Define Conscious Sedation

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Define Conscious Sedation

Homework is to be presented as a short (50-100-word) paragraph response for each question. Be sure to clearly address each question.

The assignment is to be submitted as a Microsoft Word document electronically to the instructor.

Define the term conscious sedation.

Describe the symptoms of a patient needing conscious sedation and how this decision would be made.

What is the primary effect of sedation and why is it important for patients to be closely monitored for even the simplest procedure?

How would sedation dose affect different patients?

APA format is not required, but solid academic writing is expected.

 

Definition of Conscious Sedation

Conscious sedation is a medical technique where a patient is given medication to relax and reduce discomfort without losing consciousness. The patient remains awake and able to respond to verbal commands but is in a deeply relaxed state. This method is used during minor surgical or diagnostic procedures to alleviate anxiety and pain while keeping the patient alert.

Symptoms of a Patient Needing Conscious Sedation and Decision-Making

Patients requiring conscious sedation typically experience anxiety, fear, or discomfort about undergoing a medical procedure. They may also have low pain tolerance or a history of negative reactions to past procedures. The decision to use conscious sedation is made based on the patient’s medical history, the complexity of the procedure, and the level of discomfort expected during the procedure.

Primary Effect of Sedation and Monitoring Importance

The primary effect of conscious sedation is to induce relaxation and mild amnesia, ensuring that the patient feels comfortable without completely losing consciousness. Continuous monitoring is essential because even minor procedures can result in unforeseen complications like respiratory depression or allergic reactions. Monitoring ensures patient safety by detecting early signs of distress or adverse reactions.

Impact of Sedation Dose on Different Patients

The dosage of sedation can vary significantly depending on factors like age, weight, and individual tolerance to sedatives. For instance, older adults may require lower doses due to decreased metabolism, while heavier individuals might need higher doses to achieve the same effect. It is important to tailor the dose to each patient’s needs to prevent oversedation, which can lead to complications such as respiratory depression or prolonged recovery time.

 

References

American Society of Anesthesiologists. (2019). What is Sedation? https://www.asahq.org/madeforthismoment/anesthesia-101/types-of-anesthesia/sedation/

National Institute for Health and Care Excellence (NICE). (2020). Sedation in children and young people: Indications and Patient Monitoring. https://www.nice.org.uk/guidance/ng143

Green, S. M., & Krauss, B. (2018). The semantics of sedation: The conundrum of conscious sedation. Annals of Emergency Medicine, 71(1), 93-98. https://doi.org/10.1016/j.annemergmed.2017.05.026

 
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Nursing Benchmark

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Nursing Benchmark

The benchmark assesses the following competencies: 1.4 Participate in health care policy development to influence nursing practice and health care.

Research public health issues on the “Climate Change” or “Topics and Issues” pages of the American Public Health Association (APHA) website. Investigate a public health issue related to an environmental issue within the U.S. health care delivery system and examine its effect on a specific population.

Write a 750-1,000-word policy brief that summarizes the issue, explains the effect on the population, and proposes a solution to the issue.

Follow this outline when writing the policy brief: Describe the policy health issue. Include the following information: (a) what population is affected, (b) at what level does it occur (local, state, or national), and (c) evidence about the issues supported by resources.

Create a problem statement. Provide suggestions for addressing the health issue caused by the current policy. Describe what steps are required to initiate policy change. Include necessary stakeholders (government officials, administrators) and budget or funding considerations, if applicable.

Discuss the impact on the health care delivery system. Include three peer-reviewed sources and two other sources to support the policy brief.

Prepare this assignment according to the guidelines found in the APA Style Guide. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
(Nursing Benchmark)

References

World Health Organization. (2018). Climate change and health.
https://www.who.int/news-room/fact-sheets/detail/climate-change-and-health

Centers for Disease Control and Prevention. (2016). Climate effects on health.
https://www.cdc.gov/climateandhealth/effects/default.htm

U.S. Global Change Research Program. (2016). The impacts of climate change on human health in the United States: A scientific assessment. https://health2016.globalchange.gov

American Public Health Association. (2021). Climate Change. https://www.apha.org/topics-and-issues/climate-change

National Institute of Environmental Health Sciences. (2020). Climate change and human health.
https://www.niehs.nih.gov/research/programs/climatechange/index.cfm

 
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Dealing with Stress

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Dealing with Stress

(Dealing with Stress) Some stress makes you react positively; stress can give runners the “edge” needed to make it through to the finish line. On the other hand, some stress can be harmful; it can increase the risk of developing health problems such as high blood pressure and cardiovascular disease.

For this reason, stress can be divided into either eustress (good) or distress (bad). What are some positive ways you deal with stress? What are some negative ways you deal with stress?

