Category: Nursing

Hi,

I need to respond to 2 of my peers, which I have listed below. For each peer I need you to use different resources to support your response. Each peer must have 1-2 references that are scholarly journal articles from 2021-current; the sources must be reputable, must be accessible, must have a hyperlink to access them, and full-access. I will attach my case study for this week and the instructions will be below:

Peer Response

Instructions:

Please respond to two peers post regarding their differential diagnosis list and/or plan.

• What did you find interesting about their response?
• How did their differential diagnosis list or plan compare to yours?

Responses need to address all components of the question, demonstrate critical thinking and analysis, and include peer reviewed journal evidence to support the students position.

Please be sure to validate your opinions and ideas with citations and references in APA format.

Please review the rubric to ensure that your response meets the criteria.

Here are the 2 peers I must respond to:

Brian Stormes (Peer #1):

Pertinent Positives

• 68-year-old male presenting with acute-onset, constant dizziness beginning approximately 10 hours prior, first noted upon getting out of bed to use the bathroom
• History of type 2 diabetes mellitus managed with metformin
• Polyuria and polydipsia beginning the same morning as dizziness
• Elevated blood pressure (160/97 mmHg) on presentation
• Presence of a harsh crescendodecrescendo systolic murmur best heard at the right upper sternal border with radiation to the carotids
• Mild frontal headache (2/10)
• BMI 28.43 (overweight)
• Family history significant for hypertension, diabetes, and dementia

Pertinent Negatives

• Denies chest pain, palpitations, shortness of breath, syncope, or focal neurological deficits
• No vertigo, room spinning, gait instability, or lightheadedness
• No nausea, vomiting, or visual disturbances
• Neurological exam intact with normal strength, sensation, reflexes, coordination, and negative Romberg
• No fever, infection symptoms, or recent trauma
• Oxygen saturation within acceptable range (95%)
• No orthostatic symptoms reported

Missing Information

• Orthostatic vital signs
• Hemoglobin A1c and fasting blood glucose
• Serum electrolytes and renal function
• Urinalysis to assess for glucosuria or dehydration
• Echocardiogram to further evaluate systolic murmur
• Lipid profile and cardiovascular risk assessment
• Medication adherence and recent dietary intake
• Home blood pressure and glucose monitoring data

Differential Diagnoses

1. Uncontrolled hypertension supported by elevated BP and headache, which may contribute to dizziness
2. Aortic stenosis suggested by systolic murmur radiating to carotids and exertional or positional dizziness
3. Hyperglycemia-related dehydration polyuria, polydipsia, and dizziness consistent with osmotic diuresis

Plan of Care

Diagnostics

• Obtain orthostatic blood pressures
• Basic metabolic panel, fasting glucose, HbA1c
• Urinalysis
• Lipid panel
• Transthoracic echocardiogram to assess for valvular disease
• ECG to evaluate for left ventricular hypertrophy or arrhythmia (Carey et al., 2018)

Therapeutics

• Initiate first-line antihypertensive therapy (ACE inhibitor or ARB) per ACC/AHA guidelines
• Continue metformin; adjust diabetic regimen pending lab results
• Encourage adequate oral hydration
• Lifestyle modification targeting weight reduction and sodium intake (ElSayed et al., 2023; Carey et al., 2018)

Educational

• Educate patient on blood pressure and glucose self-monitoring
• Review signs and symptoms requiring urgent evaluation (syncope, chest pain, neurological deficits)
• Discuss DASH diet principles, physical activity, and diabetes control
• Reinforce medication adherence and routine follow-up

Consultation / Referrals

• Cardiology referral for murmur evaluation and echocardiography
• Consider endocrinology if glycemic control remains suboptimal
• Nutrition referral for dietary counseling

