Catheter Associated Urinary Tract Infections

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Catheter Associated Urinary Tract Infections

Catheter Associated Urinary Tract Infections
Catheter Associated Urinary Tract Infections

Use evidence-based nursing interventions to research whether early removal of indwelling urinary catheters and shunning non-evidence based interventions does contribute to a significant decline in the risk of catheter-associated urinary tract infections among inpatients with indwelling urinary catheters.

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Catheter Associated Urinary Tract Infections

Statistics indicate that nearly 13,000 deaths occur annually due to urinary tract infections (UTIs). Approximately 75% of UTIs are linked to urinary catheters. Statistics further show that approximately 15-25% of inpatients use catheters. Still, UTIs constitute the fourth most prevalent healthcare related infection in the U.S, with over 93,000 reported inpatient incidences in 2011.

Besides, UTI’s constitute 12% of the total infections reported in acute care, while 12-16% of hospitalized adult patients have higher chances of using indwelling urinary catheters. The study of catheter-associated urinary tract infections (CAUTI) is essential as it highlights evidence-based nursing interventions needed for early removal of indwelling urinary catheters aimed at containing possible risks of CAUTIs among inpatients with indwelling urinary catheters.

Catheter Associated Urinary Tract Infections

Abstract

The research has established that the use of evidence-based nursing interventions for early removal of indwelling urinary catheters and shunning non-evidence based interventions does contribute to a significant decline in the risk of catheter-associated urinary tract infections among inpatients with indwelling urinary catheters.

Catheter Associated Urinary Tract Infections

According to Huang (2016), a urinary tract infection is a type of infection that affects the urinary tract and other parts of the urinary system including the bladder, urethra, kidney, and ureters and is the most prevalent healthcare related infection.

Center for Disease Control (CDC) statistics indicate that 13,000 deaths occur annually due to urinary tract infections (UTIs).Nearly 75% of the UTIs are linked to urinary catheters, while approximately 15-25% of inpatients use catheters (Hartley, 2015). Piechota (2016) defines indwelling urinary catheter as the urinary discharge tube that is inserted into the patient’s urinary bladder via the urethra and left in situ while continuously connected to a closed urinary drainage system. Urinary Tract Infections (UTIs) constitute the fourth most prevalent healthcare related infection with over 93,000 reported incidences in hospitalized patients in 2011 (Hartley, 2015).

Thus UTI’s constitute 12% of the total infections reported in acute care. Statistics further suggests that nearly all-healthcare related urinary tract infections occur as a result of the improper instrumentation of the urinary tract. CDC Statistics also shows that 12-16% of hospitalized adult patients have higher chances of using indwelling urinary catheters. 

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DNP from the University of Florida College of Nursing

DNP from the University of Florida College of Nursing
DNP from the University of Florida College of Nursing

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DNP from the University of Florida College of Nursing

Order Instructions:

Please answer the following questions, to the best of your ability. Please limit each response to no more than 500 words each.

1. Describe your progression as a clinician including key roles and experiences.

2. Describe all professional and community leadership roles including present or past. List activities/responsibilities for each leadership role.

3. Describe volunteer activities within the past two years and time spent on these activities.

4. Describe all scholarly activities and role in the activity.

5. What are your professional goals? Tell us how a DNP from the University of Florida College of Nursing will help you reach your goals.

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6. Describe how your area of clinical interest aligns with the DNP specialty track and how you made the decision to pursue this specialty.

7. Describe an area of clinical interest you would like to explore further as a clinical project. Why does this area interest you?

8. Describe your personal and professional experience that has best prepared you for doctoral study.*

9. The University of Florida College of Nursing is committed to creating an academically challenging and supportive educational community of students with diverse talents, experiences, and backgrounds. What in your background will uniquely contribute to our community in the College of Nursing?*

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Nursing Competencies Essay Paper

Nursing Competencies
Nursing Competencies

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Nursing Competencies

740.1.4 : Professional Accountability
The graduate analyzes the responsibilities and accountability of the professional nurse.

740.1.5 : Self Advocacy of the Nurse
The graduate integrates strategies of self-awareness and self-care into professional practice to ensure personal health and well¬being.

740.1.7 : Roles of the Nurse
The graduate analyzes the roles of the nurse as a scientist, a detective, and a manager of the healing environment.

740.1.10 : The Nursing Profession
The graduate applies historical and contemporary nursing theories and models to define their professional nursing practice.

740.1.13 : The Professional Nurse
The graduate integrates knowledge, skills, and attitudes of the nursing profession into personal and professional interactions and ethical decision making.