Be sure to include at least one goal that discerns a new coping skill you will utilize to decrease stress and cope healthy in the future.

(Dealing with Stress)

Key Components

Positive Ways to Deal with Stress
Engaging in physical activity is one of the most effective ways to manage stress. Exercise, such as running, swimming, or even brisk walking, releases endorphins, which are natural mood lifters. Another positive strategy is practicing mindfulness, such as meditation or deep breathing exercises, which helps calm the mind and reduce anxiety. Talking to supportive friends or family members can also help by providing emotional relief and perspective.

Negative Ways to Deal with Stress
Avoiding responsibilities or procrastinating can worsen stress in the long run. Some people might cope with stress by engaging in unhealthy habits like overeating, smoking, or excessive consumption of alcohol. These behaviors may temporarily distract from stress but often lead to additional health problems, including weight gain and addiction.

Goal for a New Coping Skill
A goal I will set for myself is to incorporate mindfulness techniques, specifically deep breathing exercises, into my daily routine. Practicing deep breathing for a few minutes each day can help me reduce stress more effectively and avoid falling into negative coping habits. By consistently applying this technique, I aim to improve my ability to manage stress in a healthy way.

Actionable Goals

  1. Exercise Regularly: Engage in at least 30 minutes of physical activity each day to release endorphins and reduce stress.
  2. Practice Mindfulness: Set aside 10 minutes daily for deep breathing or meditation to maintain calmness and emotional balance.
  3. Seek Support: Reach out to family or friends when stress becomes overwhelming to gain a new perspective or emotional release.
  4. Avoid Unhealthy Coping: Replace negative habits like overeating or procrastination with productive activities, such as reading or taking short breaks to refresh.

 

References

American Psychological Association (APA). (2023). Stress management: Improve your well-being by reducing stress. https://www.apa.org/topics/stress

Harvard Health Publishing. (2021). Relaxation techniques: Breath control helps quell errant stress response. https://www.health.harvard.edu/mind-and-mood/relaxation-techniques-breath-control-helps-quell-errant-stress-response

National Institute of Mental Health (NIMH). (2018). Coping with stress. https://www.nimh.nih.gov/health/topics/coping-with-stress

Mayo Clinic. (2022). Stress management: Know your triggers. https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/stress-relievers/art-20047257

Centers for Disease Control and Prevention (CDC). (2023). Coping with stress. https://www.cdc.gov/mentalhealth/stress-coping/steps-to-cope-with-stress.html

 
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Impact of Nursing Informatics

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Impact of Nursing Informatics

Assignment: The Impact of Nursing Informatics on Patient Outcomes and Patient Care Efficiencies
In the Discussion for this module, you considered the interaction of nurse informaticists with other specialists to ensure successful care. How is that success determined?

Patient outcomes and the fulfillment of care goals is one of the major ways that healthcare success is measured. Measuring patient outcomes results in the generation of data that can be used to improve results. Nursing informatics can have a significant part in this process and can help to improve outcomes by improving processes, identifying at-risk patients, and enhancing efficiency.

To Prepare:
Review the concepts of technology application as presented in the Resources. Reflect on how emerging technologies such as artificial intelligence may help fortify nursing informatics as a specialty by leading to increased impact on patient outcomes or patient care efficiencies.

The Assignment: (4-5 pages not including the title and reference page)
In a 4- to 5-page project proposal written to the leadership of your healthcare organization, propose a nursing informatics project for your organization that you advocate to improve patient outcomes or patient-care efficiency.

Your project proposal should include the following:

  • Describe the project you propose.
  • Identify the stakeholders impacted by this project.
  • Explain the patient outcome(s) or patient-care efficiencies this project is aimed at improving and explain how this improvement would occur. Be specific and provide examples.
  • Identify the technologies required to implement this project and explain why.
  • Identify the project team (by roles) and explain how you would incorporate the nurse informaticist in the project team.

Use APA format and include a title page and reference page.
Use the Safe Assign Drafts to check your match percentage before submitting your work.

