that is related to some aspect of your professional organization. At this early stage in your program, consider a problem that arises from a specific organization context, that is, your own professional setting.

For this post, discuss a possible issue or problem that is of interest to you and your professional context. What would be a problematic issue, an ongoing problem, or a situation that could be or should be improved? This will help you organize your early search for scholarly sources of information to inform your study of the problem.

Unformatted Attachment Preview

What are Problems of Practice? “Scholarly Practitioners blend practical wisdom with professional skills and knowledge to name, frame, and solve problems of practice [emphasis added]. They use practical research and applied theories as tools for change because they understand the importance of equity and social justice. They disseminate their work in multiple ways and they have an obligation to resolve problems of practice by collaborating with key stakeholders, including the university, the educational institution, the community, and individuals” (Carnegie Project on the Education Doctorate, n.d., Design-Concept section, para. 1).Problems of Practice have been defined by the Carnegie Project on the Education Doctorate (CPED), an organization of over 80 institutions committed to establishing quality EdD programs, as “a persistent, contextualized, and specific issue embedded in the work of a professional practitioner, the addressing of which has the potential to result in improved understanding, experience, and outcomes” (CPED, n.d., Design-Concepts section, para. 6).But, what, exactly, does that mean? What are problems of practice? Problems of practice are common to educational workplaces such as K–12 schools, community colleges, universities, and any organization that works to professionally develop its workforce through professional development or training opportunities. Within these organizations, a problem of practice presents itself as a performance gap between what educators define as the “ideal” or desired outcomes and the current “reality,” that is, what currently exists.The gap, whether it be an achievement gap or other performance gap, can be defined and described through an analysis of relevant data and evidence, both quantitative and qualitative. While individual institutions have unique instances of problems of practice, a problem of practice is often of such significance that it is present in some form across multiple institutions. Problems of practice usually affect groups of people rather than one individual, have a history of developing or trending over time, and are typically resistant to improvement. Problems of practice are usually complex.Root causes of these problems are more than likely multivariate and systemic in nature. For this reason, diagnosing a problem of practice requires the practitioner to recognize systems behaviors and understand the influence and interplay of contributing factors and systems dynamics both within and external to the organization. Mapping and understanding the complex nature of problems of practice will significantly increase the possibility of success in both choosing and implementing an intervention to improve outcomes and reduce the performance gap.Pitfall: Mistaking a Cause of a Problem for the Problem Itself Causes of a problem are often mistaken for the problem itself. For example, consider the following problem statement: “The problem at the community college is that instructors do not have the knowledge to effectively collect and use data to provide accurate and specific feedback to students on formative and summative assessments.” Is the instructors’ lack of knowledge the problem, or could it be the cause of a problem? The statement implies a problem with student performance but does not state one.Assuming instructors do, indeed, have a knowledge gap when it comes to formative feedback, so what? The question to ask is, “What is the problem that the instructors’ lack of knowledge causes?” Asking this question will likely lead to identification of the real problem. One problem caused by an instructor’s knowledge gap could be that first-year students are not performing as well as expected and that they do not improve from one assessment to the next. 1 Or, simply, the problem is that first-year students are not performing as well as expected at XYZ College.There could, of course, be many causes for this performance gap, one of which could be the inadequate formative feedback. The next step would be to determine whether data and evidence support the working theory that if instructors provided formative feedback, student performance would improve and, further, that the reason instructors do not provide such feedback is that they do not have the skills to do so.If data support this theory, a solution or intervention would be to address the problem of student performance by strengthening the formative feedback skills of the instructors. Pitfall: Mistaking the Solution for the Problem of Practice Likewise, a common pitfall in the identification of a problem of practice is to mistake the solution for the problem of practice. An example would be, “The problem is the lack of a professional development program for new teachers.”The “lack of professional development” is not a problem of practice. Professional development or training is a potential solution or intervention. One needs, again, to answer the question: “So what?” So what that new teachers do not have adequate professional development? The answer to that question will more than likely be the real problem. The actual problem might be that new teachers leave the district within three years resulting in high turnover rates.Or, the problem is that students of first-year teachers do not demonstrate learning outcomes. In either of these cases, a professional development program is one potential way (but not the only way!) to address the problem. An accurate statement of the problem often frees educators to consider a variety of ways the problem might be addressed rather than settling on the first idea that comes to mind. Importance of a Systems View Using Data and EvidenceWhy are problems of practice so often stated as solutions or causes of a problem? It is not always easy to differentiate the problem, the cause of the problem, and the solution to the problem because problems of practice often have multiple causes and may also, themselves, cause further problems. This is why it is always critical to evaluate problems of practice through a systems lens and establish causal and reinforcing factors for the overlapping systems within which problems or practice reside.This is necessary to fully understand the problem and determine which cause(s) of the problem can be addressed for the largest impact. As part of the analysis, it is important to learn as much as possible about the background of the problem, including its origins and evolution over time; its effect on the organization; and any current or previous attempts to resolve the problem, as well as the outcomes of those interventions.In addition, literature and research can be searched for what is known about the problem, its causes, potential ways to address it, and approaches that have worked and/or failed to work in the past or in other settings. Data and evidence are always required to establish the existence of the problem, define the historical trajectory of the problem, and substantiate potential causes of the problem. These data are important to demonstrate the need for improvement and change.In addition, data that support the definition of the problem and its cause(s) can become benchmark data to measure the impact of any intervention that is implemented. Data and evidence also become the critical common factual foundation for collaboration with stakeholders when discussing and reaching consensus on the nature of the problem, its causes, and appropriate viable solution strategies for improvement.Finally, when identifying a problem of practice, scholarly practitioners need to be reflective and honest regarding their sphere of influence or powerbase in the organization so as not to take 2 on a task that they have very little chance of changing or improving. Addressing a problem of practice is inherently collaborative, and skills of collaboration, influence, and the requisite degree of autonomy are necessary. Change theory speaks of the importance of a critical mass of stakeholders who agree both that the problem exists and that it is worthy of their time and resources to address and improve.Thus, the solution or intervention to address a problem of practice must be actionable and it must be within the scholar practitioner’s control to guide the implementation of the solution strategy. Diagnosing a Problem of Practice: Significance, Scope, and Position Answers to the following questions will assist in diagnosing a problem of practice.