References

Carey, R. M., & Whelton, P. K. (2018). Prevention, detection, evaluation, and management of high blood pressure in adults: Synopsis of the 2017 American College of Cardiology/American Heart Association Hypertension Guideline. Annals of Internal Medicine, 168(5), 351358. https://doi.org/10.7326/m17-3203

ElSayed, N. A., Aleppo, G., Bannuru, R. R., Beverly, E. A., Bruemmer, D., Collins, B. S., Cusi, K., Darville, A., Das, S. R., Ekhlaspour, L., Fleming, T. K., Gaglia, J. L., Galindo, R. J., Gibbons, C. H., Giurini, J. M., Hassanein, M., Hilliard, M. E., Johnson, E. L., Khunti, K., … Gabbay, R. A. (2023). Introduction and methodology: standards of care in diabetes2024. Diabetes Care, 47(Supplement_1). https://doi.org/10.2337/dc24-sint

Yujin Eom (Peer #2):

Pertinent Positives

The patient is a 68 year old male presenting with acute onset dizziness that began approximately 10 hours prior to evaluation. The dizziness started when rising from bed during the night and remained constant. He reports a mild frontal headache rated 2/10 and new onset polyuria and polydipsia beginning the same morning. His past medical history is significant for type 2 diabetes mellitus. Objective findings include elevated blood pressure at 160/97 and a harsh crescendodecrescendo systolic murmur best heard at the right upper sternal border with radiation to the carotid arteries. Advanced age, overweight status with central obesity, and cardiovascular risk factors increase concern for a cardiac etiology contributing to dizziness and fall risk (Gauer & Semidey, 2019; ACC/AHA, 2020).

Pertinent Negatives

The patient denies vertigo, syncope, near-syncope, gait instability, or lightheadedness. He reports no chest pain, palpitations, dyspnea, or visual changes. Neurological examination is normal, including intact cranial nerves, strength, sensation, coordination, and a negative Romberg test. Oxygen saturation is within normal limits, and there are no focal neurological deficits, making an acute neurologic event less likely (Gauer & Semidey, 2019).

Missing Information

Important missing data include orthostatic vital signs, recent glycemic control measurements such as HbA1c, electrolyte levels, renal function tests, and hydration status. Prior cardiac workup, including echocardiography, would be essential given the auscultated murmur. Additional information regarding fall history and home safety assessment would further support evaluation of fall risk in this older adult (CDC, 2017).

Differential Diagnoses

The priority diagnosis is suspected aortic stenosis, supported by the characteristic systolic murmur radiating to the carotids and the patients dizziness, which may represent presyncope. Aortic stenosis is a common cause of exertional dizziness and syncope in older adults and significantly increases fall risk (ACC/AHA, 2020). Uncontrolled hypertension is another consideration, as elevated blood pressure can contribute to headache and dizziness in the geriatric population (James et al., 2014). Hyperglycemia with osmotic diuresis is also possible given the acute onset of polyuria and polydipsia, which may result in volume depletion and dizziness. Orthostatic hypotension remains a differential diagnosis due to symptom onset upon rising, though confirmation requires orthostatic measurements (Gauer & Semidey, 2019).

Diagnostics

A transthoracic echocardiogram is indicated to confirm the presence and severity of aortic stenosis. Additional testing should include an electrocardiogram, orthostatic vital signs, basic metabolic panel, HbA1c, and urinalysis to evaluate metabolic and volume status (ACC/AHA, 2020).

Therapeutics

Blood pressure management should be approached cautiously until valvular disease is evaluated, as aggressive reduction may worsen symptoms in patients with aortic stenosis. The patient should continue metformin therapy, with adjustments guided by laboratory findings. Adequate hydration should be encouraged, and fall precautions should be implemented to reduce injury risk (CDC, 2017).

Education

The patient should be educated on fall prevention strategies, including slow positional changes and use of adequate nighttime lighting. He should be instructed to seek immediate care if symptoms such as syncope, chest pain, or worsening dizziness occur. Education regarding the significance of the cardiac murmur and the need for further evaluation is essential (ACC/AHA, 2020).