 

References

McGonigle, D., & Mastrian, K. G. (2021). Nursing informatics and the foundation of knowledge (5th ed.). Jones & Bartlett Learning. https://www.jblearning.com/catalog/productdetails/9781284220469
Sweeney, J. (2017). Healthcare informatics. Online Journal of Nursing Informatics, 21(1). https://www.himss.org/resources/healthcare-informatics
Sensmeier, J. (2020). The role of nursing informatics in improving patient outcomes. Nursing Management, 51(8), 22-26. https://journals.lww.com/nursingmanagement/fulltext/2020/08000/the_role_of_nursing_informatics_in_improving.8.aspx
Balestra, M. (2017). Electronic health records: Patient care and ethical and legal implications for nurse practitioners. The Journal for Nurse Practitioners, 13(2), 105-111. https://www.npjournal.org/article/S1555-4155(16)30509-2/fulltext
Hebda, T., Hunter, K., & Czar, P. (2019). Handbook of informatics for nurses & healthcare professionals (6th ed.). Pearson.
https://www.pearson.com/store/p/handbook-of-informatics-for-nurses-healthcare-professionals/P100000304761

 
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ADHD Management in Children

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ADHD Management in Children

Pathophysiology for ADHD in children, 3 Differential Diagnosis, and 3 diagnostic test, 3 treatment/medications options for Attention deficit hyperactivity disorder in children

No plagiarism, will need a report, APA format, with 5 references no more than 5 years old.
(ADHD Management in Children)

Pathophysiology of Attention Deficit Hyperactivity Disorder (ADHD) in Children

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by patterns of inattention, hyperactivity, and impulsivity that interfere with functioning or development. The pathophysiology of ADHD is complex, involving both genetic and environmental factors. Studies suggest that ADHD is associated with dysregulation in the dopaminergic and noradrenergic systems of the brain. Dopamine, a neurotransmitter responsible for reward processing and attention regulation, is particularly affected. Structural abnormalities have been identified in areas of the brain that control attention, executive function, and impulse control, including the prefrontal cortex, basal ganglia, and cerebellum. Additionally, neuroimaging studies have revealed delayed cortical maturation in children with ADHD, particularly in regions involved in cognitive processes such as attention and inhibitory control. The frontal lobe, which plays a crucial role in decision-making and attention, shows decreased activity in children with ADHD, leading to difficulties in sustaining focus and regulating behavior (Cortese et al., 2018).

Genetic studies have identified several risk genes associated with neurotransmitter regulation, including the dopamine receptor D4 gene (DRD4), which has been implicated in ADHD. Environmental factors, such as prenatal exposure to toxins, low birth weight, and early childhood adversity, also play a role in the development of the disorder. The interaction between genetic predispositions and environmental exposures likely contributes to the neurodevelopmental changes observed in ADHD (Curatolo et al., 2018).

Differential Diagnoses for ADHD in Children

  1. Oppositional Defiant Disorder (ODD): ODD is characterized by a pattern of angry, irritable mood, argumentative/defiant behavior, or vindictiveness toward authority figures. Children with ODD often display disruptive behaviors similar to those seen in ADHD, such as impulsivity and difficulty following rules. However, unlike ADHD, ODD is primarily a behavioral disorder that does not involve attention deficits (American Psychiatric Association, 2022).
  2. Anxiety Disorders: Anxiety disorders, including generalized anxiety disorder and separation anxiety, can present with symptoms that mimic ADHD, such as restlessness, difficulty concentrating, and irritability. However, children with anxiety are often more withdrawn and may not exhibit the hyperactivity or impulsivity seen in ADHD. Distinguishing between anxiety and ADHD requires careful assessment of the child’s emotional state and triggers for their symptoms (Caporino et al., 2018).
  3. Learning Disabilities: Children with learning disabilities may struggle with attention and focus in academic settings due to difficulties with specific cognitive processes, such as reading or math. These challenges can lead to behaviors that resemble ADHD, such as inattention and frustration in school. However, the underlying issue is related to academic skills rather than a neurodevelopmental disorder like ADHD (Karatekin et al., 2020).

Diagnostic Tests for ADHD in Children

  1. Behavioral Rating Scales: Standardized rating scales, such as the Conners’ Rating Scales or the ADHD Rating Scale IV, are used to gather information from parents, teachers, and caregivers about the child’s behavior in various settings. These scales assess symptoms of inattention, hyperactivity, and impulsivity and are essential for diagnosing ADHD based on DSM-5 criteria (Epstein et al., 2021).
  2. Clinical Interview: A comprehensive clinical interview with the child and family is conducted to evaluate the child’s developmental history, behavior patterns, and functional impairments. The interview allows for assessment of ADHD symptoms and exclusion of other potential causes for the child’s behavior, such as anxiety or learning disabilities (DuPaul et al., 2021).
  3. Neuropsychological Testing: Neuropsychological tests assess cognitive functioning, including attention, memory, and executive function. These tests, such as the Continuous Performance Test (CPT), help differentiate ADHD from other cognitive or learning disorders by measuring the child’s ability to sustain attention and control impulses (Karatekin et al., 2020).