Significance

• What is the history of the problem? How long has it been evident? Was it precipitated by some other change? What other problems does the problem under study exacerbate?
• What are the causes of the problem?
• What has been done in the past (if anything) to address the problem and bring about an improvement? How successful (or not) was the intervention?
• What does evidence/data (both qualitative and quantitative) reveal regarding the degree of severity and urgency for intervening; the amount of interconnectedness with other issues or problems; the actual gap between the ideal and what exists; and the population most affected by the problem?
• What does the literature say about the problem? Scope
• Is the “problem of practice” and the intervention that will be chosen of value to a broader audience such as a professional organization, other institutions with similar issues, or other departments/programs within your own organization? Position ?
• Is what we are considering as a “problem of practice” something that is within your sphere of influence or powerbase? Is it actionable by you given your role in the organization? If not, is it possible to secure that influence?
• Are there any particular challenges to convincing the stakeholders that the problem exists and needs to be improved? When a Problem is Not a Problem of Practice Not all problems encountered in organizations are considered problems of practice.

The problems or minor crises that arise daily in every organization are often due to random environmental or human factors that reflect normal performance variation. Examples might be a parent complaint, an absent faculty member, an unexpected request for data from the provost, 3 inclement weather, an injury on the playing field, or even a dip in student performance.These fluctuations in individual performance, organizational processes, or environmental factors commonly occur during daily routines and do not usually result have significant long-term consequences as long as institution’s processes and procedures adequately address these occurrences. As long as they do not exceed a certain frequency or, in the case of student achievement, dip below expected normal statistical variation, they are not considered problems of practice.However, if such problems occur repeatedly and lead to large-scale consequences, a minor issue can evolve into a problem of practice. For example, a parental complaint could potentially represent similar sentiments of a majority of parents. If the issue persists, it might snowball into a town hall meeting that reveals a larger leadership, communication, and/or school culture performance gap that has broader implications for the success of the entire institution.If the performance gap is supported by data and evidence, has significant consequences, and is of sufficient scope, the problem may meet the definition of a problem of practice as “a persistent, contextualized, and specific issue embedded in the work of a professional practitioner, the addressing of which has the potential to result in improved understanding, experience, and outcomes” (CPED, n.d., Design-Concepts section, para. 6).

Discussion: Problem of Practice Chronic Absenteeism Reference

Carnegie Project on the Education Doctorate. (n.d.). Design-concepts upon which to build programs definitions. Retrieved from https://www.cpedinitiative.org/page/framework

Discussion: Probability and Probability Distributions

Discussion: Probability and Probability Distributions

You are the healthcare administration leader for a health services organization and are interested in achieving a standard, whereby 90% of all patients are screened within the initial 15 minutes of arriving for a family practice appointment Discussion: Probability and Probability Distributions.

Part 1

In a random sample of 30 patients, you find that 25 were screened within 15 minutes. The probability that this event (or one more extreme) would occur, might be modeled as a binomial with the following probability statement:

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P(X?25 | N=30, p=0.9)

To solve, you use =binom.dist(25, 30, 0.9, TRUE) in Excel and find that you would expect 25 or fewer screenings in 30 trials when the success rate should be 0.9 about 17.5% of the time.

Review the resources and consider how one of the distributions presented might be useful for healthcare administration leaders. Describe in 2 or 3 paragraphs an example of how one of the distributions presented might be used in your health services organization or one with which you are familiar Discussion: Probability and Probability Distributions.

Then, generate a representative probability statement based on the scenario and solve using fictitious data. Be specific in your probability statement.

Part 2:

Your company is running a Medicare audit on Sleaze Hospital. Because Sleaze has a history of overbilling, the focus of your audit is on checking whether the billing amounts are correct. Assume that each invoice is for too high an amount with probability 0.06 and for too low an amount with probability 0.01 (so that the probability of a correct billing is 0.93) Discussion: Probability and Probability Distributions. Also, assume that the outcome for any invoice is probabilistically independent of the outcomes for other invoices.

For this Assignment, reflect on the case presented. Think about what strategies you might use to calculate associated probabilities for Sleaze Hospital, and then address the series of questions.

The Assignment: (3–5 pages)

• If you randomly sample 200 of Sleaze’s invoices, what is the probability that you will find at least 15 invoices that overcharge the customer? What is the probability you won’t find any that undercharge the customer?
• Find an integer, k, such that the probability is at least 0.99 that you will find at least k invoices that overcharge the customer. (Hint: Use trial and error with the BINOMDIST function to find k.)
• Suppose that when Sleaze overcharges Medicare, the distribution of the amount overcharged (expressed as a percentage of the correct billing amount) is normally distributed with mean 15% and standard deviation 4%.
• What percentage of overbilled invoices are at least 10% more than the legal billing amount?
• What percentage of all invoices are at least 10% more than the legal billing amount?
• If your auditing company samples 200 randomly chosen invoices, what is the probability that it will find at least five where Medicare was overcharged by at least 10%?
• Discussion: Probability and Probability Distributions

References for Discussion: Probability and Probability Distributions:

Albright, S. C., & Winston, W. L. (2015). Business analytics: Data analysis and decision making (5th ed.). Stamford, CT: Cengage Learning.

• Chapter 4, “Probability and Probability Distributions” (pp. 139–165)
• Chapter 5, “Normal, Binomial, Poisson, and Exponential Distributions” (pp. 166–221)
• Discussion: Probability and Probability Distributions

Fulton, L. V., Mendez, F. A., Bastian, N. D., & Musal, R. M. (2012). Confusion between odds and probability, a pandemic? Journal of Statistics Education, 20(3), 1–20.
Note: Retrieved from the Walden Library databases.

Microsoft. (2016). Statistical functions (reference). Retrieved from https://support.office.com/en-us/article/Statistic…

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Discussion Rage can be an energizing emotion

Discussion Rage can be an energizing emotion

Instructions

Below is an original passage from a source followed by four passages that paraphrase the source. For each of the four passages, identify whether it is or is not plagiarism and briefly explain your answer.

Paraphrase #1

Rage can actually be a positive force in our lives. It can give us the energy and the courage to resist threats and take more control over our lives than we ever imagined possible. But it’s also the emotion that our society distrusts the most, so we are taught early on to fear our own rage.

But when children immerse themselves in imaginary battles and identify with violent heroes, they learn to confront their stifled rage, fear it less, and use it against the challenges they face in life.

Is this plagiarism? Why or why not?

Paraphrase #2

We are generally taught that rage is a negative and dangerous emotion that should be suppressed. But when we constantly suppress our rage, it eventually bubbles up in uncontrollable ways. If channeled properly, however, rage can be a positive force in our lives. “It can give us the energy and the courage to resist threats and take more control over lives than we ever imagined possible.”

Is this plagiarism? Why or why not?

Original Source and Passage Jones, Gerard. “Violent Media is Good for Kids.” Perspectives on Contemporary Issues. 6th

ed. Katherine Anne Ackley. Boston: Wadsworth, 2011. 230-33. Print.

Rage can be an energizing emotion, a shot of courage to push us to resist greater threats, take more control than we ever thought we could. But rage is also the emotion that our culture distrusts the most. Most of us are taught early on to fear our own.

Through immersion in imaginary combat and identification with a violent protagonist, children engage the rage they’ve stifled, come to fear it less, and become more capable of utilizing it against life’s challenges. (232)

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Paraphrase #3

We generally think of rage as a negative and dangerous emotion, but Gerard Jones points out that it can also be an “energizing emotion, a shot of courage to push us to resist greater threats, take more control, than we ever thought we could” (232). But, unfortunately, most of us are taught to fear and distrust our own rage.

This is why many children choose to immerse themselves in imaginary combat and identification with violent protagonists. Through these strategies, children learn to engage the rage they’ve stifled, fear it less, and “utilize it against life’s challenges” (Jones 232).

Is this plagiarism? Why or why not?

Paraphrase #4 We are all aware of the negative, destructive impact that rage can have on our lives; but it is important that we also understand the positive side of rage. Rage can be a tremendous motivating force, and it can give us the courage to confront threats and take control of difficult situations.

But society has taught us to suppress our rage, and many of us suffer for the lack of its benefits. This is why so many children immerse themselves in comic books and other violent media. By identifying with violent characters, they are able to come to grips with their own rage and, more often than not, channel it ways that help them meet the challenges that life presents.

Is this plagiarism? Why or why not?

Paraphrase #5

Modern society teaches us that rage is a dangerous and destructive emotion, and most of us have learned to suppress it as much as possible. But this attitude toward rage overlooks the ways in which it can act as a positive force in our lives.

As Gerard Jones explains, “Rage can be an energizing emotion, a shot of courage to push us to resist greater threats, take more control, than we ever thought we could” (232). With no other acceptable way to confront their rage, many children turn to comic books and other media that allow them to identify with violent characters and play out violent fantasies.

In this way, many children are able to come to terms with their own rage, control it, and use it to overcome the many challenges that life presents (Jones 232).

Is this plagiarism? Why or why not?

Discussion Significant steps to protect residents

Discussion Significant steps to protect residents

Interpret research, bringing the nursing perspective, alongside perspectives of their administrative colleagues, for policy makers and stakeholders.InstructionsConsider the following scenario:In the midst of the COVID-19 pandemic, state Governors took significant steps to protect residents, including the most vulnerable populations, nursing home residents.

In Oklahoma, Governor Kevin Stitt issued policy which required any “staffer” entering a nursing home to produce a negative COVID-19 test result.Place yourself in the role of a nursing home administrator in this situation, and respond to the following: What are the gaps in this policy? (Policy is italicized above).

Does scientific evidence support this approach? Why or why not? Because this is mandated by the state, your facility must comply. Briefly explain how you will ensure compliance, while maintaining integrity of evidence-based practice.Please be sure to validate your opinions and ideas with citations and references in APA format.

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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. How do Eating Disorders affect people long term?

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, and 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.