Nursing Competencies

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740.1.15 : Healthcare Work Environment
The graduate evaluates how the vision, values, mission, and philosophy of an organization align with an individual’s professional values, beliefs, and approaches to inter-professional collegiality.

INTRODUCTION

The purpose of this task is to develop a working knowledge of nursing theory, nursing ethics, and professional accountability and apply these concepts to your professional clinical practice. You will be required to think about real-life scenarios and how they relate to nursing codes in your professional practice.

REQUIREMENTS

Your submission must be your original work. No more than a combined total of 30% of the submission and no more than a 10% match to any one individual source can be directly quoted or closely paraphrased from sources, even if cited correctly. An originality report is provided when you submit your task that can be used as a guide.

You must use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate your work. Each requirement below may be evaluated by more than one rubric aspect. The rubric aspect titles may contain hyperlinks to relevant portions of the course.

Nursing Competencies

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A. Identify a nursing theory that has influenced your values and goals.

  1. Explain how nurses apply the identified theory from part A to implement excellent nursing practices.
  2. Discuss how the identified theory from part A fits your professional practice.

B. Identify the contributions of two historical nursing figures in the nineteenth or twentieth century.

  1. Compare the differences in contributions of the two historical figures identified in part B.
  2. Describe how the contributions of the two historical figures influence your professional nursing practice.

C. Explain the functional differences between the State Board of Nursing and the American Nurses Association (ANA).

  1. Define the roles of these two organizations.
  2. Explain how these two organizations influence your nursing practice.
  3. Explain the requirements for professional license renewal in your state.
    a. Discuss the consequences of failure to maintain license requirements in your state.
  4. Compare the differences between registered nursing license requirements in a compact state versus a non-compact state.

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D. Discuss the functional differences between the Food and Drug Administration and the Center for Medicare and Medicaid Services (see the web links below).

  1. Discuss how the two regulatory agencies influence your professional nursing practice.
    a. Describe your role as a patient advocate in promoting safety when a patient has requested to use an alternative therapy.

E. Discuss the purposes of the Nurse Practice Act in your state and its impact on your professional practice.

  1. Discuss the scope of practice for a RN in your state.
  2. Discuss how your state defines delegation for the RN.

F. Apply each of the following roles to your professional practice:
• a scientist
• a detective
• a manager of the healing environment

G. Identify two provisions from the American Nurses Association (ANA) Code of Ethics (see web link below).

  1. Analyze how the two provisions identified in part G influence your professional nursing practice.
  2. Describe a nursing error that may occur in a clinical practice (e.g., clinical setting, skills lab, or simulation).
    a. Explain how the ANA provisions identified in part G can be applied to the error discussed in part G2.

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H. Identify four leadership qualities or traits that represent excellence in nursing.

  1. Discuss the significance of the four leadership qualities identified in part H in the nurse’s role as each of the following:
    • a leader at the bedside
    • within a nursing team or interdisciplinary team
  2. Identify how your work environment impacts the following:
    • nursing leadership
    • decision making
    • professional development

I. Acknowledge sources, using APA-formatted in-text citations and references, for content that is quoted, paraphrased, or summarized.

J. Demonstrate professional communication in the content and presentation of your submission.

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Policy Brief: Nursing Shortage

Policy Brief: Nursing Shortage
Policy Brief: Nursing Shortage

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Policy Brief: Nursing Shortage

Instructions:

A policy brief is a concise summary of an issue, event, or a problem.  There may be supporting documents, but these are used sparingly and selectively; most often they are not submitted with the “brief.”  Be aware that while policy briefs are shorter than papers or reports, they are not any less scholarly or rigorous.  In fact, some individuals find them harder to write, as decisions have to be made about what content to include and what not to include.  The author has to be concise yet document and substantiate points.   So, while the basic write-up of this “brief” is short, one should not underestimate the analysis that underpins it.  Assertions have to be supported with logical arguments, data, or expert opinions.  Use standard sized margins and a 11 or 12 point font.

Policy Brief: Nursing Shortage

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Directions

1.         Choose a policy area/issue on the WNA or AANP websites (links provided in Policy Brief Resources folder in Moodle). You are NOT to use the APRN Modernization act as it is serves as the example for the assignment.

2.         Explore and define the problem. Provide data to establish prevalence, importance, or significance of the problem. Try to describe through the lens of an APN.