Consultation and Referrals

Referral to cardiology is warranted for further evaluation and management of suspected aortic stenosis. Additional referrals may be considered based on diagnostic results and fall risk assessment.

References

American College of Cardiology/American Heart Association. (2020). 2020 ACC/AHA guideline for the management of patients with valvular heart disease. Journal of the American College of Cardiology, 77(4), e25e197. https://doi.org/10.1016/j.jacc.2020.11.018

Centers for Disease Control and Prevention. (2017). Falls are serious and costly.

Gauer, R. L., & Semidey, M. J. (2019). Dizziness: Approach to evaluation and management. American Family Physician, 100(12), 756764.

James, P. A., et al. (2014). Evidence-based guideline for the management of high blood pressure in adults. JAMA, 311(5), 507520.

The focus of Assessment 4 is on how informatics support monitoring of nursing-sensitive quality indicator data. You will develop an 810 minute audio (or video) training module to orient new nurses in a workplace to a single nursing-sensitive quality indicator critical to the organization. Your recording will address how data are collected and disseminated across the organization along with the nurses role in supporting accurate reporting and high quality results. Professional Context The American Nursing Association (ANA) established the National Database of Nursing Quality Indicators (NDNQI) in 1998 to track and report on quality indicators heavily influenced by nursing action. NDNQI was established as a standardized approach to evaluating nursing performance in relation to patient outcomes. It provides a database and quality measurement program to track clinical performance and to compare nursing quality measures against other hospital data at the national, regional, and state levels. Nursing-sensitive quality indicators help establish evidence-based practice guidelines in the inpatient and outpatient settings to enhance quality care outcomes and initiate quality improvement educational programs, outreach, and protocol development. The quality indicators the NDNQI monitors are organized into three categories: structure, process, and outcome. Theorist Avedis Donabedian first identified these categories. Donabedians theory of quality health care focused on the links between quality outcomes and the structures and processes of care (Grove et al., 2018). Nurses must be knowledgeable about the indicators their workplaces monitor. Some nurses deliver direct patient care that leads to a monitored outcome. Other nurses may be involved in data collection and analysis. In addition, monitoring organizations, including managed care entities, exist to gather data from individual organizations to analyze overall industry quality. All of these roles are important to advance quality and safety outcomes. Preparation As you begin to prepare this assessment you are encouraged to complete the Donabedian Quality Assessment Framework activity. Quality health care delivery requires systematic action. Completion of this will help you succeed with the assessment as you consider how the triad of structure (such as the hospital, clinic, provider qualifications/organizational characteristics) and process (such as the delivery/coordination/education/protocols/practice style or standard of care) may be modified to achieve quality outcomes. This assessment requires you to prepare an 810 minute narrated tutorial (with optional video) for new nurses on the importance of nursing-sensitive quality indicators. To successfully prepare for your assessment, you will need to complete the following preparatory activities: Review the nursing-sensitive quality indicators presented in the Assessment 04 -: Informatics and Nursing Sensitive Quality Indicators [PDF] Download Assessment 04 -: Informatics and Nursing Sensitive Quality Indicators [PDF]resource and select one nursing-sensitive quality indicator to use as the focus for this assessment. Conduct independent research on the most current information about the selected nursing-sensitive quality indicator. Interview a professional colleague or contact who is familiar with quality monitoring and how technology can help to collect and report quality indicator data. You do not need to submit the transcript of your conversation, but do integrate what you learned from the interview into the audio tutorial. Consider these questions for your interview: What is your experience with collecting data and entering it into a database? What challenges have you experienced? How does your organization share with the nursing staff and other members of the health care system the quality improvement monitoring results? What role do bedside nurses and other frontline staff have in entering the data? For example, do staff members enter the information into an electronic medical record for extraction? Or do they enter it into another system? How effective is this process? Recording Your Presentation To prepare to record your presentation, complete the following: Set up and test your microphone or headset and webcam using the installation instructions provided by the manufacturer. You only need to use the headset if your audio is not clear and high quality when captured by the microphone. Practice using the equipment to ensure the audio and video quality is sufficient. Review Using Kaltura for Kaltura to record your presentation. View Creating a Presentation: A Guide to Writing and Speaking. This video addresses the primary areas involved in creating effective audiovisual presentations. You can return to this resource throughout the process of creating your presentation to view the tutorial appropriate for you at each stage. Practice presenting using PowerPoint, Keynote, Slides, Canva or another presentation platform. Notes: You may use other tools to record your tutorial. You will, however, need to consult Using Kaltura for instructions on how to upload your recorded tutorial into the courseroom, or you must provide a working link your instructor can easily access. If you require the use of assistive technology or alternative communication methods to participate in this activity, please contact DisabilityServices@Capella.edu to request accommodations. Instructions For this assessment, first review the nursing-sensitive quality indicators presented in the Assessment 04 – Informatics and Nursing Sensitive Quality Indicators [PDF] Download Assessment 04 – Informatics and Nursing Sensitive Quality Indicators [PDF]resource and select one nursing-sensitive quality indicator to use as the focus for this assessment. Next, imagine you are a member of a Quality Improvement Council at any type of health care system, whether acute, ambulatory, home health, managed care, et cetera. Your Council has identified that newly hired nurses would benefit from comprehensive training on the importance of nursing-sensitive quality indicators. The Council would like the training to address how this information is collected and disseminated across the organization. It would also like the training to describe the role nurses have in accurate reporting and high-quality results. The council prefers a recorded presentation using PowerPoint or a similar application. This will allow the education department to show the presentation during new hire training. As a result of this need, you offer to create a presentation orienting new hires to these topics. You know that you will need speakers notes to guide your recording. You plan to incorporate the insights you learned from conducting an interview with an authority on quality monitoring and the use of technology to collect and report quality indicator data. You determine that you will cover the following topics in your presentation: Introduction: Nursing-Sensitive Quality Indicator What is the National Database of Nursing-Sensitive Quality Indicators? What are nursing-sensitive quality indicators? Which particular quality indicator did you select to address in your tutorial? Why is this quality indicator important to monitor? Be sure to address the impact of this indicator on the quality of care and patient safety. Why do new nurses need to be familiar with this particular quality indicator when providing patient care? Collection and Distribution of Quality Indicator Data According to your interview and other resources, how does your organization collect data on this quality indicator? How does the organization disseminate aggregate data? What role do nurses play in supporting accurate reporting and high-quality results? As an example, consider the importance of accurately entering data regarding nursing interventions. Enhancing Outcomes Explain how your health care organization uses nursing-sensitive quality indicators to enhance patient safety, patient care outcomes, and organizational performance reports. Describe how a nursing-sensitive quality indicator establishes evidence-based practice guidelines for nurses to follow when using patient care technologies to enhance patient safety, satisfaction, and outcomes. After building your presentation in PowerPoint, Keynote, Slides, Canva, or another presentation platform, practice delivering your tutorial several times before recording. When you record your presentation be sure your slides are visible in the recording. Important: Record your narrated presentation in Kaltura. (Do not record and submit the narration in PowerPoint because your file will become too large to upload.) Additional Requirements Communication: Deliver a professional, effective tutorial on a selected quality indicator that engages new nurses and motivates them to accurately report quality data in a timely fashion. Length: 810 minute recording. Use Kaltura to record the narration and upload your recording to the courseroom or provide a working link your instructor can access. Script: A separate document with the script or speaker’s notes is required. Important: Submissions that do not include the script or speaker’s notes will be returned as a non-performance. References: Cite a minimum of three scholarly and/or authoritative sources. APA: Submit, along with the recording, a separate reference page that follows APA style and formatting guidelines. For an APA refresher, consult the Evidence and APA page on Campus. Reference Grove, S. K., Gray, J. R., Jay, G. W., Jay, H. M., & Burns, N. (2018). Understanding nursing research: Building an evidence-based practice (7th ed.). Elsevier. Competencies Measured By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and scoring guide criteria: Competency 1: Describe nurses’ and the interdisciplinary team’s role in informatics with a focus on electronic health information and patient care technology to support decision making. Describe nursing-sensitive quality indicators in general and explain the importance of a selected indicator to the quality of care and patient safety. Describe the interdisciplinary teams role in collecting and reporting quality indicator data to enhance patient safety, patient care outcomes, and organizational performance reports, including the data that currently exists about a quality indicator. Competency 3: Evaluate the impact of patient care technologies on desired outcomes. Explain how a health care organization uses nursing-sensitive quality indicators to enhance patient safety, patient care outcomes, and organizational performance reports. Competency 4: Recommend the use of a technology to enhance quality and safety standards for patients. Describe how a nursing-sensitive quality indicator establishes evidence-based practice guidelines for nurses to follow when using patient care technologies to enhance patient safety, satisfaction, and outcomes. Competency 5: Apply professional, scholarly communication to facilitate use of health information and patient care technologies. Deliver a professional, effective tutorial along with speaker notes on a selected quality indicator that engages new nurses and motivates them to accurately report quality data in a timely fashion. Submission includes a reference list with at least three scholarly references. Follow APA style and formatting guidelines for citations and references.