Discussion Social Emotional Intelligence Table

Social Emotional Intelligence Power SkillsScenarioSelf-Awareness:

Mindfulness

Identifying emotions

Assertiveness

I work at the emergency department of a level 5 health facility. Majority of the patients received into the hospital go through the emergency department, particularly persons with complicated illnesses. The importance of self-awareness in improving the nurse-patient relationship in my experience cannot be overemphasized. Patient P.A was a 28-year-old obese African American lady who presented to the emergency department with difficulty in breathing. Her examination revealed a respiratory rate of 23 breaths per minute, blood pressure of 124/87 mmHg, temperature of 36.60C and oxygen saturation of 88 %. Auscultation revealed wheezing in both right and left lungs with no added sounds. Her presentation showed classical signs and symptoms of acute asthmatic exacerbation, but I was assertive to run diagnostic lab tests (Younas et al., 2020). The chest expiratory spirometry revealed an FEV1/FVC ratio of 0.68, which was moderately reduced. I was mindful of her respiratory distress and started her on inhaled salbutamol immediately. I learned that she was diagnosed with asthma at 18 years and started on oral prednisolone but had exposed herself to cat fur before her current exacerbation. I was becoming angry at why she should expose herself to well-known allergens but I identified my emotions, controlled them and explained to her why it was important to avoid triggers for her condition.Interpersonal communication:

Active Listening

Relationship Building

Caring & Consideration

While working at the emergency department, I had to maintain proper eye contact while observing other communication cues such as facial expressions, gesture and posture (Sibiya, 2018). During consultation, I could tell we were both active listeners as marked by the questions she raised. I was concerned why she had experienced another exacerbation whereas she had medication. On learning her triggers, I advised her to avoid pet fur and other allergens. Also, I promised to consult with other care team members to determine whether she would require an increment in the dosage.Executive Function:

Shifting

Selective attention

Inhibition

Shifting encompasses individual capacity to switch between tasks and strategies. At the emergency department, my experience required shifting from observing vital signs to administering medication and monitoring the therapeutic effects plus potential side effects. Selective attention comprises focusing on specific tasks while ignoring irrelevant information. Patient P.A was particularly talkative and I had to concentrate on details that were relevant to her medical history. At instances, I had to apply leading questions to derive the information required. Inhibition is a professional’s capacity to voluntarily suppress the dominant response. I exhibited inhibition when I was agitated during the first phase of the consultation process, in which P.A was giving irrelevant information. The agitation developed since at the emergency department my responsibility includes attending to the needs of multiple critical patients, requiring fast medical service. Nonetheless, I suppressed the agitation on recalling that therapeutic conversation is part of the patient’s medical needs, prompting me to pay full attention.Social Awareness:

Empathy

Service ethic

Organizational awareness

I portrayed empathy by recognizing, comprehending and attending to the emotions and perspectives of patient P.A. Among her worries was that her asthmatic attack was due to witchcraft which is part of the superstitions surrounding her ethnic upbringing. I listened attentively to her views, without unnecessarily disregarding her opinion, and explained to her the scientific basis and pathophysiology of asthma. The information she gained enabled her to understand how her medication worked. Service ethics is the professional’s capacity to comprehend and respond to patients’ needs. I explained to P.A the basis of her illness to assist her deal with the superstitions and also enable her understand how her medication worked. Organizational awareness constitutes comprehension of how a system works. I referred P.A to a general physician who would recommend to her the most effective strategies of managing her condition. The physician would also provide her with more information regarding her state and the most recent advances in management.Self-Management:

Positive affirmation

Maintenance of healthy-work balance

Self-care is a diverse subject, incorporating multiple aspects. In my experience at the emergency department, I realized positive self-affirmation resulted in positive attitudes that lead to increased self-satisfaction and stronger interprofessional relationships (Nazareth et al., 2018). I also learned to maintain a healthy work-life balance to avoid overworking and related exhaustion or stress. I engaged in breaks via activities such as having lunch, strolls and calling loved ones that enabled me to stay sharp, motivated and healthy. Maintaining the balance is instrumental in avoiding psychological complications such as depression, anxiety, insomnia and heart diseases.

 

References

• Nazareth, J. C. F., de Almeida Neto, O. P., da Silva, M. R., Rodrigues, L. R., & Pedrosa, L. A. K. (2018). Quality of life related work of nursing professionals in sterilization material center. Bioscience Journal, 34(4). http://www.seer.ufu.br/index.php/biosciencejournal/article/view/38940
• Sibiya, M. N. (2018). Effective communication in nursing. Nursing, 119, 19-36. https://dx.doi.org/10.5772/intechopen.74995
• Younas, A., Rasheed, S. P., Sundus, A., & Inayat, S. (2020). Nurses’ perspectives of self?awareness in nursing practice: A descriptive qualitative study. Nursing & Health Sciences, 22(2), 398-405. https://onlinelibrary.wiley.com/doi/abs/10.1111/nhs.12671#:~:text=Self%E2%80%90awareness%20enables%20nurses%20to,Eckroth%E2%80%90Bucher%2C%202010).

“Telenursing and Remote Access Telehealth” (pp. 359–388)

Dykes

Discussion: The Application of Data to Problem-Solving NURS 6051 Example Solution

For decades, different institutions have been acquiring information and using it to solve various problems. Small businesses, as well as large enterprises, have also been doing the same. In the healthcare sphere, nurses have been using different methods to obtain data, which is then analyzed and later used to find solutions for various problems in the sector. As McConigle and Mastrian (2017) mentioned, the nursing profession is information-intensive. Without collecting relevant data, the nursing sector would be unable to deliver quality services to patients, thereby crippling the entire healthcare realm.

Informatics Clinical Application

While working as a Clinical Nurse Coordinator, sometimes back, data collection was a vital part of my operation. On the 28-bed telemetry floor, I realized that whenever I approached the management without adequate data to support my ideas about solving various problems at the workplace, the concepts would be brushed aside.

However, the administration was always happy to listen to my thoughts on something if my presentation had adequate data to support the concepts. Therefore, no matter how good your thoughts are, they do not mean a lot unless you have gathered enough facts to support them. That is why the data collection and analysis process is vital to the nursing practice realm. 