3.         Conduct a search for possible options to address the problem.

4.         Identify two possible options to address the policy problem, one of which must be a current Bill; seek out organizational positions, and/or interview influential and key interests about the issue.

5.         Compare and contrast the two options in an objective, balanced manner.  Consider the benefits and limitations of each, the winners and losers (i.e., stakeholders) for each.  Consider costs-benefits.

Policy Brief: Nursing Shortage

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6.         Based on an objective analysis, determine your solution and why you prefer the option/action you do. Be sure you address issues related to distributional equity.

7.         Write up your recommendation with any provisos, cautions, or limitations.  Be sure to identify the alternative that you have not chosen and to discuss why your preferred option is better than that one.

8.         Discuss resources needed to implement.

9.         Maximum length is 2, single-spaced pages, 11-12 point font, standard margins.  (Note: this spacing is a deviation from APA format). Note: references may be on an additional 3rd page.  No abstract needed.)

Brief Policy: Nursing shortage

Congress: Text – H.R.2581 – 116th Congress (2019-2020): Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2019 | Congress.gov | Library of Congress

Organization: The Nursing Workforce | American Nurses Association (nursingworld.org)

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Advanced Practice Nurse Synthesis of Policy, Healthcare Systems, and Nursing Organizations Impact

Synthesis of Policy, Healthcare Systems, and Nursing Organizations Impact on the Advanced Practice Nurse
Synthesis of Policy, Healthcare Systems, and Nursing Organizations Impact on the Advanced Practice Nurse

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Synthesis of Policy, Healthcare Systems, and Nursing Organizations Impact on the Advanced Practice Nurse

•           Find an organization that coincides with your specialty (If you can’t find one use AANP).

***My organization will be Mental Health of American

•           Explain the advocacy priorities of the organization you have chosen.

•           Focus on one of the issues from the organization’s advocacy priorities.

o          Explain the issue you have chosen in depth and why it is important to you using an example from a clinical experience or work situation. Do not support your choice with a personal story.

o          From the viewpoint of an Advanced Practice Nurse, discusses challenges and opportunities envisioned for the advanced practice registered nurse related to the issue and examples provided.

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o          Identify who the stakeholders are related to the issue. Discuss why they are impacted by the advocacy priority and how they influence policy. Include both formal and informal stakeholders (ie: healthcare providers and patient advocacy groups).

o          Describe needed revisions in local, state, federal, or organizational regulations or policies to attain the desired outcome/revision (provide at least one example, no need to provide all four).

Your paper should be no more than 5-6 pages, excluding the cover page and reference page.  No abstract is required.  You must use APA format, or your paper will be returned.  If your paper exceeds 6 pages, your professor will stop reading at 6 pages.  Use headings within your paper. Use sufficient references to assure your paper is scholarly and unbiased.  Upload your assignment to Moodle by the due date. 

You will be assessed on the following criteria:

•           Critically presents the issue and the literature supporting it;

•           Succinctly but poignantly states own position;

•           Applies course content and draws on scholarly literature to develop a logical argument in appraisal of the evidence, the issue, and a potential solution;

•           Poses a viable, creative, and innovative solution that has the potential to transform the health care system vis-à-vis the problem/issue that is the topic of the paper;

•           Communicates in a scholarly manner, which is commensurate with graduate educational standing.

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Example Outline of Paper

•           Description of chosen organization (Introduction-one paragraph)

o          Paraphrase mission of organization

o          If a specialty organization, describe the specialty and how it impacts or supports the specialty

•           Description of advocacy priorities for the organization (1-2 paragraphs depending on how many there are)

•           Describe one of the priorities that you identify with most in your practice currently (1-2 paragraphs including the points below)

o          Paraphrase the advocacy priority and how it supports the specialty or advanced practice nurse

o          Describe how this advocacy priority relates to practice

•           Briefly describe the advanced practice nurse within this specialty (1-2 paragraphs)

o          Practice priorities/competencies

o          Strengths

o          Billing practices (if known)

•           From the viewpoint of an advanced practice nurse in this specialty:

o          Identify who the stakeholders are related to the issue

         Discuss why they are impacted by the advocacy priority and how they influence policy (1-2 paragraphs)

o          Discusses challenges for the advanced practice nurse in this specialty related to the advocacy priority you have chosen (1-2 paragraphs)

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         Support with evidence (peer reviewed articles)

o          Discuss opportunities envisioned for the advanced practice registered nurse related to become more involved with the issue (1-2 paragraphs)

         Support with evidence (peer reviewed articles)

o          Describe needed revisions in at least one of the following areas: local, state, federal, or organizational regulations or policies to attain the desired outcome/revision (provide at least one example, no need to provide all four) (1-2 paragraphs)

         Support your view with rationale synthesized from peer reviewed journal articles

•           Closing paragraph (1 paragraph)

o          Summarize the whole paper using one sentence to summarize each major section with a closing statement of position on the issue.

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Synthesis of Policy, Healthcare Systems, and Nursing Organizations Impact on the Advanced Practice Nurse: Evaluative Criteria for Assessment

Student:  _________________           Topic:  ___________________

In the final paper, the student Exceeds Expectations            Meets Expectations    Falls below Expectations of Graduate Level

1.         Identifies an organization that aligns with future specialty. Presents the advocacy priorities for the organization.

Evidence          

Faculty Feedback:                             

2.         Succinctly identifies a single priority from the organization and why it is important using an example from a clinical experience or work situation. (Do not support your choice with a personal story.)

Evidence          

Faculty Feedback:                             

3.         Astutely discusses key stakeholders, challenges and opportunities envisioned for the advanced practice registered nurse related to the chosen advocacy priority/issue using evidence to support.

Evidence          

Faculty Feedback:                             

4.         Clearly describes needed revisions in local, state, federal, or organizational regulations or policies to attain the desired outcome/revision (provide at least one example).                    

Evidence          

Faculty Feedback:                             

5.         Summarizes the above points in a PowerPoint in 5-7 slides. Provides visual appeal in the presentation. Provides feedback for one other student’s presentation. 

Evidence          

Faculty Feedback:         

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6.         Communicates in a scholarly manner, which is commensurate with graduate educational standing, and in accordance with APA formatting.                               

Review the six outcome criteria and reflect on your performance in addressing each in your paper.  Then, answer the following questions:

1.         Identify one of the criteria that you struggled to adequately address but for which you believe you were eventually successful.  Comment on what strengths you brought to bear in resolving your uncertainty and struggle.

2.         Identify one of the criteria that you struggled to address and still are not sure how well you addressed it in your health policy brief.  What gaps in knowledge, ways of thinking, resources, etc. might underlie that struggle?  How will you address them (i.e., what plan might you create)?

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A Nurse Practitioner-Initiated Bill in the Spring 2014 Nebraska Unicameral Legislature

A Nurse Practitioner-Initiated Bill
A Nurse Practitioner-Initiated Bill

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A Nurse Practitioner-Initiated Bill in the Spring 2014 Nebraska Unicameral Legislature

Order Instructions:

CASE STUDY Unit 3: A Nurse Practitioner-Initiated Bill in the Spring 2014 Nebraska Unicameral Legislature

An example of agenda setting in 2014 was an effort by the Nebraska Nurse Practitioners (NNP), a state nursing association, to find a state senator who would introduce a bill into the Nebraska unicameral legislative session to eliminate the Integrated Practice Agreement (IPA) from the Nurse Practitioner Practice Act (Nebraska Legislature, 2014).

The public hearing for the bill was held on January 31, 2014; the sponsoring state senator’s goal was for the bill to emerge from the seven-member Health and Human Services Committee with support from all or most of the members (Senator S. Crawford, personal communication, January 2014).

A Nurse Practitioner–Initiated Bill in the Spring 2014 Nebraska Unicameral Legislature

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Prior to the bill’s introduction, the NNP had to undergo review by the Nebraska Credentialing Review (407) Program. This state-level review program had been created to evaluate current Nebraska health professionals who are seeking to expand their scope of practice or to evaluate the scope of practice of a new type of provider (Nebraska Department of Health and Human Services, n.d.).

As part of its review, the NNP submitted extensive documentation to three review bodies—an ad hoc Technical Review Committee appointed by the director of the Nebraska Division of Public Health, a second review by the State Board of Health, and a third review by the director of the Division of Public Health. These reviews represented input from the Department of Health and Human Services (DHHS) about possible concerns for Nebraskans in either public health or safety.

Although the recommendations at the three levels are advisory, they serve to inform state senators when considering and voting on proposed legislation (D. Wesley, lobbyist, personal communication, June 2013). The NNP proposal received support at the first two levels; at the second level, the vote was 12–5 to eliminate the IPA requirement (Whitmire, 2013).

There also were recommendations with this second vote to (1) have practice requirements for the new graduate nurse practitioner (NP) and (2) have ongoing competency evaluations of all NPs. At the third level of review, the director and chief medical director of the DHHS were strongly opposed to the NNP proposal (Ruggles, 2013).