1. Application of Course Knowledge: Answer all questions/criteria with explanations and detail.

• Describe the disaster preparedness plan at your current or past workplace.
• Identify potential gaps or areas for improvement in disaster preparedness.
• How can you advocate for necessary changes?
• In what ways can you promote community engagement and resilience in disaster preparedness efforts in the broader community?

Weekly Discussion: 6 (USLO 6.1)

Nurses can advocate through the use of data and Evidence-Based Practice (EBP) to inform healthcare decisions. Incorporating EBP into the delivery of healthcare results in cost-effective care, improved resource allocation, and enhanced patient outcomes.

• Reflect on your current area of nursing practice and identify an EBP that could be incorporated into your unit or organization. (womens hospital- antepartum/postpartum)
• Provide a rationale for why the EBP should be adopted. Utilize a scholarly source to substantiate adopting the EBP.
• Discuss the link between healthcare advocacy through best practices and the financial outcomes of an organization.
• How would incorporating the chosen EBP positively impact cost-effective care delivery, resource allocation, and patient outcomes in your organization?

1. Application of Course Knowledge: Answer all questions/criteria with explanations and detail.

• How might extended reality technologies, such as virtual reality, augmented reality, or mixed reality be utilized in your intended specialty area of advanced nursing practice?
• What type of product that is currently available would be best suited for the application you described?
• What are potential barriers to the implementation and use of the technology in your future practice area?

I have attached the instructions and research articles to use. please follow the rubric.

6 page double spaced paper and a matching powerpoint on Hemodynamic Alterations and Care of Clients (hypertensive states, and trauma clients) with the following: centered headings, Introduction; Health Care Outcomes Based on Evidenced Based Practice; and Conclusion. The reference list will be on the 7th page. Also include a title page and then an abstract as the second page. Follow the format and instructions below: 1. Introduction at beginning of paper 2. The topic in the Literature a. Description of Topic – provide a clear definition and description of the Topic b. Topic’s Development – examine the history 3. Discuss how your topic affects health care and health care outcomes based on evidenced- based practice 4. Conclusion paragraph at end of paper 5. Documentation a. Paraphrasing and direct quotation appropriately used (only 2 direct quotes in the paper). Direct quotes are when you type the sentence word for work and cite author, year, and page number. b. Correct source for paraphrases and quotes included c. Citations follow APA format correctly 6. References a. A minimum of 8 references used b. References follow APA format correctly 7. Overall Format a. Outline followed with headings provided for logical flow in general layout b. Comprehensive, concise, and interesting writing style used c. Correct spelling, punctuation, and grammar used d. Follows APA style throughout paper Sample paper and powerpoint provided,

