Operational Analysis and Quality Improvement
Have you noticed that the quality of care you have received was better before or after the most recent healthcare reform. Why?
Archive for month: January, 2022
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week 4 health policy and promotion
Health policy unfolds daily and drives clinical practice in the US. The student will investigate current policies or legislation underway for a specific health-related issue. The Student will develop a scholarly APA formatted supported by evidence. The rubric:1. Introduction to population or problem (incidence, prevalence, epidemiology, cost burden etc)2. Description of how the policy is intended for a specific population, program or organization3. Specific legislators involved in the policy development and dissemination4. Identify the role of the APRN in assisting with the policy or refuting the policy – this requires the evidence to support opinion, ideas and/or concepts.5. Discuss how the policy influences clinical practice and is used to promote best outcomes6. Examine how the policy can be used by the interprofessional team to ensure coordinated and comprehensive care for the specific population7. Conclusion – summarize findings8. APA format – use of primary peer-reviewed references as much as possible
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Nutrition
AssignmentNew creative food label design of a food product in a given scenario.DescriptionThe learning objectives for this chapter expand upon foundational concepts in nutrition including dietary requirements across the lifespan, applications of food technologies, and food labels. This assignment requires students to design and create their own version of the FDA food label for the following scenario, which includes calculating the Daily Value Percentage (DV %) according to principles introduced in the chapter.A consumer is buying the product below. For reference, the consumer is a 31-year-old male who works as a Pilates and kickboxing instructor. He works 6-7 hours per day. He has a family history of heart disease on his mother’s side, but is healthy and has no pre-existing conditions himself.Product Name: Protein Power Jelly Peas5 servings per containerServing size 2/3 cup (15 grams)Calories: 200Total fat: 7 gramsSaturated fat: 2 gramsTrans fat: 0 gramsCholesterol: 15 mgSodium: 210 mgTotal carbohydrate: 18 gramsDietary fiber: 3 gramsTotal sugars: 8 gramsAdded sugars: 2 gramsProtein: 21 gramsVitamin A: 4 mcgCalcium: 170 mgPotassium: 210 mgIron: 9 mgStudents should not be copying and pasting into an FDA food label template, but rather designing their own version of what they believe is a sufficiently informational label.Students should be able to answer the following four questions:1 Daily Values: what are the daily value percentages of the aforementioned nutrients and components?2 Nutrition Facts: what is the relevant nutritional information displayed on the label, such that consumers are able to make well-informed decisions?3 Design Choice: what are the differences between your and the FDA’s food labels?4 Evaluation: is your food label more or less effective than FDA’s, and how so?Students should also provide an organized list of APA-formatted citations and sources.Student Resources/Recommended Readings:• Distance Learning Systems 2020 Nutrition eBook, Chapter 1• Canva templates and Fotor
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Week’s discussion !!
Social media is increasingly being used as a population health intervention, providing an inexpensive way to provide health information. Most social media sites require succinct information. Select a top practice problem to address the following.Identify the selected practice problem.Describe an evidence-based intervention to address the practice problem.Create an informational population health “Tweet” as part of a social marketing intervention. This “Tweet” should be no more than 280 characters to promote awareness of the health problem and intervention. Your “Tweet” should be current, captivating, and applicable for the population at risk.Identify one measurable outcome to the “Tweet”.