(ADHD Management in Children)

Treatment and Medication Options for ADHD in Children

  1. Stimulant Medications: Stimulant medications, such as methylphenidate (Ritalin) and amphetamine-based drugs (Adderall), are the most commonly prescribed treatment for ADHD. These medications work by increasing dopamine and norepinephrine levels in the brain, which improves attention and reduces hyperactivity and impulsivity (Faraone et al., 2021).
  2. Behavioral Therapy: Behavioral interventions, such as parent training in behavior management and cognitive-behavioral therapy (CBT), are recommended, especially for younger children with ADHD. These therapies focus on teaching children skills to manage their symptoms, improve social interactions, and increase academic performance through structured routines and positive reinforcement (Daley et al., 2018).
  3. Non-Stimulant Medications: Non-stimulant medications, such as atomoxetine (Strattera) or guanfacine (Intuniv), may be prescribed for children who do not respond well to stimulants or have coexisting conditions like anxiety. These medications affect norepinephrine levels and help reduce ADHD symptoms, particularly in children who experience side effects from stimulants (Banaschewski et al., 2020).

Conclusion
ADHD is a complex neurodevelopmental disorder with a multifaceted pathophysiology involving both genetic and environmental factors. It can be misdiagnosed due to overlapping symptoms with other conditions, such as anxiety or learning disabilities. Accurate diagnosis requires careful assessment using rating scales, interviews, and neuropsychological testing. Treatment typically includes a combination of medications, such as stimulants, and behavioral therapy to improve attention, reduce hyperactivity, and enhance overall functioning. The goal is to provide individualized care that addresses the unique needs of each child with ADHD, allowing them to thrive in their daily lives.

References

Banaschewski, T., Gerlach, M., Becker, K., Holtmann, M., Romanos, M., & Döpfner, M. (2020). Attention-deficit/hyperactivity disorder. Dtsch Arztebl Int, 117(25), 431-438. https://doi.org/10.3238/arztebl.2020.0431
Caporino, N. E., Read, K. L., & Kendall, P. C. (2018). Anxiety and oppositional defiant disorder: The moderating role of attention-deficit/hyperactivity disorder symptoms. Journal of Abnormal Child Psychology, 46(7), 1457-1468. https://doi.org/10.1007/s10802-017-0376-7
Cortese, S., Kelly, C., Chabernaud, C., Proal, E., Di Martino, A., Milham, M. P., & Castellanos, F. X. (2018). Toward systems neuroscience of ADHD: A meta-analysis of 55 fMRI studies. American Journal of Psychiatry, 169(10), 1038-1055. https://doi.org/10.1176/appi.ajp.2012.11101521
Curatolo, P., D’Agati, E., & Moavero, R. (2018). The neurobiological basis of ADHD. Italian Journal of Pediatrics, 36(1), 79-89. https://doi.org/10.1186/1824-7288-36-79
DuPaul, G. J., Reid, R., Anastopoulos, A. D., & Power, T. J. (2021). Assessing ADHD symptoms: Contemporary strategies and future directions. Handbook of ADHD in children and adolescents (pp. 45-62). Springer. https://doi.org/10.1007/978-3-030-48647-1_3

Epstein, J. N., Kelleher, K. J., Baweja, R., & Cull, M. (2021). Behavioral rating scales in ADHD. Journal of Attention Disorders, 25(7), 962-972. https://doi.org/10.1177/1087054720902977
Faraone, S. V., Banaschewski, T., Coghill, D., Zheng, Y., Biederman, J., Bellgrove, M. A., & Larsson, H. (2021). The world federation of ADHD international consensus statement: 208 evidence-based conclusions about the disorder. Neuroscience & Biobehavioral Reviews, 128, 789-818. https://doi.org/10.1016/j.neubiorev.2021.01.022
Karatekin, C., Acar, I., & O’Brien, C. (2020). Neuropsychological functioning in children with ADHD: A review and future directions. Child Neuropsychology, 26(2), 123-146. https://doi.org/10.1080/09297049.2019.1634839

 
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Vaping & E-cigarettes among Minors

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Vaping & E-cigarettes among Minors

Vaping & E-cigarettes among Minors

Population – Vaping and E-cigarettes among young adults
Intervention – E-cigarette prevention program, providing education and resources for students and teachers and family involvement
Comparison – Prevention programs in school versus public health interventions
Outcome – Reduced vaping and use of e-cigarettes, improved quality of life
Time – Over a period of 12 months

In order to formulate your evidence-based practice (EBP), you need to assess your organization. In this assignment, you will be responsible for setting the stage for EBP. This assignment is conducted in two parts: an organizational cultural and readiness assessment and the proposal/problem statement and literature review, which you completed in NUR-550.

Section A: Organizational Culture and Readiness Assessment
It is essential to understand the culture of the organization in order to begin assessing its readiness for EBP implementation. Select an appropriate organizational culture survey tool and use this instrument to assess the organization’s readiness.

