Conclusions of an Integrative Research Review.

Order Description
Read the integrative research review article by Knisely, Carpenter, and Ah “Pharmacogenomics in the nursing literature: An integrative review.” Then complete a four-five page analysis and critique paper, 750-1000 words. In this critique you will complete the Synopsis, Credibility, and Clinical Significance components from pages 409-413 of your textbook, Appendix D: “Completed Appraisal: Conclusions of an Integrative Research Review.”

Title your page with the following heading:
•Learning Activity #3: Your Name and the Date.
•Appraisal: Conclusions of an Integrative Research Review.
•Citation: Knisely, M. R., Carpenter, J. S., & Ah, D. V. (2014). Pharmacogenomics in the nursing literature: An integrative review. Nursing Outlook, 62(4), 285-296. doi.org/10.1016/j.outlook.2014.03.004.

A. Synopsis:
1.How many persons were involved in conducting the review?.
2.What topic or question did the integrative research review address?.
3.How were potential research reports identified?.
4.What determined if a study was included in the analysis?.
5.How many studies were included in the review?.
6.What research designs were used in the selected research studies?.
7.What were the consistent and important across-studies conclusions?.

B. Credibility:
8.Was the topic clearly defined? Yes ___ No ___ Not clear ___.
9.Was the search for studies and other evidence comprehensive and unbiased? Yes ___ No ___ Not clear ___.
10.Was the screening of citations for inclusion based on explicit criteria? Yes ___ No ___ Not clear ___.
11.Were the included studies assessed for quality? Yes ___ No ___ Not clear ___.
12.Were the design characteristics and the findings of the studies displayed or discussed in sufficient detail? Yes ___ No ___ Not clear ___.
13.Was there truly an integration (synthesis) of findings – not merely reporting of findings from each study individually? Yes ___ No ___ Not clear ___.
14.If different findings were found between studies, did the reviewers explore why differences in findings might have occurred? Yes ___ No ___ Not clear ___.
15.Did the reviewers distinguish between conclusions based on consistent findings from a sufficient number of studies and those based on inferior evidence? Yes ___ No ___ Not clear ___.
16.Which conclusions were supported by consistent findings from two or more studies? Yes ___ No ___ Not clear ___.
17.Are the conclusions credible? All ___ Some ___ No ___.

C. Clinical Significance:
18.Across studies, is the size of the treatment or the strength of the association found or the meaningfulness of qualitative findings strong enough to make a difference in patient outcomes or experiences of care? Yes ___ No ___ Not clear ___.
19.Are the conclusions relevant to the care the nurses give? Yes ___ No ___ Not clear ___.
20.Are the conclusions clinically significant? Some ___ No ___.

D. Conclusion:

21. Conclude the paper with your thoughts about using integrative research reviews to find evidence about clinical practice problems. Is this approach a practice that you could use in your own clinical practice setting?

 

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DIVERTICULITIS

Order Description
THIS ASSIGNMENT IS BE PATHOPHYSIOLOGY OF DIVERTICULITIS.

Date of Care:
Patient Initials: G M Age: 75 Gender: FEMALE

Reason for Hospitalization:
Abdominal pain, Perforated Diverticulitis
Surgical Procedures with dates: post day 4 Exploratory laparotomy, with sigmoidectomy, colostomy on the left abdomen, and Hartmann’s procedure/end colostomy. 3/8/15, Post menopausal hormone replacement at the age of sixty.
Admitting Medical Diagnosis: Abdominal pain, Perforated Diverticulitis Vitamin –D deficiency

Current Medical Diagnosis: Abdominal pain, Perforated Diverticulitis. Vitamin-D deficiency, vertigo,

Past Medical & Surgical History: CVA, 3 years ago, post menopausal hormone replacement at the age of sixty one 14 years ago. vertigo
Smoking History: Formal smoker, quit more than one year ago

Allergies: Patient stated no drug or food allergies known.

Psychosocial and Cultural Assessment

Marital Status: 0 married 0 single 0 divorced 0 partnered 0 widowed
Occupation (if retired, list previous): Was Elementary school teacher for 36 years. Retired 15 years ago.
Mood/Affect: calm but looks drowsy.
Ethnicity: African American.
Other relevant psychosocial and cultural data: Has two children, one is a medical doctor, (OBGYN), with one daughter that is in pre med school. Another is a collage chemistry professor, also has one daughter and two grand children. Her husband died of colon cancer 5 years ago at the age of 77 years old, also was a retired social worker and a deken at the church. Her both parents died at the earlier age. has one brother with the hx of CVA, HTN, Never use any ETOH/substance abuse.