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Post-Priya
Respond to at least two of your colleagues who were assigned to a different case than you. Explain how you might apply knowledge gained from your colleagues’ case studies to you own practice in clinical settings.If your colleagues’ posts influenced your understanding of these concepts, be sure to share how and why. Include additional insights you gained.If you think your colleagues might have misunderstood these concepts, offer your alternative perspective and be sure to provide an explanation for them. Include resources to support your perspective.Case #29 The depressed man who thought he was out of options.The patient is a 69-year-old male with unremitting chronic depression. He has suffered from depressive episodes for 40 years and has always had a good response to treatment until 5 years ago when he relapsed on venlafaxine. Two years ago, he underwent nine treatments of ECT with partial response. He has tried every known antidepressant and augmentation available in the past few years.The patient should be asked about recent stressful life events, consumption of illicit drugs, alcohol abuse, current medical conditions and prescribed medications (Preda, 2018). If the patient was in my office, I would also want to ask questions to gain an understanding of the severity of his depression. It is important to assess the overall severity of depression symptoms because symptom severity corelates with suicide risk (Preda, 2018). The PHQ-9 screening could be used, and this screening asks about feelings of hopelessness, loss of pleasure in doing things, and feelings of being better off dead. A focused severity assessment for hopelessness, suicidal ideation, and psychotic symptoms is recommended; these symptoms independently increase the risk for suicide (Preda, 2018). This patient reports feeling severely depressed and demoralized, as well as, helplessness, hopelessness, and worthlessness. His depression is the worst it has ever been.Family members are helpful informers, they can ensure medication compliance, and can encourage patients to change behaviors that continue depression (Halverson, 2019). Some questions I would ask family members would include whether the patient is taking their medication and I would ask the family to provide some insight as to how the patient behaves at home. The wife reports that she feels he is letting go and giving up.There are no lab tests that will confirm depressive disorder, however, labs can be ordered to rule out illnesses that may present as depressive disorder such as endocrinological or neurological diseases. Labs tests may include TSH, B12, RPR, HIV test, electrolytes, BUN and creatinine, blood alcohol, and blood and urine toxicology screening. Neuroimaging can help clarify the nature of the neurologic illness that may produce psychiatric symptoms, but these studies are costly and may be of questionable value in patients without discrete neurologic deficits (Halverson, 2019). CT scanning or MRI of the brain should be ordered for suspected organic brain syndrome. PET scans provide a means for studying receptor binding of certain ligands and the effect a compound may have on receptors (Halverson, 2019).Differential diagnosis would include major depressive disorder, bipolar disorder, and/or poor or rapid metabolism. From 25-50% of cases of Treatment Resistant Depression (TRD) are associated with bipolar disorder; this is by far the most common individual cause of TRD (Preda, 2018). The remaining 50-75% are associated with noncompliance, poor or rapid metabolism, or misdiagnosis (Preda, 2018). This patient is exhibiting signs and symptoms consistent with major depressive disorder, such as anhedonia, loss of energy, feelings of worthlessness, depressed mood, which have been consistent for more than a two week period. TRD is defined as MDD that fails to respond to at least two antidepressant trials that are of adequate dose and duration; the two antidepressants may belong either to the same class or to different classes (Preda, 2018).SSRIs, which include fluoxetine, sertraline, paroxetine, citalopram, escitalopram, and fluvoxamine, have become the first-line treatment for major depression (Brown, 2011). SSRIs work by selectively blocking the reuptake of serotonin to increase the amount of serotonin available in synapses in the brain (Brown, 2011). The STAR*D trial examined various strategies for treatment resistant depression in patients who did not respond to an initial SSRI, including switching to another SSRI antidepressant, changing medication class, and switching to CBT. Fair quality studies have indicated a trend toward greater effectiveness when switching to an SNRI such as venlafaxine than with citalopram, fluoxetine, or paroxetine (Halverson, 2019).For patients with major depressive disorder, I would start the patient on citalopram 20mg and increase the dose to a maximum of 40mg. If the patient failed to respond, I would change to venlafaxine 75mg daily extended release tablet and increase dose if tolerated. I could not find any contraindications or dosing alterations needed for Citalopram or venlafaxine related to ethnicity.Week 20 follow-up concluded with ordering venlafaxine levels. This had been considered 20 weeks prior. I