Nursing Homework Help

Identify one person from the illness group you chose in Week 1 (please see attached/illness group used in week 1). The person should not be a patient at the facility in which you work. You can use friends, family members, or coworkers. Do not use the person’s name in the paper but only initials. Administer the questionnaire you created in Week 1 to that person. Compile the data and analyze the responses to better illustrate where this person, his or her family, and friends are in relation to accepting the diagnosis in relation to the standard health or illness definitions. The analysis should also include coping skills, treatment, and support aspects of the illness. Identify how this will direct care plan development for the chosen illness group.

Compile a report of your interview with the questions you created, the responses you received, your analysis, and your interpretation of how it will affect planning care for the group in a 4- to 5-page Microsoft Word document.

Support your responses with examples.

On a separate references page, cite all sources using APA format.

Social Determinants of Health

Answer one of the following questions:

· Increasingly, health policymakers are becoming aware of the social determinants of health and the role they play in prevention disease and promoting health and wellness. In the “Frameworks for Action in Policy and Politics” chapter, examine Box 1-1 (Political Aspects of the Social Determinants of Health) and Figure 1-6 (The Who, What, Where, When, and Why of Nursing’s Policy Influence). Then compare these with the story about Lilian Wald’s work in New York City. Reflect on the “what” of Wald’s strategies. In your opinion, which did she use effectively?

Looking further at the “what” in Figure 1-6 and answer any one of the following questions:

o Discuss at least three competencies/strategies that you have used effectively.

o Identify three competencies/strategies that you don’t currently use and discuss how you might incorporate them into your advocacy toolbox.

Review the four recommendations in the IOM report The Future of Nursing: Leading Change, Advancing Health and find your state’s action coalition(https://campaignforaction.org/our-network/state-action-coalitions/)USE THIS LINK OR WEBSITE TO ACCES THE STATE’S ACTION

· . Discuss your state’s action coalition’s work as it aligns with these four recommendations. Is each recommendation being addressed? Based on your analysis of the website, how would you describe your state’s progress toward meeting the IOM recommendations?APA FORMAT AND REFERENCES NEEDED.

WK #5 DQ:

Apply information from the Aquifer Case Study to answer the following discussion questions:

· Discuss the Mr. Payne’s history that would be pertinent to his genitourinary problem. Include chief complaint, HPI, Social, Family and Past medical history that would be important to know.

· Describe the physical exam and diagnostic tools to be used for Mr. Payne. Are there any additional you would have liked to be included that were not?

· Please list 3 differential diagnoses for Mr. Payne and explain why you chose them.  What was your final diagnosis and how did you make the determination?

· What plan of care will Mr. Payne be given at this visit, include drug therapy and treatments; what is the patient education and follow-up?

Forty-five-year-old white male truck driver complaining of two weeks of sharp, stabbing back pain. The pain was better after a couple of days but then got worse after playing softball with his daughter. This morning his pain is so bad that he had trouble getting out of bed.

You and Dr. Lee take a few minutes to review Mr. Payne’s chart:

Vital signs:

· Temperature: 98.6° Fahrenheit

· Heart rate: 80 beats/minute

· Respiratory rate: 12 breaths/minute

· Blood pressure: 130/82 mmHg

· Weight: 170 pounds

· Body Mass Index: 24 kg/m2

Past Medical History: Diabetes, well controlled. Hypertension, fair control. Hyperlipidemia, fair control.

Past Surgical History: None

Social History: Works as a truck driver, which involves lifting 20-35 lbs 4 hours of the day, married with 2 daughters,

Habits: Quit smoking two years ago, drinks 1 to 2 beers occasionally on the weekends, no history of IV drug use.

Medication:

· metformin 500mg 2 twice daily

· glyburide 5mg 2 twice daily

· amlodipine 2.5 mg daily

· lisinopril 40 mg daily

· simavastin 40 mg daily

Allergies: No known drug allergies.

Can you tell me about your back pain?”

“As I told the nurse, the pain started two weeks ago after I lifted a box at work. Right away, I got this sharp pain on the left side of my back. The box wasn’t even that heavy.

“I talked to the nurse at work; she said to ice it and to take ibuprofen. It got better after three days. But, I was playing softball with my daughter last weekend, and the pain came back. This time it was worse than before. This week, the pain is so bad I can hardly get out of bed. I get a sharp pain in my back which goes down my left leg to my ankle.”

“On a scale of 0 to 10, 10 being the worst, how severe is the pain?”

“It’s probably a 7.”

“Have you found anything that improves the pain?”

“Ibuprofen and Naproxen worked at first, but they are not helping much anymore.”

“What about positions that make things better or worse?”

“The pain is worse with any movement of my back or sitting for a long time. It is better when I lie down.”

“Have you had back pain before?”

“Yes, I have back pain from time to time. But I’m usually better after 2 to 3 days. This is the worst pain I have ever had.”

Review of Systems

Mr. Payne does not have numbness or weakness in his legs. The pain is better when he lies down. He denies urinary frequency, dysuria, problems with bowel or bladder control, fever or chills, nausea or vomiting, or weight loss. He denies any specific trauma, except for when he lifted a 10-pound box at work. He denies unrelenting night pain.

Based on your differential, you determine that it is highly likely that Mr. Payne is experiencing a mechanical cause of back pain with nerve involvement such as a disc herniation. It is possible that he has spinal fracture, but a lack of trauma history makes the latter unlikely. It is important to consider cauda equina syndrome, as it calls for immediate surgical investigation, but it is unlikely in the absence of neurological symptoms like loss of bowel or bladder control. Finally, infectious etiology, such as pyelonephritis, is unlikely without fever and chills, urinary frequency and dysuria.

Back Exam – Standing:

Mr. Payne has normal curvature, tenderness on palpation on the left lumbar paraspinous muscle with increase tone. Full range of motion, but has pain with movement. His gait is normal. He can walk on his heels and toes. He can do deep knee bends.

Back Exam – Seated:

Mr. Payne denies feeling pain when checked for CVA tenderness. He has no pain in his right leg with the modified version of SLR. While he does not exhibit a true tripod sign, he does complain of pain when his left leg is raised. Mr. Payne’s reflexes are 2+ and equal at the knees and 1+ at both ankles. The motor exam reveals no weakness of the muscles of the lower extremities. His sensory exam is normal.

Pulmonary Exam: His lungs are clear.

Cardiovascular Exam: His cardiac exam demonstrates a regular rhythm, no murmur or gallop.

Three weeks later, Mr. Payne returns for his follow-up appointment and you discover the following:

Pertinent History

Mr. Payne has had little relief with the treatment prescribed. He is frustrated that he has been in pain for more than a month. His pain has been progressively worse. It radiates down the lateral part of his left leg and side of his left foot. This pain is worse than the back pain. He does not have any problems with bowel or bladder control and there is no weakness of his leg.

Pertinent Exam Findings

Vital signs: stable

Neurologic: Normal gait, but moves slowly due to pain; range of motion is full, with pain on flexion; SLR is positive at 45 degree on the left; motor strength intact; reflexes 2+ bilaterally at the knees, absent at the left ankle, 1+ at the right ankle.

Dr. Lee agrees with your diagnosis of radiculopathy of S1 nerve root with progression. She orders an MRI and sets up an appointment to see Mr. Payne after the MRI.

You and Dr. Lee now return to Mr. Payne’s exam room to talk about treatment options with him. Dr. Lee tells Mr. Payne to avoid strenuous activities but to remain active. Dr. Lee increases the dosage of naproxen to 500 mg BID to take with food. Since his pain is intense (7/10), he is given a prescription for acetaminophen with codeine to take at night, when his pain is severe. Mr. Payne declines a muscle relaxant because they usually make him drowsy. He would like to be referred to physical therapy as it was helpful in the past.

FOLLOW-UP TREATMENT

MANAGEMENT

One week later, Mr. Payne returns for follow-up. You review the results of the MRI report.

MRI report:

1. Moderate-size, herniated disc at L5-S1 with associated marked impingement on the left S1 nerve root and mild to moderate impingement on the right S1 nerve root. There is mild central canal stenosis.

2. Annular tear with a small central disc herniation at L4-5 causing mild central canal stenosis.

You review the findings with Dr. Lee. She agrees with your diagnosis of radiculopathy of S1 nerve root due to a large herniated disc at L5-S1.

You call Mr. Payne two weeks later to see how he is doing. He reports that he is doing quite a bit better. He went to an osteopathic physician who did some manual therapy and started him on a strict walking program. He is very encouraged and plans on losing weight through exercise and diet.

I need it by 6pm EST Monday (August 20). Please follow all instructions.

Database Marketing

This week you will obtain information on database marketing to support the Marketing Mix section of your Final Project. As discussed in Chapter 10 of the course text, database marketing centers on gathering customer-based information such as gender, age, occupation, and lifestyles. As an example, to better understand the wants and needs of patients and their families, the Happy Valley marketing director monitors activities on the long-term care center’s web page. Data is collected regarding specific links viewed such as activities, skilled care services offered, and physical therapy. If a certain link is viewed more than other links, this could indicate to the marketing director that potential patients and their family members prefer specific amenities or services. Those amenities or services would then be marketed as a priority for the organization. Considering the marketing plan for your chosen healthcare organization, construct a three- to four-page paper in which you:

Describe your understanding of database marketing and how it could potentially be applied to your marketing plan for the Final Project.

Discuss the benefits and drawbacks of using database marketing.

State the ethical, legal, and HIPAA issues that need to be considered.

Articulate reasons why you would implement or exclude the use of database marketing in your marketing plan for the Final Project.

The paper

Must be three to four double-spaced pages in length (not including the title page and references page) and formatted according to APA

Must include a separate title page with the following:

Title of paper

Student’s name

Course name and number

Instructor’s name

Date submitted

Must use at least three scholarly sources in addition to the course text.

Must document all sources in APA style

Must include a separate references page that is formatted according to APA style

Wk 2/disc/An

Which factor do you feel has the most impact on family members? This is a difficult question for me to answer. Being a hospice nurse, I see on a daily basis, the impacts of chronic illness on family members. I would have to say that in my experience, depending on their situation, one topic may have a greater impact than for other families. I have also found that the impact of one often leads to impacts by others. For example, children, who often live out of state, have to take time off of work to care for their ill parents. This in turn leads to financial strain as well as their family feeling neglected. If the patient requires around the clock care, then the carer because socially isolated as well as physically exhausted.

The physical exhaustion is something I see frequently due to the medicine regimen in the active dying phase of life. Often, the patient needs to be medicated every two hours and if there is only one caregiver that person does not get enough rest. This can lead to physical and emotional strain.

On a personal note, my mother cared for her mentally challenged sister for five years after my grandmother passed. She was very socially isolated because they didn’t leave the house much. I could see my mother because more depressed and having a shorter temper. I would try to help by staying with my aunt while my mother got out of the house but she always felt guilty and never stayed gone long. Now that my aunt has passed, my mother is volunteering and sitting with patients in hospice to allow their families that much needed time away. She has been an asset to these families because she can help them on a personal level.