Data helps to support arguments conclusively (Sweeney, 2017). Currently, there is an idea that I am trying to put on the table that involves proving to the management that the facility needs more nurses on the telemetry floor to free-charge nurses for the numerous patient tasks that they handle during the shifts. Charge nurses ensure everything runs smoothly at a medical facility during a certain shift. They assume leadership during the hours that they are in charge.

Their clinical experience ensures that other nurses in the department deliver quality care to the patients. If a nurse fails to deliver, they are supposed to report them to the management. They are also responsible for coming up with work schedules, overseeing discharges and admissions, and helping to check up on patients.

In the 28-bed telemetry floor, charge nurses are too busy to oversee their real duties, primarily because there are not enough nurses in the department. Instead of playing the oversight role, they carry out the usual nursing tasks like administering medicine and checking up on patients occasionally. On a daily basis, the number of RNs versus patients is recorded and computerized. Presently, I have data collected over the previous month.

My preliminary analysis of the data reveals that the number of patients seems to be overwhelming the nurses. Many patients are being admitted to the floor, forcing the charge nurse to leave their actual oversight duties to attend to patients. Things can easily slip out of hand in such scenarios since no one oversees the various patient care processes. I have also been collecting patient feedback during the period, based on which I have concluded that patient satisfaction is dismal whenever the charge nurse is involved in patient care.

Informatic competence helps to alter clinical decisions positively and eventually improve patient outcomes (McConigle & Mastrian, 2017). Data collected over six months will be adequate to fully convince the management of the need for a change at the facility to improve patient outcomes as well as satisfaction.

As the nursing profession evolves, technology is bound to influence patient outcomes significantly (Nagle et al., 2017). The need for EHR competence is also going to rise. EHR makes data collection and analysis easier. As a young practitioner, I plan on becoming familiar with the various technology-based methods of data collection and analysis to improve myself as a nurse and ultimately advance the nursing profession.          

Discussion: The Application of Data to Problem-Solving NURS 6051 Week 1 Discussion References

McGonigle, D., & Mastrian, K. G. (2021). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.

Nagle, L. M., Sermeus, W., Junger, A., & Bloomberg, L. S. (2017). Evolving Role of the Nursing Informatics Specialist. Forecasting Informatics Competencies for Nurses in the Future of Connected Health, 212.

Sweeney, J. (2017). Healthcare informatics. On-Line Journal of Nursing Informatics, 21(1). https://search.proquest.com/indexingvolumeissuelinkhandler/2034896/On+-+Line+Journal+of+Nursing+Informatics/02017Y02Y01$23Feb+2017$3b++Vol.+21+$281$29/21/1;jsessionid=CE90CAE74C27162F08A1240D7D181354.i-0ff9edadb0c803625

Discussion: The Application of Data to Problem-Solving NURS 6051 Week 1 Discussion Instructions

In the modern era, there are few professions that do not to some extent rely on data. Stockbrokers rely on market data to advise clients on financial matters. Meteorologists rely on weather data to forecast weather conditions, while realtors rely on data to advise on the purchase and sale of property. In these and other cases, data not only helps solve problems, but adds to the practitioner’s and the discipline’s body of knowledge

Module 1: What Is Informatics? (Weeks 1-2)

Students will:

• Analyze how data collection and access can be used to derive knowledge in a healthcare setting
• Analyze the role of the nurse leader in using clinical reasoning and judgement in the formation of knowledge
• Explain the role of the nurse as a knowledge worker
• Explain concepts of nursing informatics
• Create infographics related to nursing informatics and the role of the nurse as a knowledge worker

Discussion: The Application of Data to Problem-Solving

In the modern era, there are few professions that do not to some extent rely on data. Stockbrokers rely on market data to advise clients on financial matters. Meteorologists rely on weather data to forecast weather conditions, while realtors rely on data to advise on the purchase and sale of property. In these and other cases, data not only helps solve problems, but adds to the practitioner’s and the discipline’s body of knowledge.

Of course, the nursing profession also relies heavily on data. The field of nursing informatics aims to make sure nurses have access to the appropriate date to solve healthcare problems, make decisions in the interest of patients, and add to knowledge.

In this Discussion, you will consider a scenario that would benefit from access to data and how such access could facilitate both problem-solving and knowledge formation.

To Prepare:

• Reflect on the concepts of informatics and knowledge work as presented in the Resources.
• Consider a hypothetical scenario based on your own healthcare practice or organization that would require or benefit from the access/collection and application of data. Your scenario may involve a patient, staff, or management problem or gap.

By Day 3 of Week 1

Post a description of the focus of your scenario. Describe the data that could be used and how the data might be collected and accessed. What knowledge might be derived from that data? How would a nurse leader use clinical reasoning and judgment in the formation of knowledge from this experience?

Assignment: The Nurse Leader as Knowledge Worker

The term “knowledge worker” was first coined by management consultant and author Peter Drucker in his book, The Landmarks of Tomorrow (1959). Drucker defined knowledge workers as high-level workers who apply theoretical and analytical knowledge, acquired through formal training, to develop products and services. Does this sound familiar?

Nurses are very much knowledge workers. What has changed since Drucker’s time are the ways that knowledge can be acquired. The volume of data that can now be generated and the tools used to access this data have evolved significantly in recent years and helped healthcare professionals (among many others) to assume the role of knowledge worker in new and powerful ways.

In this Assignment, you will consider the evolving role of the nurse leader and how this evolution has led nurse leaders to assume the role of knowledge worker. You will prepare a PowerPoint presentation with an infographic (graphic that visually represents information, data, or knowledge. Infographics are intended to present information quickly and clearly.) to educate others on the role of nurse as knowledge worker.