Advance Directives (Nursing Admission Assessments)

Do not resuscitate (DNR) order: 0 yes 0 no Living will: 0 yes 0 no

Physical Assessment Data?RANGE OF FINDINGS (ESPECIALLY IF UNSTABLE)
ASSESSMENT PARAMETER FINDINGS
Temp:
7:30am 99.9
10:00am 98.7 (3/11/15)
12:00am 98.3
HR
7:30am 76
10:00am 84 (3/11/15)
12:00am 86
RR:
7:30am 18
10:00am 18 (3/11/15)
12:00pm 20
SpO2 (pulse oximetry):
7:30am 97% room air
10:00am 98% room air (3/11/15)
12:00am 98% room air.
BP:
7:30am 136/67 position lying l/arm
10:00am 128/ 59 position sitting l/arm (3/11/15)
12:00pm 124/60, position lying l/arm
PAIN Assessment:
TYPE OF PAIN SCALE: (Note location, intensity etc.) At the time of assessment patient verbalized no pain round the stoma and surgical site pain 0/10. patient stated the “nurse gave me Percocet an about one and half to two house ago this am ok for now”

Height 66.0 method wing span. Weight: 166lbs 11 oz (75.60kg) lying down bed scale. 3/11/15
BMI: 26.8
CHANGE from BASELINE? How much? + or –Mrs GM is overweight. Normal weight range would be from 115to 150 pounds.
Hemodynamic Monitoring
(IF APPLICABLE) n/a
Swan Ganz catheter:
location, waveform, dressing, readings: n/a
Arterial line:
location, waveform, dressing, Allen’s sign: n/a
Balloon pump:
location, dressings, settings, distal pulses n/a
REVIEW OF SYSTEMS
Briefly describe assessment finding in the areas outlined below.
Include any additional abnormal findings that are not listed below.
Physical Assessment Data?RANGE OF FINDINGS (ESPECIALLY IF UNSTABLE)
Psychosocial:
Anxiety level:
Calm, look drowsy but verbalized concern of been in the hospital, alert and oriented x 3
Visitors/support systems:
Two children are very involved and supportive said patient.
Neurological:
Glasgow coma scale (explain any deficiencies) Total 15.

Pupils (size/ reaction/ consensual): Rt: 3mm PERL Lt: 3mm PERL
Movement of extremities:
Unable to assess for the gait at the time, patient stated she can walk to the bathroom but not at the time, however bed pan was offered to the patient before the assessment. And strongly able to move all extremities with no pain verbalized..
BIS monitor reading: n/a
Other: Patient alert to person, oriented to place, oriented to time (3/117:30), however look drowsy.

Skin and Mucous Membranes:
Color:
Pink
Temperature (route):
7:30am 98.9 Axilla
10:00am 98.3 oral
12:00am 98.7 oral. warm to touch equal
Edema (specific location and grade): No edema present on assessment.
Wounds/incisions/drains
(including location, dressing, drainage): Colostomies on the left abdomen stoma with surrounding tissue pink in color, Tx change bag every day and PRN. middle Abdominal wound surgical incision site pink in color with 10 staples intact no drainage , no odor, no swelling noted Dehiscence measurement11x 2×6.5cm. Treatment wet to dry dressing twice daily and PRN. patient albumin level 4.8g/dl
Other:
Cardiovascular:
ECG rhythm n/a
Heart sounds:
Clear on auscultation, no murmurs, rubs or gallops, no edema.
Pulses(specific location and grade):: 2+ Redial pulses bilaterally and 2+ dorsalis pulses bilaterally.
Pacemaker: rate/mA/sensitivity: n/a
IV sites (List location, type of line, dressing appearance, fluid/rate)

Periphery line to the right for arm. Site no s/sx of (infection) no redness, no swelling observed.
Other:
Gastrointestinal:
Abdomen (inspection):
Non distended, no masses/tenderness, no organomegaly, no hernias, however Colostomy on the left lower abdomen, middle Abdominal wound surgical incision site pink in color with 10 staples intact no drainage noted, Dehiscence measurement11x 2×6.5cm. Treatment wet to dry dressing twice daily. Patient albumin level 2.4g/dl.
Bowel sounds:
Present in all quadrants. Colostomy bag with gas, small loose but not diarrhea in the bag
Diet:
Apetite: Patent was on NG tube progressed to clear liquid, than just started this morning on regular diet, appetite poor, ate only 25 % breakfast, and lunch only 15% .
Tube feeding (rate and type): n/a Residuals:
Ostomy (site and appearance): Pink tissue round surrounding site.
Stools: Colostomy bag with small loose but not diarrhea in the bag
Other: n/a
Genitourinary:
Urine (color, odor, character):
Clear yellow no odor urine
Catheter:
n/a
Conduit: n/a
Dialysis access:
n/a
INTAKE/OUTPUT
(24 hour total) INTAKE: PO: about 240cc IV:n/a OUTPUT: voided x 3, bed pan offered
Respiratory:
Artificial airway: n/a
ET tube (size):
(cm/mark-taped at teeth/gumline): n/a
Ventilator settings:
n/a
O2 saturation %:
7:30am 97% room air
10:00am 98% room air (3/11/15)
12:00am 98% room air.
Supplemental O2:
2L N/C PRN, not in use at the time of assessment.
Rate/depth/pattern/effort:
Regular, Even and unlabored. RR 18-20.
Breath sounds:
Unlabored, symmetrical.
Sputum:
Moist clear white
Chest tubes (location, drainage, amount of suction):
n/a
Other: n/a

Diagnostic Tests
Include relevant normal and abnormal findings; provide complete ABGs with interpretation

Test
Norms
Baseline
Current value/date
Why
Abnormal?
Test
Norms Admission
Value/date Current
value/date
Why
Abnormal?
White blood cells
4.8-10.8 14. 9 This result is elevated due to diverticulitis (inflammation) K
3.5-5.5 4.6 Within normal limit
Blood Sugar
75-120 109 mg/dl Within normal limit Mg 1.5-2.4mEq/l 2.0mEq/l Within normal limit
Hemoglobin
12.0-15.5 9.4gm/dl This result is low due perforated diverticulitis (inflammation and vitamin D deficiency. Na
130-144 138.0mmol/l within normal limit
Hematocrit
34.9-44.5 28.2% Within normal limit Cl 98-110 108.0mM Within normal limit
Platelets

150-450 402 Within normal limit Ph
PT/INR Ca 8.10.5 8.5mg/dl Within normal limit
APTT BUN
8.26 15 mg/dl This result is elevated due to perforated diverticulitis (inflammation and vitamin D deficiency
CK-MB
Creatinine 0.4-1.2 0.40mg/dl Within normal limit
Myoglobin
Albumin 3.4-5.4g/dl 4.8mg/dl within normal limit
Troponin
Protein 6.3-8.2 5.8mg/dl This result is low due perforated diverticulitis (inflammation
OTHER:

Other:
Chest x-ray:
12 lead EKG: Other abnormal:
ABGs: (pH, PCO2, HCO3, PO2, BE)
Interpretation:
Echo:
CT: Other abnormal:
Other: Other abnormal:
Medication Medication Medication
Augmentin 875/125mg 1 tab po q12hrs x 6days for surgical sit prophylaxis.
Ondansetron (zofraninjection) 2 mg/ml injection 2ml, iv push,Q6h PRN for nausea/vomiting.

Percocet 5/325mg 2 tab po q4hrs prn for pain Ibuprofen 600mg po 1 tab 4 times daily for pain

Meclizine 12.5mg po 1 tab po tid for vertigo Phenol 1.4 %throat spray 180ml (chlorasptic GEQ) 1 spray po prn for sore throat.

Premarin 625 1 tab poqhs, For post menopausal hormone replacement.

Asprin 81mg po 1 tab dail, for cva prophylaxis.

Vitamin D2 50,000iu cap po twice a week.
For vitamin D deficiency.

Daily MVI 1 tab daily for supplement
PART II: Key Problems and Associated Nursing Diagnoses
Directions: Based on the completed, corresponding patient data profile, do the following:
1) select 4 key problems
2) select 4 associated nursing diagnoses
3) prioritize the selections

PRIORITIZE
(label 1-4) KEY PROBLEM NURSING DIAGNOSIS

1
Abdominal pain Acute pain
2
Poor appetite Imbalanced nutrition less then body requirements.

3
Vertigo
Ineffective individual coping
4
skin Risk for impaired tissue integrity
PATHOPHYSIOLOGY REVIEW NURS 424
Student Name:______________________________ Clinical Assignment #:_____

Pathophysiology Review

(NOTE: State the typical presentation and then your patient’s specific presentation)

(NOTE: State the typical treatment regimen and then your patient’s individualized treatment regimen)

(NOTE: State the typical course and prognosis and compare to your clients course and prognosis)

 

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Short Critical Discussion Paper

Order Description
Case Study
Background information:
The Sydney Community Hospital (SCH), a 110 bed community hospital situated in the outer northern suburbs of the Sydney, has provided general acute medical, surgical, obstetric and emergency services to the local community. Over the last 15 years the population of the area has increased significantly to include a much larger proportion of young families and a significant number of retirement villages with nursing homes attached. The hospital is no longer able to provide the range of services and care required to meet the needs of the community and the resources allocated.

To deal with these changes the Government has allocated resources to redevelop the hospital facilities and restructure the organisation to provide a focus on the health needs of the growing population and to provide a number of specialty services including cancer, paediatric, cardiovascular, renal services, trauma services, aged care and community services. The bed numbers will increase to 200, with an increase in the capacity for community clinics in the specialties.

• The Vision statement of the hospital is to“Provide positive health experiences for the community”.
• The stated mission of the new, larger hospital is “to provide highest quality, specialist health care in partnership with patients, carers, the community at large and other health care providers”.
• The overall strategic goals of the new organisation are “to develop high performing, multidisciplinary teams within the specialist services in order to provide high quality, patient-centred care that is effective, efficient and able to respond to the changing health needs of the population”.

The existing hospital has a traditional, functional organisational structure but the management team is currently reviewing alternative organisational structures which might be better suited to the changing internal and external environments of the organisation and which have the potential to improve communication and collaboration across teams as well as accountability for resource utilisation, quality of care and patient outcomes.

Essay instructions:

After reading the case study above and using the course materials and essential readings, develop a short, critical essay style discussion paper.
Within the essay, ensure that the following four (4) key points below are part of the discussion.
1. The advantages and limitations of the existing hospital organisational structure for the current health care environment and changing health needs of the population.
2. Suggest an alternative organisational structure that might be suitable for the new health service; describe the features of such a structure and identify how that structure might better facilitate the achievement of the new mission and strategic goals of the organisation.
3. Identify the key lines of authority and responsibility for achieving the overall organisational goals within the suggested structure (you may wish to compare this with the key lines of authority and responsibility in the previous functional structure).
4. Critically analyse the advantages and limitations of the suggested type of structure in relation to the changing health care environment and what the organisation wishes to achieve for patients, carers and the community.

This assignment requires you to read andcritically analysethe material from Module 1 of the Unit Learning Modules and the Study Guide in order to understand organisations from the point of view of their purpose and what they aim to achieve (the vision, mission and strategic goals); how organisational structures provide lines of authority and responsibility for achieving the mission and goals and the advantages and limitations of the various organisational structures commonly used in health care.
The analysis should critically examine the type of organisational structure that would be suitable for an organisation undergoing the described change and redevelopment and comment on the usefulness of that type of structure in helping the organisation to achieve the stated mission, strategy and goals.

In writing this critical discussion paper, it is important to:
• read and interpret the information provided in the course materials; to question and evaluate that information; relate the theory to what happens in practice;
• identify problems and possible solutions, develop an argument (or series of arguments) and support your suggestions and arguments with evidence from the literature and examples from the field.

The two primary aims of this type of critical reading, thinking and writing are to
• analyse and evaluate the work of other people and
• develop your own arguments (supported by evidence, specifically appropriate references).

Developing a critical approach to thinking allows you to assess information and to develop an informed opinion which can be supported by reliable evidence. It also enables you to interpret others opinions and have the ability to discuss issues in an informed and open manner. Critical thinking means thinking carefully, questioning and testing what you hear and read, and being prepared to examine and, if necessary, change your beliefs and ideas.

The marking sheet
These are on pages 21-22 and provide the criteria and standards against which your assignment will be marked.

Ensure that you cover all points on the marking sheet and that your critical discussion paper is structured to include an introduction, a number of paragraphs covering the key points of the assignment and a conclusion.