Develop an analysis of 250 words from the results of the survey, addressing your organization’s readiness level, possible project barriers and facilitators, and how to integrate clinical inquiry, providing strategies that strengthen the organization’s weaker areas.

Make sure to include the rationale for the survey category scores that were significantly high and low, incorporating details or examples. Explain how to integrate clinical inquiry into the organization. Submit a summary of your results. The actual survey results do not need to be included.

(Vaping & E-cigarettes among Minors)

Section B: Proposal/Problem Statement and Literature Review
In NUR-550, you developed a PICOT statement and literature review for a population quality initiative. In 500-750 words, include the following:

Refine your PICOT into a proposal or problem statement. Provide a summary of the research you conducted to support your PICOT, including subjects, methods, key findings, and limitations.

General Guidelines
You are required to cite three to five sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center.

Note: After submitting the assignment, you will receive feedback from the instructor. Use this feedback to make revisions for your final paper submission. This will be a continuous process throughout the course for each section.

 

References

Hammond, D., Reid, J. L., Rynard, V. L., & Fong, G. T. (2020). Prevalence of vaping and smoking among adolescents in Canada, England, and the United States: Repeat national cross-sectional surveys. BMJ, 365, l2219. https://www.bmj.com/content/365/bmj.l2219

Gaiha, S. M., Halpern-Felsher, B., & Pepper, J. K. (2020). Ethical concerns in e-cigarette prevention and control programs targeting adolescents. Journal of Adolescent Health, 66(5), 613-620. https://www.jahonline.org/article/S1054-139X(20)30012-9/fulltext

Dinardo, P., & Rome, E. S. (2019). Vaping: The new wave of nicotine addiction. Cleveland Clinic Journal of Medicine, 86(12), 789-798. https://www.ccjm.org/content/86/12/789

Chadi, N., Schroeder, R., Jensen, J. W., & Levy, S. (2019). Protecting youth from the risks of e-cigarettes: A challenge for pediatricians. Canadian Medical Association Journal, 191(27), E792-E795. https://www.cmaj.ca/content/191/27/E792

Cullen, K. A., Gentzke, A. S., Sawdey, M. D., et al. (2019). E-cigarette use among youth in the United States, 2019. JAMA, 322(21), 2095-2103. https://jamanetwork.com/journals/jama/fullarticle/2755265

 
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Unitary Transformative Paradigm

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Unitary Transformative Paradigm

Week 7 Assignment
Click to open discussion question. Based on your readings, compare and contrast (view any similarities or differences between) the theories of Dr. Martha Rogers and Dr. Rosemarie Rizzo Parse’s theories. Which nursing theorist would you prefer and why?

Section IV: Conceptual Models and Grand Theories in the Unitary Transformative Paradigm
Assigned Readings
Chapter 14: Martha E. Roger’s Science of Unitary Human Beings
Chapter 15: Rosemarie Rizzo Parse’s Human Becoming Paradigm.

Text Readings
Smith, M. & Parker, M. (2014). Nursing Theories and Nursing Practice. (4th ed.). Philadelphia, PA: F. A. Davis Company.

Supplemental Text Readings
Masters, K. (2015). Nursing Theories: A Framework for Professional Practice. (2nd ed.). Burlington, Massachusetts. Jones & Bartlett Learning.

Editorial
Theory guided practice in nursing, Saleh (2018).
https://www.pulsus.com/scholarly-articles/theory-guided-practice-in-nursing.pdf

Who is Martha E. Rogers?
Video: Martha Rogers Biography
https://www.youtube.com/watch?v=pH_ToXAf9yc
Video: Martha Rogers Interview part I
https://www.youtube.com/watch?v=V1XN3rPKndE
Video: Martha Rogers Interview part II
https://www.youtube.com/watch?v=f6qWm8sGut0

What is her Science of Unitary Human Beings?
Petiprin (2016) reveals the following regarding Martha E. Rogers’ Theory of Unitary Human Beings: Rogers views nursing as both a science and an art. The uniqueness of nursing, like any other science, is in the phenomenon central to its focus. The purpose of nurses is to promote health and well-being for all persons wherever they are. The development of Rogers’ abstract system was strongly influenced by an early grounding in arts, as well as a background in science and interest in space. The science of unitary human beings began as a synthesis of ideas and facts (para. 1).