Reference: Drucker, P. (1959). The landmarks of tomorrow. New York, NY: HarperCollins Publishers.

To Prepare:

• Review the concepts of informatics as presented in the Resources.
• Reflect on the role of a nurse leader as a knowledge worker.
• Consider how knowledge may be informed by data that is collected/accessed.

The Assignment:

• Explain the concept of a knowledge worker.
• Define and explain nursing informatics and highlight the role of a nurse leader as a knowledge worker.
• Include one slide that visually represents the role of a nurse leader as knowledge worker.
• Your PowerPoint should Include the hypothetical scenario you originally shared in the Discussion Forum. Include your examination of the data that you could use, how the data might be accessed/collected, and what knowledge might be derived from that data. Be sure to incorporate feedback received from your colleagues’ responses.

NURS 6051 Module 2: The Role of the Informatics Specialist in Healthcare (Weeks 3-4)

Discussion: Interaction Between Nurse Informaticists and Other Specialists

Nature offers many examples of specialization and collaboration. Ant colonies and bee hives are but two examples of nature’s sophisticated organizations. Each thrives because their members specialize by tasks, divide labor, and collaborate to ensure food, safety, and general well-being of the colony or hive.

Of course, humans don’t fare too badly in this regard either. And healthcare is a great example. As specialists in the collection, access, and application of data, nurse informaticists collaborate with specialists on a regular basis to ensure that appropriate data is available to make decisions and take actions to ensure the general well-being of patients.

In this Discussion, you will reflect on your own observations of and/or experiences with informaticist collaboration. You will also propose strategies for how these collaborative experiences might be improved.

To Prepare:

• Review the Resources and reflect on the evolution of nursing informatics from a science to a nursing specialty.
• Consider your experiences with nurse Informaticists or technology specialists within your healthcare organization.

By Day 3 of Week 3

Post a description of experiences or observations about how nurse informaticists and/or data or technology specialists interact with other professionals within your healthcare organization. Suggest at least one strategy on how these interactions might be improved. Be specific and provide examples. Then, explain the impact you believe the continued evolution of nursing informatics as a specialty and/or the continued emergence of new technologies might have on professional interactions.

By Day 6 of Week 3

Respond to at least two of your colleagues* on two different days, offering one or more additional interaction strategies in support of the examples/observations shared or by offering further insight to the thoughts shared about the future of these interactions.

Assignment: The Impact of Nursing Informatics on Patient Outcomes and Patient Care Efficiencies

In the Discussion for this module, you considered the interaction of nurse informaticists with other specialists to ensure successful care. How is that success determined?

Patient outcomes and the fulfillment of care goals is one of the major ways that healthcare success is measured. Measuring patient outcomes results in the generation of data that can be used to improve results. Nursing informatics can have a significant part in this process and can help to improve outcomes by improving processes, identifying at-risk patients, and enhancing efficiency.

To Prepare:

• Review the concepts of technology application as presented in the Resources.
• Reflect on how emerging technologies such as artificial intelligence may help fortify nursing informatics as a specialty by leading to increased impact on patient outcomes or patient care efficiencies.

The Assignment: (4-5 pages not including the title and reference page)

In a 4- to 5-page project proposal written to the leadership of your healthcare organization, propose a nursing informatics project for your organization that you advocate to improve patient outcomes or patient-care efficiency. Your project proposal should include the following:

• Describe the project you propose.
• Identify the stakeholders impacted by this project.
• Explain the patient outcome(s) or patient-care efficiencies this project is aimed at improving and explain how this improvement would occur. Be specific and provide examples.
• Identify the technologies required to implement this project and explain why.
• Identify the project team (by roles) and explain how you would incorporate the nurse informaticist in the project team.
• Use APA format and include a title page and reference page.
• Use the Safe Assign Drafts to check your match percentage before submitting your work.

Learning Resources

McGonigle, D., & Mastrian, K. G. (2021). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.

• Chapter 25, “The Art of Caring in Technology-Laden Environments” (pp. 525–535)
• Chapter 26, “Nursing Informatics and the Foundation of Knowledge” (pp. 537–551)

Mosier, S., Roberts, W. D., & Englebright, J. (2019). A Systems-Level Method for Developing Nursing Informatics Solutions: The Role of Executive Leadership. JONA: The Journal of Nursing Administration, 49(11), 543-548.

Ng, Y. C., Alexander, S., & Frith, K. H. (2018). Integration of Mobile Health Applications in Health Information Technology Initiatives: Expanding Opportunities for Nurse Participation in Population Health. CIN: Computers, Informatics, Nursing, 36(5), 209-213.

Sipes, C. (2016). Project management: Essential skill of nurse informaticists. Studies in Health Technology and Informatics, 225, 252-256.

The Impact of Nursing Informatics on Patient Outcomes and Patient Care Efficiencies Example Solution

The ultimate goal of every healthcare practice is to provide the best services to the patients. These goals are gauged and reflected in the quality of the health care services. Patient care efficiency and safety are two elements of quality in healthcare. The role of healthcare technology in improving patient care efficiency, timeliness, and outcomes cannot be overemphasized (Agency for Healthcare Research and Quality, 2021). 

In the medical and surgical units in healthcare delivery, bed-bound patients require timely monitoring to reduce their risks of pressure sores and venous thromboembolism. Turning of patients and change of positions are some of the nursing interventions used on bedbound patients to prevent hospital-acquired pressure injuries (HAPI) (Pickham et al., 2018). 

Regular turning every two hours in the inpatient units requires proper scheduling. Using nursing informatics can make this process easier, timely, and safe. This paper aims to describe a project proposal to utilize nursing informatics to prevent hospital-acquired pressure injuries through regular turning.