agree with ordering this lab and I would have opted to do this before pursuing ECT. A lab is much less invasive, less expensive, and without the side effects he is experiencing at this point.The patient’s aphasia and mood are improving but his mood is still low. He hadn’t had labs completed. The venlafaxine stayed at 225mg and aripiprazole was increased. Aripiprazole was increased to 15mg. When used to augment treatment with an SSRI or SNRI for depression, the dose would be no greater than 10mg. I disagree with this change.By week 28 the patient labs show low levels of venlafaxine on a 225mg dose. The dose was increased to 300mg. Up to 600mg/day has been given for heroic cases (Stahl, 2014). I agree with this change. His aripiprazole was discontinued. I agree with discontinuing since the venlafaxine was not at a therapeutic level.The patient was still not showing improvement by week 32. Another blood level was drawn. At week 36, the level was low on a 300mg dose. The dose was increased to 375mg. The patients BP is good and there have not been any side effects. He has shown some improvement after the dose increase. An increase to 450mg was made and levels ordered. By week 40, the patient was feeling hopeful and mood was improving. His lab values were in the low therapeutic range. At 450mg/day, the patient was still within the dosage for a heroic case. He was tolerating well. The suggestion at this point was to raise dose by 75mg/day, redraw level and raise again to 600mg if still in therapeutic range. I think this is a good strategy based on the patient’s improvement and his ability to tolerate the dose. Lessons learned include the importance of therapeutic drug level monitoring when this is an option. Possible reasons for low levels could be: pharmacokinetic failure, genetic variant causing pharmacokinetic failure, or noncompliance. Finally, never give up.ReferencesBienenfeld, David. (2018). Screening tests for depression. Medscape. Retrieved from https://emedicine.medscape.com/article/1859039-overviewBrown, Charles. (2011). Pharmacotherapy of major depressive disorder. US Pharmacist, 36(11), HS3-HS8. Retrieved from https://www.uspharmacist.com/article/pharmacotherapy-of-major-depressive-disorderHalverson, Jerry. (2019). Depression. Medscape. Retrieved from https://emedicine.medscape.com/article/286759-overviewHowland, R. H. (2008a). Sequenced treatment alternatives to relieve depression (STAR*D). Part 2: Study outcomes. Journal of Psychosocial Nursing and Mental Health Services, 46(19), 21–24. doi:10.3928/02793695-20081001-05. Retrieved from Walden Library databases.Howland, R. H. (2008a). Sequenced treatment alternatives to relieve depression (STAR*D). Part 1: Study design. Journal of Psychosocial Nursing and Mental Health Services, 46(9), 21–24. doi:10.3928/02793695-20080901-06. Retrieved from Walden Library databases.Preda, Adrian. (2018). Major depressive disorder: Disabling and dangerous. Medscape. Retrieved from https://reference.medscape.com/slideshow/major-depressive-disorderPigott H. E. (2015). The STAR*D Trial: It Is Time to Reexamine the Clinical Beliefs That Guide the Treatment of Major Depression. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 60(1), 9-13.Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
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weekly discussion post- one main post and two responses to peers “THYROID DISEASE”
☰ Menu×NURS 6551: Primary Care of WomenBack to BlackboardSyllabusCourse CalendarCourse OverviewCourse InformationResource ListWeek 1Week 2Week 3Week 4Week 5Week 6Week 7Week 8Week 9Week 10Week 11Student SupportWalden LinksGuidelines and PoliciesBack to BlackboardHelpWeek 2: Common Screenings for WomenMany screening procedures are often recommended and routinely used with women to detect diseases in the earliest stages possible. Consider Cindy, who was 28 years old when she received the results of her annual pap smear. The results of the test were abnormal, leading to a diagnosis of human papillomavirus (HPV). While Cindy’s type of HPV did not require treatment, subsequent annual pap smears were highly recommended due to risks associated with the disease. Five years later, after another round of abnormal screening results, Cindy was diagnosed with aggressive cervical cancer, which was then successfully treated (Tamika & Friends, Inc., 2011). For diseases like cervical cancer, screenings and early detection can save patients’ lives, as it did in Cindy’s case. As an advanced practice nurse caring for women, you must be able to provide recommendations for screening tests, interpret test results, and develop care plans that meet the unique needs of patients.Learning ObjectivesBy the end of this week, students will:Evaluate strengths and limitations of guidelines for screening proceduresAnalyze the influence of guidelines on clinical decision makingAnalyze the impact of advanced practice nurses on issues related to screening guidelinesEvaluate diagnoses for patientsEvaluate treatment and management plansUnderstand and apply key terms, principles, and concepts related to clinical guidelines on screening proceduresAnalyze differences between common screenings for younger women and common screenings for older womenDiscussion: Guidelines on Screening Procedures”THYROID DISEASE”The