Immune

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Discuss what is happening on a cellular level with the disease process. Be careful to realize that patients have co-morbidities and you may need to discuss the other diseases impact on the pathophysiology and care of the patient.  Three (3) resources after 2008 are required along with APA format. 

A 38 year female old med student goes to her physician with complaints of arthralgia and a new rash on her face bilaterally. The rash get worse when in the sun. When she is fatigued, she complains of a sharp pain in her chest when taking a deep breath. She has experienced this before, but this present episode has been the worst she has ever felt. An exam was completed and tests ordered. The following results are:

Physical:

Temperarture, respiratory rate, and BP normal, Heart rate regular and normal

Facial rash macular over the bridge of her nose and cheeks. Discoid scaling also noted on her extensor surfaces of her arms.

Joint pain and stiffness and pain in hands on active and passive motion

Pleural friction rub auscultated with deep respiration

Other systems examined normal.

Labs:

Serum electrolytes – normal

Hemoglibin and Hematocrit – low

Platelet count – slightly low

White blood cells – normal

BUN and Creatinine – elevated

Urine – Positive for Protein

CXR – Small pleural effusion noted

Antinuclear antibody (ANA) – positive

Anti-DNA antibodies – positive

Diagnosis: Systemic Lupus Erythematosus (SLE)

Questions:

1. What is the common descriptive term for this patient’s facial rash and why?

1. What does sunlight do to people with this disease that they are taught t avoid it?

1. Which lab results indicate renal dysfunction. Is this dysfunction related to SLE? Why or why not?

1. State the other signs and symptoms of SLE that are manifested in this patients physical exam and labs? Give the rationale for each.

1. What is the pathophysiology behind SLE causing widespread tissue damage?

1. What is discoid lupus and is it different from SLE?

1. What type of teaching and management plan will be need to be devised by the APN for this patient?

2nd Discussion post

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All students are expected to contribute meaningful discussion related to the discussion topic of cultural diversity.  The term “cultural diversity” can also refer to having different cultures respect each other’s differences. Please answer and discuss the following questions.

  • What is culturally sensitive nursing care?
  • How do you assess culture in nursing?
  • How can nurses improve/nurture diversity?

On-line etiquette and respect is expected! Plagiarism will not be tolerated. The student must document the use of sources per APA 7th edition guidelines. See Discussion Rubric under DQ content tab for grading requirements. I have also attached a link with the Rubric directly in the discussion question. 

1 Initial post due: 11/3/23 9:00pm 

  • Initial post 300 word minimum; 2 scholarly reference minimum within 5 yrs

2 Peer responses due: 11/17/23 9:00pm

  • 2 Peer responses 100 word minimum; 1 scholarly reference minimum within 5 years

Qualitative Research Article Critique

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Medical Ethics

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1) You will select a current medical ethics issue to research.

Select a topic related to one of the following current medical ethics issues:

* End of Life

* Eugenics and Human Genetics

* Medical Research

* Reproductive Issues

* Organ Donation and Transplantation

* Public Health Issues

* Access to Health Care

* Biotechnology

2) Complete the template that is posted below.

Nursing Assignment

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Choose one of the articles below, and address the essay prompt associated with it.

Park, M. (2009). Ethical issues in nursing practice. Journal of Nursing Law, 13(3), 68-77. doi:10.1891/1073-7472.13.3.68

Link:  

Ethical issues in nursing practice Links to an external site.
    

Essay Prompt: Identify primary areas for legal and ethical issues faced by oncology nurses in this study (Park, 2009), and strategies they may have developed to work with those ethical issues.

Or,

Croke, E. (2006). Nursing malpractice: determining liability elements for negligent acts. Journal of Legal Nurse Consulting, 17(3), 3.

Link: 

Nursing malpractice: determining liability elements for negligent actsLinks to an external site.

Essay Prompt: Identify primary problems that led to the malpractice suits (Croke, 2006), and identify the role the nurse played and what the nurse did wrong.

Your 1-2 page paper should include adhere to APA formatting and references/ citations for the article.  Additional sources are optional.

clinical ethics

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Apply this model (table 2-1) to a challenging situation in your nursing career that required you to consider the ethical dimensions of the patient case and the role you played in providing care. Specifically apply and address the questions within each topic area as they pertain to your situation.