Four completion certificates from the LinkedIn courses are clearly evident in the Ethically Competent Practice section of the portfolio. However, the submission does not include a corresponding 3-5 paragraph reflective explanation addressing how the training contributes to professional identity and culturally competent patient care. The candidate should add a clear reflection in the Ethically Competent Practice section. there is 4 training certificates those are the certificates it is referring to

Required Questions:

Does HIPAA affect a patients right to access his or her medical records or determine who can see the information?

If so, describe the patients rights. What can patients do if they believe their rights are being denied?

How do you file a complaint regarding a HIPAA violation with the Office of Civil Rights?

Exactly what must a covered entity do to notify patients when theres a breach of unsecured, protected health information?

How does the Office for Civil Rights investigate a complaint of HIPAA violation? Are any other agencies involved? How can complaints be resolved? What penalties, if any, can the Office for Civil Rights impose on doctors and hospitals for violations

Fictional Case Presentation:

Create a case of an adult patient experiencing anxiety. This case can be based on real clinical experience or entirely fictional. Ensure the case includes comprehensive background information, including the patients personal history, lifestyle, and any relevant contextual factors (e.g., recent life changes, family dynamics, work environment).

Symptom Description and Diagnosis:

• Thoroughly explain the patients symptoms, incorporating both psychological and physical manifestations of anxiety. Highlight the duration, frequency, and impact of these symptoms on the patients daily life.
• Based on the patient history as well as symptoms presented, provide a precise diagnosis according to the DSM-5 criteria. Justify the diagnosis by clearly linking the symptoms to the specific criteria.

Treatment Options and Efficacy:

• Discuss different treatment options (first-line, second-line, and so on) for the diagnosed anxiety disorder.
• These should include a mix of therapeutic approaches as needed (e.g., cognitive-behavioral therapy, medication, lifestyle modifications).
• For each treatment option, provide a detailed analysis of its efficacy, citing recent and relevant research studies. Include statistical data or findings that support the effectiveness of each treatment.

First-Line Treatment Recommendation:

• Identify the first-line treatment you would recommend for this particular case. Justify your choice by explaining why this treatment is most suitable for the client, considering their specific symptoms, personal history, and any other relevant factors.
• Discuss potential challenges or considerations in implementing this treatment, such as patient preferences, potential side effects, or barriers to access.

Additional Considerations:

• Include information about which other professionals could be involved in the treatment plan and what their roles would be.
• Include any additional factors that you think are important for understanding and treating the patients anxiety. This could involve discussing comorbid conditions, social determinants of health factors, cultural considerations, or the clients support system.

Research and References:

• Ensure that all claims about treatment efficacy are backed by credible research. Cite at least two peer-reviewed journal articles or authoritative sources to support your analysis.
• Include a reference list at the end of your assignment following APA formatting guidelines.

Presentation Example Structure

Case Presentation:

• Client Background: Age, occupation, family status, personal history, recent life events.
• Symptoms: Detailed description including psychological, physical, and behavioral symptoms.

Diagnosis:

• Symptom Analysis: Link symptoms to DSM-5 criteria.
• Diagnosis: Provide the exact diagnosis and justify it.

Treatment Options:

• Treatment 1: Description and efficacy with research citations.
• Treatment 2: Description and efficacy with research citations.
• Treatment 3: Description and efficacy with research citations.

First-Line Treatment Recommendation:

• Recommended Treatment: Detailed rationale.
• Implementation Challenges: Potential issues and solutions.

Additional Considerations:

• Discuss any other relevant factors impacting treatment and outcomes.

Research and References:

• List of cited research studies and sources.