goal of health promotion and education is to help prevent disease in patients. However, this is not always successful, and disease it not always preventable. With disease, early detection is ideal, often making screening procedures a routine part of clinical care. Unfortunately, many patients do not utilize these health services. This can be attributed to lack of awareness or access to care, financial concerns, or even levels of comfort with health care providers. In your role as the advanced practice nurse, you must be aware of potential obstacles for patients and implement strategies to ensure patients receive necessary screenings. Although a variety of screening procedures are recommended for women at various stages of life, not all screenings are appropriate for all patients. Understanding the strengths and limitations of each screening, as well as current guidelines for use is essential to effectively facilitate patient care. For this Discussion, the course Instructor will assign a specific topic for you to research.To prepare:Review this week’s media presentation, as well as Chapters 6 and 8 of the Tharpe et al. text and the U.S. Department of Health and Human Services article in the Learning Resources.Research guidelines on screening procedures for the topic assigned to you by the course Instructor (e.g., guidelines on screening for domestic violence, safety, nutrition, osteoporosis, heart disease, mental health, eating disorders, thyroid disease, pap smear, mammogram, cancer, and sexually transmitted infections). Note: The course Instructor will assign a topic to you by Day 1 of this week.Reflect on strengths and limitations of the screening guidelines.Consider how the guidelines might support your clinical decision making.By Day 3Post an explanation of the guidelines on screening procedures for the topic assigned to you “THYROID DISEASE”. Include an explanation of strengths and limitations of the guidelines. Then, explain how the guidelines might support your clinical decision making.By Day 6Respond to at least two of your colleagues on two different days who were assigned different topics than you. Explain a patient scenario in which your colleague’s guidelines might not be appropriate. Then, explain how you would provide care for the patient in the scenario. Finally, explain how you, as an advanced practice nurse, might be able to impact issues related to these screening guidelines.Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
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Diseases
Disease – Breast CancerChoose a disease that interests you and describe it in epidemiological terms. This should include a brief history of the disease, a definition of the disease and symptoms, the treatment prognosis, and incidence, prevalence, morbidity, and mortality data. Also include major risk factors of the disease and populations at risk. Use current evidence to develop and support your post.
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Nutrition and disease
Module 04 ContentNutrition plays a vital role in a person’s overall health and well-being. Not getting enough of the recommended nutrients over the long-term can lead to malnutrition which often results in disease and illness.In a 3-page paper, written in APA format using proper spelling/grammar, address the following:Define malnutrition and identify a specific disease that can result from it.Perform library research about the selected disease, and explain its physiological effects on a person’s body.Describe the relationship between specific foods/nutrients and the disease. Use the questions below to guide your response.Does research indicate that a lack of specific foods/nutrients increase a person’s chance of contracting the disease?Are there specific foods/nutrients that should be avoided by an individual afflicted with the disease?How do specific foods/nutrients work physiologically within the body to help combat the disease?Evaluate nutritional recommendations to help combat the disease.Cite at least 3 credible references and present the resources in APA format on the References page.For information about the impact of diseases on body systems and assessing the credibility of resources, consult the resources below.How do I know if a source is credible?I need to find information about a disease and the body system it impacts.
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HEALTH POLICY ANALISIS PAPER
Select a Health Policy Analysis Paper on a local, state or federal policy that you have explored along with recommendation based upon analysis1- Analyse and evaluate the Health Policy2-Identify aplication of health policy into clinical practice.3-Paper must have an introduction and a conclusion.4-Maximun 6 pages (not including title and references page )5-APA format and 5 references withim 5 years
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UNIT 7 JOURNAL
Read Chapter 14, Complementary and Alternative Strategies.You will post this response to the online Journal using the text submission tool.Create a journal entry of 200-250 words reflecting on your personal experiences or thoughts regarding alternative therapies, integrating content from the reading into your entry.
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PAYMENT METHODS