The Project

This project will employ the use of electronic health records and wearable device technology to monitor and implement their nursing plan. In an inpatient unit, different patients require different recurrent interventions to maintain their health and improve recovery. The project will require that nurses coordinate with other healthcare professionals through the institution’s electronic health record system to make decisions and plan care. 

In this project, bedbound patients will be monitored remotely through the use of healthcare technologies technology. Patients who cannot ambulate or are not physically active because they are mentally or physically debilitated in the two inpatient units will be identified by the shift nurses and monitored through the electronic health records systems. The nurse will explain the role of technology to patients or their families. 

Because different patients will have different schedules for turning, the technology will alert the shift nurses through the electronic health records system. The monitoring will take place at the nurse’s station. The patient will have a sensor technology that will be connected to the EHR through the institution’s local area network (LAN). During that shift, the nursing staff will then implement the two-hourly turning plans after the alert reminder by the system.

Stakeholders

This project will involve various stakeholders involved in direct and indirect patient care. The project will require input from the charge nurses of the two units. The charge nurses will offer the necessary leadership strategies to ensure their shift nurses work as a team to achieve patient care goals. The nurse informaticist will be needed for the success of the project’s technological and care delivery aspects.

The informaticist will ensure the planning for compatibility and usability of the system are given priority for efficiency of use. This project will also impact the patients and their families as they are the immediate recipients of care in the institution. Their feedback and participation will be crucial determinants of the project’s success and the care delivered.

The institution’s procurement officers and accountants will also be impacted because of the need for their services during the purchase and implementation of the technologies. This project will also impact physicians and surgeons because they will be required to prescribe turning and ambulation for these patients and follow them up.

Patient Outcomes and Care Efficiencies

Efficiency in any process is a measurable outcome. The nurses’ input and the output of the care are essential elements of the efficiency of the care delivery. The cost and time spent in providing the care should be commensurate with the cost and time incurred by the patient during this care process. This project will reduce the time spent on physical monitoring of patients requiring two-hour turning (Pickham et al., 2018; Pickham et al., 2018). 

The project will personalize the time for the patient’s two-hourly turning and center the schedule around the patient’s needs. Therefore, the project will enhance patient-centered care by avoiding the generalization of nursing plans for all patients in the unit. The alerts from this new system of planning will reduce the risks of medical errors by ensuring that the patient receives nursing care in time without fail. 

This new clinical decision support system will minimize errors due to omission because, at the same time, the nurse will be performing the two-hour turning, they will also have the opportunity to check physically on the patient through physical examination. The sensor technology will be able to alert the system on extra findings such as vital signs.

Required Technology

The project will require two technological systems interconnected through the institution’s networks and alert system. Sensory technology will be enabled through a wearable device that will detect lateral and vertical motion of the patient’s body and monitor the duration of inactivity (Renganathan et al., 2019). Duration of inactivity exceeding two hours will be provided an alert to the nurse at the station for prompt action. 

By monitoring the patient self turns and nurses turning, this technology will reduce the time the patient spends in inactivity (Schutt et al., 2018). The electronic health records will ensure that the patient data and records of interventions, inclusion physical turning, are available efficiently to every nurse attending to these patients at any time of the day. 

Therefore, computer systems will have constant connectivity, and a network will be required to implement this project. The entire clinical decision support system (CDSS) will require portable computers and tablets for easier access anywhere in the unit.

Project Team

The project team will consist of a project manager, the two charge nurses in the medical and surgical units, the institution’s procurement officer, and the nurse manager. The project manager will be a nurse informaticist who will coordinate all project activities. The charge nurses will offer collaborative communication between nurses and other team members and provide timely feedback on the progress and usability of the system. 

The procurement officer will be involved in the financial planning and purchase of additional technology to support the EHR. The nurse manager will offer the administrative support and approval of the institution’s administration before implementing the project and oversee that the legal aspects of the project are maintained.

Conclusion

The care of bedbound patients will be made better through this new system of alert system and monitoring. This project aims at improving patient care outcomes and efficiency through a clinical decision support system. The CDSS will include sensory technology using a wearable device and connected to the EHR that will provide a time alert for two-hourly turning for each bedbound patient. The technology will reduce the time spent monitoring these patients and improve monitoring efficiency. The project team will consist of a nurse informaticist as the project manager, charge nurses, and nurse manager.

References

Agency for Healthcare Research and Quality. (2021, October). Quality and patient safety resources. Ahrq.Gov. https://www.ahrq.gov/patient-safety/resources/index.html

Pickham, D., Berte, N., Pihulic, M., Valdez, A., Mayer, B., & Desai, M. (2018). Effect of a wearable patient sensor on care delivery for preventing pressure injuries in acutely ill adults: A pragmatic randomized clinical trial (LS-HAPI study). International Journal of Nursing Studies, 80, 12–19. https://doi.org/10.1016/j.ijnurstu.2017.12.012

Renganathan, B. S., Nagaiyan, S., Preejith, S. P., Gopal, S., Mitra, S., & Sivaprakasam, M. (2019). Effectiveness of a continuous patient position monitoring system in improving hospital turn protocol compliance in an ICU: A multiphase multisite study in India. Journal of the Intensive Care Society, 20(4), 309–315. https://doi.org/10.1177/1751143718804682

Schutt, S. C., Tarver, C., & Pezzani, M. (2018). Pilot study: Assessing the effect of continual position monitoring technology on compliance with patient turning protocols. Nursing Open, 5(1), 21–28. https://doi.org/10.1002/nop2.105

Sharp, C. A., Schulz Moore, J. S., & McLaws, M.-L. (2019). Two-hourly repositioning for prevention of pressure ulcers in the elderly: Patient safety or elder abuse? Journal of Bioethical Inquiry, 16(1), 17–34. https://doi.org/10.1007/s11673-018-9892-3

NURS 6051 Module 3: Data-Information-Knowledge-Wisdom (DIKW) (Week 5)

Discussion: Big Data Risks and Rewards

When you wake in the morning, you may reach for your cell phone to reply to a few texts or email messages that you missed overnight. On your drive to work, you may stop to refuel your car. Upon your arrival, you might swipe a key card at the door to gain entrance to the facility. And before finally reaching your workstation, you may stop by the cafeteria to purchase a coffee.

From the moment you wake, you are in fact a data-generation machine. Each use of your phone, every transaction you make using a debit or credit card, even your entrance to your place of work, creates data. It begs the question: How much data do you generate each day? Many studies have been conducted on this, and the numbers are staggering: Estimates suggest that nearly 1 million bytes of data are generated every second for every person on earth.

As the volume of data increases, information professionals have looked for ways to use big data—large, complex sets of data that require specialized approaches to use effectively. Big data has the potential for significant rewards—and significant risks—to healthcare. In this Discussion, you will consider these risks and rewards.

To Prepare:

• Review the Resources and reflect on the web article Big Data Means Big Potential, Challenges for Nurse Execs.
• Reflect on your own experience with complex health information access and management and consider potential challenges and risks you may have experienced or observed.

By Day 3 of Week 5

Post a description of at least one potential benefit of using big data as part of a clinical system and explain why. Then, describe at least one potential challenge or risk of using big data as part of a clinical system and explain why. Propose at least one strategy you have experienced, observed, or researched that may effectively mitigate the challenges or risks of using big data you described. Be specific and provide examples.

By Day 6 of Week 5

Respond to at least two of your colleagues* on two different days by offering one or more additional mitigation strategies or further insight into your colleagues’ assessment of big data opportunities and risks.

NURS 6051 Module 4: Technologies Supporting Applied Practice and Optimal Patient Outcomes (Weeks 6-8)

Discussion: Healthcare Information Technology Trends

Throughout history, technological advancements have appeared for one purpose before finding applications elsewhere that lead to spikes in its usage and development. The internet, for example, was originally developed to share research before becoming a staple of work and entertainment.

But technology—new and repurposed—will undoubtedly continue to be a driver of healthcare information. Informaticists often stay tuned to trends to monitor what the next new technology will be or how the next new idea for applying existing technology can benefit outcomes.

In this Discussion, you will reflect on your healthcare organization’s use of technology and offer a technology trend you observe in your environment.

To Prepare:

• Reflect on the Resources related to digital information tools and technologies.
• Consider your healthcare organization’s use of healthcare technologies to manage and distribute information.
• Reflect on current and potential future trends, such as use of social media and mobile applications/telehealth, Internet of Things (IoT)-enabled asset tracking, or expert systems/artificial intelligence, and how they may impact nursing practice and healthcare delivery.

By Day 3 of Week 6

Post a brief description of general healthcare technology trends, particularly related to data/information you have observed in use in your healthcare organization or nursing practice. Describe any potential challenges or risks that may be inherent in the technologies associated with these trends you described.

Then, describe at least one potential benefit and one potential risk associated with data safety, legislation, and patient care for the technologies you described.

Next, explain which healthcare technology trends you believe are most promising for impacting healthcare technology in nursing practice and explain why. Describe whether this promise will contribute to improvements in patient care outcomes, efficiencies, or data management. Be specific and provide examples.

By Day 6 of Week 6

Respond to at least two of your colleagues* on two different days, offering additional/alternative ideas regarding opportunities and risks related to the observations shared.

Assignment: Literature Review: The Use of Clinical Systems to Improve Outcomes and Efficiencies

New technology—and the application of existing technology—only appears in healthcare settings after careful and significant research. The stakes are high, and new clinical systems need to offer evidence of positive impact on outcomes or efficiencies.

Nurse informaticists and healthcare leaders formulate clinical system strategies. As these strategies are often based on technology trends, informaticists and others have then benefited from consulting existing research to inform their thinking.

In this Assignment, you will review existing research focused on the application of clinical systems. After reviewing, you will summarize your findings.

To Prepare:

• Review the Resources and reflect on the impact of clinical systems on outcomes and efficiencies within the context of nursing practice and healthcare delivery.
• Conduct a search for recent (within the last 5 years) research focused on the application of clinical systems. The research should provide evidence to support the use of one type of clinical system to improve outcomes and/or efficiencies, such as “the use of personal health records or portals to support patients newly diagnosed with diabetes.”
• Identify and select 4 peer-reviewed research articles from your research.
• For information about annotated bibliographies, visit https://academicguides.waldenu.edu/writingcenter/assignments/annotatedbibliographies

The Assignment: (4-5 pages not including the title and reference page)

In a 4- to 5-page paper, synthesize the peer-reviewed research you reviewed. Format your Assignment as an Annotated Bibliography. Be sure to address the following:

• Identify the 4 peer-reviewed research articles you reviewed, citing each in APA format.
• Include an introduction explaining the purpose of the paper.
• Summarize each study, explaining the improvement to outcomes, efficiencies, and lessons learned from the application of the clinical system each peer-reviewed article described. Be specific and provide examples.
• In your conclusion, synthesize the findings from the 4 peer-reviewed research articles.
• Use APA format and include a title page.
• Use the Safe Assign Drafts to check your match percentage before submitting your work.

Learning Resources

McGonigle, D., & Mastrian, K. G. (2021). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.

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