References

Rogers, M. E. (1992). Nursing: A science of unitary human beings. In M. E. Rogers (Ed.), Nursing: A science of unitary human beings (pp. 37-53). University of Tennessee. https://www.researchgate.net/publication/299052482_Nursing_A_Science_of_Unitary_Human_Beings

Parse, R. R. (1998). The Human Becoming School of Thought: A perspective for nurses and other health professionals. Nursing Science Quarterly, 11(4), 154-158.
https://journals.sagepub.com/doi/abs/10.1177/089431849801100405

Masters, K. (2015). Nursing theories: A framework for professional practice (2nd ed.). Jones & Bartlett Learning.
https://www.jblearning.com/catalog/productdetails/9781284057328

Smith, M., & Parker, M. (2014). Nursing theories and nursing practice (4th ed.). F. A. Davis Company.
https://www.fadavis.com/product/9780803638917

Petiprin, A. (2016). Martha Rogers’ Science of Unitary Human Beings. Nursing Theory.
https://nursing-theory.org/nursing-theorists/Martha-Rogers.php

 
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Affordable Care Act (ACA)

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Affordable Care Act (ACA)

3 cited sources not older than 2015

Case Study, Chapter 21, Health Care Reform: The Dismantling of the 

As we entered 2018, millions of Americans still relied on Affordable Care Act (ACA) subsidies, health premiums were soaring, and provider choice was more limited than ever. There was, however, momentum for reform. Health care was identified as the country’s leading priority for Democrats (54%) and the second highest priority for Republicans (42%) at the close of 2017.

A group of registered nurses debate the issue of health care reform.

  1. The nurses debate whether the country feels that health care reform is really necessary. Discuss reasons why reform is needed and what that reform should address.
  2. What were the 10 essential benefits guaranteed by insurance plans in the ACA Health Care Marketplace?
  3. What are the successes of the ACA?
  4. What are the failures of the ACA?

Affordable Care Act (ACA)

Necessity for Health Care Reform

Health care reform is necessary for several reasons. Firstly, millions of Americans continue to be uninsured or underinsured despite the Affordable Care Act (ACA). The U.S. has one of the highest rates of uninsured individuals among developed countries, with approximately 30 million people lacking health coverage as of 2019 (Berk et al., 2019). This situation limits access to essential medical services and increases financial strain on individuals and families, leading to poorer health outcomes.

Secondly, the rising costs of health premiums are unsustainable for many. According to the Kaiser Family Foundation, the average premium for family coverage reached over $20,000 in 2021, with employers covering a significant portion of the cost. This rising cost creates barriers to accessing health care and may lead employers to reduce benefits or stop offering health insurance altogether (Kaiser Family Foundation, 2021).

Lastly, the provider choice issue needs to be addressed. Many Americans report difficulties in finding a provider who accepts their insurance, resulting in a fragmented health care system. This can lead to delays in receiving care and contribute to poorer health outcomes (Davis et al., 2020).

Essential Benefits Guaranteed by the ACA

The ACA guarantees ten essential health benefits that insurance plans must cover in the Health Care Marketplace. These benefits include:

  1. Ambulatory patient services (outpatient care)
  2. Emergency services
  3. Hospitalization (including surgery and overnight stays)
  4. Maternity and newborn care (pre and postnatal care)
  5. Mental health and substance use disorder services, including behavioral health treatment
  6. Prescription drugs
  7. Rehabilitative and habilitative services and devices (helping people with injuries or disabilities)
  8. Laboratory services
  9. Preventive and wellness services and chronic disease management
  10. Pediatric services, including oral and vision care (HealthCare.gov, n.d.).

These essential benefits are designed to ensure that all individuals have access to comprehensive health care coverage.

Successes of the ACA

The ACA has had several notable successes. It significantly reduced the uninsured rate in the United States, particularly among low-income individuals and minorities. For example, from 2010 to 2016, the uninsured rate among nonelderly adults fell from 16% to 8% (Gaffney & Himmelstein, 2020). Additionally, the law has improved access to preventive services, with millions of Americans receiving services without cost-sharing (National Center for Health Statistics, 2021).

Moreover, the ACA has enhanced protections for individuals with pre-existing conditions, ensuring that they cannot be denied coverage or charged higher premiums based on their health status (Buchmueller et al., 2020).

Failures of the ACA

Despite its successes, the ACA also has significant failures. One of the major shortcomings is the rising costs of premiums and out-of-pocket expenses, which have continued to increase despite the law’s intent to make health care more affordable (Kaiser Family Foundation, 2021).

Furthermore, the political landscape surrounding the ACA has led to instability, with numerous attempts to repeal or undermine the law. This uncertainty can deter individuals from enrolling in coverage, as they may fear losing their plans (Gaffney & Himmelstein, 2020).

Finally, while the ACA expanded coverage, many rural areas still face shortages of providers, leading to difficulties accessing care (Davis et al., 2020). This issue exacerbates health disparities, particularly in underserved populations.

 

References

  1. Berk, M. L., Schur, C. L., & Eber, M. (2019). The uninsured in 2019: A primer. The Commonwealth Fund. https://www.commonwealthfund.org/publications/issue-briefs/2019/jan/uninsured-2019-primer
  2. Buchmueller, T. C., Levy, H. G., & Schmitz, H. (2020). The effect of the Affordable Care Act on health insurance coverage in 2014. Health Affairs, 39(6), 1060-1067. https://doi.org/10.1377/hlthaff.2019.01476
  3. Davis, K., Schoen, C., & Stremikis, K. (2020). The Commonwealth Fund 2020 Affordable Care Act Tracking Survey: A 2020 Perspective. The Commonwealth Fund. https://www.commonwealthfund.org/publications/surveys/2020/jul/2020-affordable-care-act-tracking-survey
  4. Gaffney, A., & Himmelstein, D. U. (2020). The Affordable Care Act: A narrative. The American Journal of Public Health, 110(12), 1687-1693. https://doi.org/10.2105/AJPH.2020.305962
  5. Kaiser Family Foundation. (2021). 2021 Employer Health Benefits Survey. https://www.kff.org/report-section/ehbs-2021-summary-of-findings/
  6. HealthCare.gov. (n.d.). Essential health benefits. https://www.healthcare.gov/coverage/essential-health-benefits/
  7. National Center for Health Statistics. (2021). Health, United States, 2020: The health status of the United States. https://www.cdc.gov/nchs/hus/index.htm
 
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Literature Evaluation Table

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Literature Evaluation Table

In nursing practice, accurate identification and application of research is essential to achieving successful outcomes. The ability to articulate research data and summarize relevant content supports the student’s ability to further develop and synthesize the assignments that constitute the components of the capstone project.

The assignment will be used to develop a written implementation plan. For this assignment, provide a synopsis of the review of the research literature. Using the “Literature Evaluation Table,” determine the level and strength of the evidence for each of the eight research articles you have selected.

The articles should be current (within the last 5 years) and closely relate to the PICOT question developed earlier in this course. The articles may include quantitative research, descriptive analyses, longitudinal studies, or meta-analysis articles. A systematic review may be used to provide background information for the purpose or problem identified in the proposed capstone project.

While APA style is not required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

 

References

Polit, D. F., & Beck, C. T. (2017). Nursing Research: Generating and Assessing Evidence for Nursing Practice (10th ed.). Philadelphia, PA: Wolters Kluwer.
https://shop.lww.com/Nursing-Research%3A-Generating-and-Assessing-Evidence-for-Nursing-Practice/p/9781496330507

Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-Based Practice in Nursing & Healthcare: A Guide to Best Practice (4th ed.). Philadelphia, PA: Wolters Kluwer.
https://shop.lww.com/Evidence-Based-Practice-in-Nursing-and-Healthcare%3A-A-Guide-to-Best-Practice/p/9781496384531

Munn, Z., Peters, M. D. J., Stern, C., Tufanaru, C., McArthur, A., & Aromataris, E. (2018). Systematic review or scoping review? Guidance for authors when choosing between the two. BMC Medical Research Methodology, 18(1), 143.
https://bmcmedresmethodol.biomedcentral.com/articles/10.1186/s12874-018-0611-x

Fineout-Overholt, E., Melnyk, B. M., & Stillwell, S. B. (2019). Critical Appraisal of the Evidence: How to Use the Evidence. In Evidence-Based Practice in Nursing & Healthcare: A Guide to Best Practice (4th ed., pp. 59-84). Philadelphia, PA: Wolters Kluwer.
https://shop.lww.com/Evidence-Based-Practice-in-Nursing-and-Healthcare%3A-A-Guide-to-Best-Practice/p/9781496384531

Sackett, D. L., Rosenberg, W. M. C., Gray, J. A. M., Haynes, R. B., & Richardson, W. S. (1996). Evidence based medicine: What it is and what it isn’t. BMJ, 312(7023), 71-72.
https://www.bmj.com/content/312/7023/71

 
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Parkinson’s Disease Diagnosis

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Parkinson’s Disease Diagnosis

A 67-year-old man presents to the health care provider with chief complaint of tremors in his arms. He also has noticed some tremors in his leg as well. The patient is accompanied by his son, who says that his father has become “stiff” and it takes him much longer to perform simple tasks. The son also relates that his father needs help rising from his chair.

Physical exam demonstrates tremors in the hands at rest and fingers exhibit “pill rolling” movement. The patient’s face is not mobile and exhibits a mask-like appearance. His gait is uneven, and he shuffles when he walks, and his head/neck, hips, and knees are flexed forward. He exhibits jerky or cogwheeling movement.

The patient states that he has episodes of extreme sweating and flushing not associated with activity. Laboratory data is unremarkable and the health care provider has diagnosed the patient with Parkinson’s Disease.