A Nurse Practitioner–Initiated Bill in the Spring 2014 Nebraska Unicameral Legislature

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APRNs in Nebraska set the agenda with four goals in mind:

Decrease barriers to their full scope of practice

Provide more and needed access to health care (especially primary care and mental health care) in rural parts of the state

Meet the emerging primary healthcare needs associated with an increased Nebraska population having health insurance because of the Affordable Care Act

Decrease the exodus of APRNs to contiguous states that did not have such IPA agreements (Sundermeier, 2013/2014)

In seeking passage of this bill, Nebraska NPs wanted to join the 17 other states and the District of Columbia that had facilitated full scope of practice availability for nurse practitioners. As noted by Bobrow and Dryzek (1987), this case study underscores the importance of contextual dimensions furthering agenda setting. As noted previously, there were four important contexts in setting this agenda topic at this time in this state.

This agenda, which was based on evidence-based practice studies and the promotion of all nurses working to their full potential, is also advocated by the National Academy of Medicine (Institute of Medicine, 2010). By providing legislative language to a state senator to introduce a bill, APRNs set the agenda in Nebraska.

A Nurse Practitioner–Initiated Bill in the Spring 2014 Nebraska Unicameral Legislature

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A variety of strategies were implemented to further the agenda goal. This chapter’s author served as chair of the Nebraska Nurses Association’s Legislative Advocacy and Representation Committee (LARC). This committee worked in unison and collaboratively with the NNP, its lobbyist, the NNA lobbyist, and the sponsoring state senator to serve as the lead strategists and voices. APRNs used public media to promote their perspectives. For example, following a negative review from the Nebraska DHHS, one APRN educated the public via an op-ed article about APRNs in the state’s largest newspaper (Holmes, 2013). She noted several of the previously made arguments as support for why APRNs wanted the IPA eliminated.

The bill passed by a 43–0 vote during the last day of the 2014 unicameral session. However, the governor vetoed the legislation, and there was not time for the unicameral legislature to enact an override.

In early 2015, the bill was reintroduced, passed, and signed by the new governor on March 5, 2015 (Lazure, Cramer, & Hoebelheinrich, 2016). Other factors facilitating its passage included

A Nurse Practitioner–Initiated Bill in the Spring 2014 Nebraska Unicameral Legislature

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(1) education regarding APRN capabilities along with advocacy during the campaigns of 17 new state senators;

(2) obtaining commitments from both gubernatorial candidates that they would not veto the bill if reintroduced in 2015;

(3) ongoing advocacy by the earlier noted nursing groups; and (

4) interprofessional health groups that both supported the bill and said they would testify at a public hearing. Nebraska is now one of 21 states in which nurse practitioners have full practice authority (Pohl, Thomas, Barksdale, & Werner, 2016).

Read the Case Study above to Answer the Questions Below:

1: How does the Kingdon model apply to the Nebraska case study?

2: How can all healthcare providers support one another and further some of the IOM goals or Healthy People 2030 goals using the Kingdon Model to get the policy process started?

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APN policy and procedures

APN policy and procedures
APN policy and procedures

APN policy and procedures

Order Instructions:

Provide your thoughts about the process used to guide the policy process AND explain how the APN/RN could impact this particular policy process.

This reading is meant to provide an extensive example of policy process AND motivate students to think about how they could be a part of the policy process, even a small component.

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Understanding Nursing theory Essay

Understanding Nursing theory
Understanding Nursing theory

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Understanding Nursing theory

Order Instructions:

The purpose of this formal scholarly paper is to facilitate the student’s utilization, understanding, and application of a selected nursing theory that will inform their roles as advanced practice nurses and to continue their scholarly development.

Guidelines

You will choose one theory/model that we are covering in the course but it must be different than the one used for the group project. This means that you will need to “fast forward” and begin reading about the theories/models to be covered, as it is not possible to coverall theorists before the paper is due. Envision a theory-based model of advanced practice.

Provide a detailed description of the theory/model. Describe empirical evaluation and application to practice. Discuss the attributes and limitations of the theory/model.

Understanding Nursing theory

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How could the theory/model selected guide your practice? How would you like to work and provide theory informed practice with clients, what services would you offer? Weave together empirical and aesthetic ways of knowing along with ethical, personal, and emancipatory patterns as you illustrate how you would integrate this in your practice.