Please remember to:
• write in clear, concise English,
• avoid long lists or dot points and lengthy quotes and
• use examples from the case study to demonstrate your understanding of the ideas and concepts from the literature.

You may wish to use headings to structure your assignment. Remember, all ideas and concepts drawn from textbooks, the literature or websites must be correctly acknowledged and referenced.

For this first assignment it is not necessary to go beyond the Unit Learning Modules and the essential readings which have been supplied.

The School’s referencing requirement is the American Psychological Association (APA). Full details of the APA Style Guide can be found at: http://library.uws.edu.au/FILES/cite_APA.pdf

 

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Case study questions

1.    Evaluate the patient’s admitting history and physical. Are there any signs or symptoms that support the diagnosis of anemia?

2.    What laboratory values or other tests support the diagnosis of megaloblastic macrocytic anemia? List all abnormal values and explain the likely cause for each abnormal value.

3.    What hematological values normally change in pregnancy?

4.    Define the following types of anemia: megaloblastic anemia, pernicious anemia, normocytic anemia, microcytic anemia. Include nutrients the deficiency of which can cause or be caused (distinguish) by these anemias.

5.    Vitamin B12 and folate deficiencies are often difficult to distinguish from one another. Describe the interdependence of these two nutrients and how the deficiency of one may be related to the deficiency of the other.

6.    List the most common causes of folate and B12 deficienies.

7.    Explain why the following tests were included in the medical diagnostic work-up:
a.    anti-intrinsic factor antibodies

b.    anti-parietal cell antibodies

c.    methylmalonic acid

d.    homocysteine

8.    Discuss the specific nutritional requirements during pregnancy. Be sure to address all macro- and micronutrients that are altered during pregnancy.

9.    Assess Mrs. ABC’s height and weight. Calculate her BMI and % usual body weight

10.    Check Mrs. ABC’s prepregnancy weight. Plot her weight gain on the maternal weight gain curve (indicate your source). Is her weight gain adequate? How does her weight gain compare to the current recommendations?

11.    Determine Mrs. ABCs energy and protein requirements. Explain the rationale for the method you used to calculate these requirements.

12.    Using her 24-hr recall, compare her dietary intake with her requirements for energy, protein, folate, B12 and iron. Indicate the method you used for calculation.

13.    Write a PES statement for each nutrition problem.

14.    Mrs. ABC says she does not take her prenatal vitamin. What nutrient does this supplement provide?

15.    List factors that you would monitor to assess her pregnancy, nutritional and B12 status.

16.    Complete the ADIME sheet.

A – Assessment
S – Subjective
Chief Complaint:

UBW:

Weight change: gain / loss

Appetite:

Chewing / swallowing problem / sore mouth

Nausea / vomiting / diarrhea / constipation

Food intolerance / allergies:

Diet prior to admit:    Nutritional supplement:

Vitamins / herbs:

Food  preparation:

Factors affecting food intake:

Social / cultural / religious / financial

Other:

O – Objective
Current Diet Order:

Medical Diagnosis:
Past Medical History:

Nutrition Focused Physical Signs & Symptoms:

Age:

Gender: Male      ?
Female  ?    Ht:    Wt:        Admit    ?
Current   ?    DBW:    BMI:
% UBW:

% wt ?:    % DBW:    Other:
Nutritionally Relevant Laboratory Data:

Drug Nutrient Interaction:

Estimated Energy Need:

______________ kcal / day
Based on:
Estimated Protein Need:

_______________  g/day
Based on:    Estimated Fluid Need:

_____________ ml / day
Based on:
Nutrition Diagnosis (D)
A – Assessment (A)
State no more than 2 priority Nutrition Diagnosis  statements in PES Format. Use Nutrition Diagnosis Terminology sheet
ND Term (Problem)  related to (Etiology) as evidenced by (Signs and Symptoms) :

1.

2.

Nutrition Intervention (I)
P – Plan

List Nutrition Interventions. Use Nutrition Intervention Terminology sheet. (The intervention(s) must address the problems (diagnoses).

Goal(s):

Plan for Monitoring and Evaluation (M E)

List indicators for monitoring and evaluation. Use Nutrition Assessment and Monitoring & Evaluation sheets. (Upon follow-up, the plan for monitoring would indicate if interventions are addressing the problems).

 

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