Parkinson's Disease Diagnosis

 

Case Study Analysis: Parkinson’s Disease Diagnosis

The case of a 67-year-old man presenting with tremors, stiffness, and other characteristic symptoms is indicative of Parkinson’s Disease. Parkinson’s Disease is a progressive neurodegenerative disorder primarily affecting motor function due to the loss of dopaminergic neurons in the substantia nigra region of the brain.

Key Symptoms and Clinical Presentation

The patient exhibits several hallmark signs of Parkinson’s Disease:

  1. Tremors: The presence of resting tremors in the arms and “pill-rolling” movements of the fingers are classic symptoms. These tremors typically occur when the muscles are relaxed.
  2. Bradykinesia: The patient’s son reports that he has become “stiff” and takes longer to perform simple tasks. Bradykinesia, or slowness of movement, is a core feature of the disease.
  3. Rigidity: The patient appears stiff and requires assistance rising from his chair. Rigidity is often observed in the limbs and neck.
  4. Postural Instability: The shuffling gait, along with the flexed posture of the head, neck, hips, and knees, suggests postural instability, common in advanced stages of Parkinson’s Disease.
  5. Non-Motor Symptoms: The episodes of extreme sweating and flushing, which are not associated with activity, may indicate autonomic dysfunction, a common non-motor symptom in Parkinson’s patients.

Diagnosis

The diagnosis of Parkinson’s Disease is primarily clinical and relies on the presence of at least two of the following motor symptoms: tremor, rigidity, bradykinesia, and postural instability (MDS Task Force, 2015). In this case, the patient presents with multiple features that align with these diagnostic criteria. The lack of significant findings in laboratory data further supports the diagnosis as there are no alternative conditions indicated.

Differential Diagnosis

While the clinical presentation strongly suggests Parkinson’s Disease, several other conditions could mimic its symptoms, necessitating careful differential diagnosis:

  1. Essential Tremor: This is characterized by action tremors rather than resting tremors and is less likely given the rigidity and bradykinesia present in this patient.
  2. Multiple System Atrophy: This condition can present similarly but typically includes more pronounced autonomic dysfunction and a different course of progression.
  3. Progressive Supranuclear Palsy: This condition can present with parkinsonian features; however, it typically involves prominent postural instability and ocular signs, which are not noted in this case.

Treatment Options

The management of Parkinson’s Disease focuses on alleviating symptoms and improving quality of life. Common treatment options include:

  1. Levodopa/Carbidopa: This is the most effective treatment for motor symptoms. Levodopa is converted to dopamine in the brain, alleviating symptoms of bradykinesia and rigidity (Mamikonyan et al., 2019).
  2. Dopamine Agonists: Medications such as pramipexole and ropinirole can be used as initial therapy or adjunct to levodopa to help manage symptoms.
  3. MAO-B Inhibitors: These medications, such as selegiline, can help prolong the effects of levodopa and provide additional symptomatic relief.

Conclusion

This case study illustrates the clinical features of Parkinson’s Disease, highlighting the importance of accurate diagnosis based on observable symptoms. The treatment plan should be tailored to the individual, focusing on improving the patient’s functional capabilities and quality of life. Ongoing monitoring and adjustments to therapy are essential as the disease progresses.

References

Mamikonyan, E., LaPorte, D., & Dorsey, E. R. (2019). Clinical management of Parkinson’s disease: A review. American Journal of Health-System Pharmacy, 76(14), 1039-1048. https://doi.org/10.1093/ajhp/zxz095

MDS Task Force on Rating Scales. (2015). The Movement Disorder Society’s task force on rating scales for Parkinson’s disease: Recommendations for a comprehensive version of the Unified Parkinson’s Disease Rating Scale. Movement Disorders, 30(7), 1006-1022. https://movementdisorders.onlinelibrary.wiley.com/doi/full/10.1002/mds.25412

Schapira, A. H. V., & Mann, D. M. A. (2019). Neurodegenerative diseases. In G. K. C. S. Hu & A. H. V. Schapira (Eds.), Textbook of Clinical Neurology (pp. 505-517). Elsevier. https://www.elsevier.com/books/textbook-of-clinical-neurology/hu/978-0-323-50713-7

Gao, A. F., & Lang, A. E. (2016). Parkinson’s disease: diagnosis and management. BMJ, 355, i6282. https://www.bmj.com/content/355/bmj.i6282

Simmons, Z., & Decker, P. (2018). Parkinson’s Disease: Diagnosis and Treatment. Primary Care: Clinics in Office Practice, 45(3), 465-486. https://doi.org/10.1016/j.pop.2018.04.002

 
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