Paper: Descriptions and Requirements

For the paper there is a minimum of 6 required references: Chinn & Kramer textbook + textbook chapter on selected theorist in Smith & Parker + recent primary source + application in practice, research, or management by someone using that theory/model. All references must be current and fall within the past 15 years. The only exceptions will be for a theorist who has died. For example, Rogers died in 1994, and her seminal article appeared in Nursing Science Quarterly in 1992. This must be used as the primary source for her model. (Do not use Rogers’ 1970 book).

Understanding Nursing theory

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Stay as up-to-date as possible. Internet sites may be acceptable as additional sources of information provided they are primary sites, i.e., the theorist or the major organization formed for those using the theory/model manage the site; do not use secondary sites or Wikipedia. You are encouraged to read more widely and cite additional references beyond those required. No secondary sources for the theory/model, other than the chapters for required reading, will be accepted. If you are not familiar with Nursing Science Quarterly, become familiar with it. It is a major resource for current nursing theory content.

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Pathophysiology Essay Paper

Pathophysiology
Pathophysiology

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Pathophysiology

Order Instructions:

Write a paper excluding the title page, reference page and Mind Map that addresses the following:

For each of the three scenarios explain the pathophysiology, associated alterations and the patients’ adaptive responses to the alterations caused by the disease processes. You are required to discuss all three scenarios within the paper component of this assignment.

Construct one mind map on a selected disorder presented in one of the scenarios. Your Mind Map must include the epidemiology, pathophysiology, risk factors, clinical presentation, and diagnosis of the disorder, as well as any adaptive responses to alterations.

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Pathophysiology

Consider the following scenarios:

Scenario 1:

Jennifer is a 2-year-old female who presents with her mother. Mom is concerned because Jennifer has been “running a temperature” for the last 3 days. Mom says that Jennifer is usually healthy and has no significant medical history. She was in her usual state of good health until 3 days ago when she started to get fussy, would not eat her breakfast, and would not sit still for her favorite television cartoon. Since then she has had a fever off and on, anywhere between 101oF and today’s high of 103.2oF.

Mom has been giving her ibuprofen, but when the fever went up to 103.2oF today, she felt that she should come in for evaluation. A physical examination reveals a height and weight appropriate 2-year-old female who appears acutely unwell. Her skin is hot and dry. The tympanic membranes are slightly reddened on the periphery, but otherwise normal in appearance. The throat is erythematous with 4+ tonsils and diffuse exudates. Anterior cervical nodes are readily palpable and clearly tender to touch on the left side. The child indicates that her throat hurts “a lot” and it is painful to swallow. Vital signs reveal a temperature of 102.8oF, a pulse of 128 beats per minute, and a respiratory rate of 24 beats per minute.

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Pathophysiology

Scenario 2:

Jack is a 27-year-old male who presents with redness and irritation of his hands. He reports that he has never had a problem like this before, but about 2 weeks ago he noticed that both his hands seemed to be really red and flaky. He denies any discomfort, stating that sometimes they feel “a little bit hot,” but otherwise they feel fine. He does not understand why they are so red. His wife told him that he might have an allergy and he should get some steroid cream. Jack has no known allergies and no significant medical history except for recurrent ear infections as a child.

He denies any traumatic injury or known exposure to irritants. He is a maintenance engineer in a newspaper building and admits that he often works with abrasive solvents and chemicals. Normally he wears protective gloves, but lately they seem to be in short supply so sometimes he does not use them. He has exposed his hands to some of these cleaning fluids, but says that it never hurt and he always washed his hands when he was finished.

Pathophysiology

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Scenario 3:

Martha is a 65-year-old woman who recently retired from her job as an administrative assistant at a local hospital. Her medical history is significant for hypertension, which has been controlled for years with hydrochlorothiazide. She reports that lately she is having a lot of trouble sleeping, she occasionally feels like she has a “racing heartbeat,” and she is losing her appetite. She emphasizes that she is not hungry like she used to be. The only significant change that has occurred lately in her life is that her 87-year-old mother moved into her home a few years ago. Mom had always been healthy, but she fell down a flight of stairs and broke her hip.

Her recovery was a difficult one, as she has lost a lot of mobility and independence and needs to rely on her daughter for assistance with activities of daily living. Martha says it is not the retirement she dreamed about, but she is an only child and is happy to care for her mother. Mom wakes up early in the morning, likes to bathe every day, and has always eaten 5 small meals daily. Martha has to put a lot of time into caring for her mother, so it is almost a “blessing” that Martha is sleeping and eating less. She is worried about her own health though and wants to know why, at her age, she suddenly needs less sleep.

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