In your conclusion, discuss the impact of the Four Topics process. Did applying these principles shape your decision making in any way?  Does this seem like a valid process for you to apply in your practice? 

TABLE 2-1 Four Topics Method for Analysis of Clinical Ethics Cases

Medical Indications: The Principles of Beneficence and Nonmaleficence

1. What is the patient’s medical problem? Is the problem acute? Chronic? Critical? Reversible? Emergent? Terminal?

2.  What are the goals of treatment?

3.  In what circumstances are medical treatments not indicated?

4.  What are the probabilities of success of various treatment options?

5.  In sum, how can this patient be benefited by medical and nursing care, and how can harm be avoided?

Patient Preferences:  The Principle of Respect for Autonomy

1. Has the patient been informed of benefits and risks, understood this information, and given consent?

2.  Is the patient mentally capable and legally competent, and is there evidence of incapacity?

3.  If mentally capable, what preferences about treatment is the patient stating?

4.  If incapacitated, has the patient expressed prior preferences?

5.  Who is the appropriate surrogate to make decisions for the incapacitated patient?

6.  Is the patient unwilling or unable to cooperate with medical treatment? If so, why?

Quality of Life: The Principles of Beneficence and Nonmaleficence and Respect for Autonomy

1.  What are the prospects, with or without treatment, for a return to normal life, and what physical, mental, and social deficits might the patient experience even if treatment succeeds?

2.  On what grounds can anyone judge that some quality of life would be undesirable for a patient who cannot make or express such a judgment?

3.  Are there biases that might prejudice the provider’s evaluation of the patient’s quality of life?

4.  What ethical issues arise concerning improving or enhancing a patient’s quality of life?

5.  Do quality-of-life assessments raise any questions regarding changes in treatment plans, such as forgoing life-sustaining treatment?

6.  What are plans and rationale to forgo life-sustaining treatment?

7.  What is the legal and ethical status of suicide?

Contextual Features: The Principles of Justice and Fairness

1.  Are there professional, interprofessional, or business interests that might create conflicts of interest in the clinical treatment of patients?

2.  Are there parties other than clinicians and patients, such as family members, who have an interest in clinical decisions?

3.  What are the limits imposed on patient confidentiality by the legitimate interests of third parties?

4.  Are there financial factors that create conflicts of interest in clinical decisions?

5.  Are there problems of allocation of scarce health resources that might affect clinical decisions?

6.  Are there religious issues that might influence clinical decisions?

7.  What are the legal issues that might affect clinical decisions?

8.  Are there considerations of clinical research and education that might affect clinical decisions?

9.  Are there issues of public health and safety that affect clinical decisions?

10.  Are there conflicts of interest within institutions and organizations (e.g., hospitals) that may affect clinical decisions and patient welfare?

Strep Pharyngitis in 8 years old

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Instructions: Select one of the topic mentioned below and discuses filling the attached form.

Topics: 

Strep Pharyngitis in 8 years old

Requirements

Ø The discussion must address the topic

Ø Rationale must be provided

Ø Use at least 600 words (no included 1st page or references in the 600 words)

Ø May use examples from your nursing practice

Ø Formatted and cited in current APA 7

Ø Use 3 academic sources, not older than 5 years. Not Websites are allowed.

Ø Plagiarism is NOT permitted

ASSESSING NEUROLOGICAL SYMPTOMS

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A 40 year old female presents with complaint of a headache for one week. Reports a “head cold” 3 weeks ago.  Thought it was getting better, but sinus symptoms are back and even worse.

Describes the headache is located across her forehead; feels like pressure behind my eyes and unable to breathe out of nose. Also feels mucus running down the back of throat.  Pain sometimes severe (8/10) but with acetaminophen reduces to moderate (4/10) and occasionally mild (2/10).  Occasional nonproductive cough.  Feels feverish at times; noted frequent sneezing and no appetite. Bending over seems to make the headache worse.  “Acetaminophen improves my headache, but doesn’t take it away.” Taking Sudafed HCL 120 mg every 12 hours, with some relief. Symptoms are worse in the morning – awakes with a headache. Ranges from 2/10 at its best to 8/10. Difficulty with concentrating at job and feels very tired.

Response

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Respond using APA, at least 2 scholarly references

Leadership Insights

Research indicates that promoting leadership development among employees requires the existence of effective organizational leadership (Mabona et al., 2022). This provided insight as the building up of our nursing leadership has been stagnant due to unease with executive leadership. Strong, effective leadership, or lack of, directly influences care, quality and motivation of staff (Mansel & Einion, 2019). We have nurses and leaders with great approaches for change, but a lack of motivation to do so. What was lacking was effective communication strategies, the ability for nurses to be actively involved in making decisions regarding patient care and having a substantial level of professional independence and influence over our work environment (Mabona et al., 2022).

During this week’s reading and research I stumbled across transformational leadership being an evidence-based leadership theory for nursing practice. It makes sense as building a trusting and respectful relationship is essential for implementing and fostering an empowering work environment. An empowering work setting is marked by the provision of information, support, resources, and learning opportunities (Mabona et al., 2022). Creating a supportive work environment fosters a culture of shared knowledge and a higher sense of duty and liability among nurses, while simultaneously safeguarding against and alleviating nurse burnout (Iqbal et al., 2019). Leaders who strive to cultivate a positive work environment through transformational leadership value and consider various viewpoints, display a comprehensive understanding of concerns, recognize and encourage the valuable contributions of nurses, effectively communicate achievements to boost confidence, maintain an approachable demeanor, and provide assistance to their staff (Mabona et al., 2022).

Transformational Leadership in Practice

We recently hired a new Chief Executive Officer (CEO), a position that has historically been filled by personnel with a clinical or medical background. This CEO however does not have this background. Rather than that hindering his abilities as a leader, he inspirationally utilized that as a key tool in motivating staff. Upon our first interaction, he encouraged the nursing team to take ownership of our profession/department and provide him with justifications to our needs and goals. He was transparent in pointing out that he is naïve to what we do and what our needs are, yet was able to still support us a valuable partners in the organization and pledge support to our success as well. This defined him as a transformational leader.

Interestingly enough, study findings show that when nursing staff perceives their leader as transformational, their psychological empowerment is enhanced, and they have higher well-being, which in turn increases their commitment to their workplace (Iqbal et al., 2019). This deemed true for our organization. The CEO sparked motivation that was lacking previously and motivated the nursing team to implement changes that were long overdue. Our admissions process was tedious and outdated for quite some time and was needing revamped but had previously lacked the support to do so. We then did a time study on the process for two-weeks, reviewed the ways in which we could improve that process, piloted those changes, completed a time study to evaluate the effectiveness of those changes, and then received the approval to move forward with those changes. A transformational leadership model has had a positive impact on our department and facility as a whole. Employee attitudes and behaviors have changed which has in turn increased job performance, satisfaction, and turnover.

References

Iqbal, K., Fatima, T., & Naveed, M. (2019). The impact of Transformational leadership on nurses’ organizational Commitment: a multiple mediation model. European Journal of Investigation in Health, Psychology and Education, 10(1), 262–275. https://doi.org/10.3390/ejihpe10010021

Mabona, J. F. M., Van Rooyen, D., & Ham-Baloyi, W. T. (2022). Best practice recommendations for healthy work environments for nurses: An integrative literature review. Health Sa Gesondheid- Journal of Interdisciplinary Health Sciences, 27. https://doi.org/10.4102/hsag.v27i0.1788

Mansel, B., & Einion, A. (2019). ‘It’s the relationship you develop with them’: emotional intelligence in nurse leadership. A qualitative study. British Journal of Nursing, 28(21), 1400–1408. https://doi.org/10.12968/bjon.2019.28.21.1400

Health Assessment

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. Analyze the subjective portion of the note. List additional information that should be included in the documentation.Analyze the objective portion of the note. List additional information that should be included in the documentation.Is the assessment supported by the subjective and objective information? Why or why not. Would diagnostics be appropriate for this case, and how would the results be used to make a diagnosis. Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature.