Category: Nursing

JOURNAL ENTRY # 2

On any given day, a nurse can play a pivotal role in someones life. Experienced nurses often share stories of previous experiences and draw upon these experiences when circumstances warrant.

Hence, reflection can be a valuable tool. It serves as a tool for not only recalling experiences but also for applying lessons learned from those experiences. Keeping a nursing journal provides these benefits and more.

TO PREPARE

• Refer to the current Clinical Guidelines found in this weeks Learning Resources and consider how these guidelines inform your clinical experience.
• Refer to your FNP or AGPCNP Clinical Skills and Procedures Self-Assessment Form you submitted in Week 1, and consider how your self-assessment might inform your Assignment.
• Refer to your Patient Log in Meditrek and reflect on Weeks 610 of your clinical experience, and reflect on your observations and experiences with patients during this time.

Journal Entry #2 (450500 words):

In your journal entry, answer the following questions:

Learning and Experiences

Reflect on the 3 most challenging patient encounters and discuss what was most challenging for each.

• What did you learn from this experience?
• What resources did you have available?
• What evidence-based practice did you use for this patient?
• What new skills are you learning?
• What would you do differently?
• How are you managing patient flow and volume?

Communicating and Feedback

Ask yourself the following self-reflective questions:

• How might I improve on my skills and knowledge, and how do I communicate that back to my Preceptor?
• How am I doing? What is missing?
• What type of feedback am I receiving from my Preceptor?

To prepare:

• Review the Required Learning Resources
• Review quality improvement models and processes
• Review the infographic resources provided
• Review the Quality Improvement Models Handout
• Select one quality improvement process or model from the following list: Six Sigma, FADE, PDSA

The Assignment

1. Construct an infographic that focuses on a quality improvement initiative by selecting one of the following quality improvement process or model: Six Sigma, FADE, or PDSA.
2. In your infographic, you will describe the quality improvement model or process and incorporate an example to illustrate how the chosen model/process can be applied in your area of practice.

LEARNING RESOURCES:

REQUIRED MEDIA:

Forde-Johnston, C. (2023). [Video]. YouTube.

Required readings:

Spath, P., & Devane, A. (2023). (4^th ed). Health Administration Press.

Chapter 5, Continuous Improvement (pp. 122145)

Agency for Healthcare Research and Quality. (2020).

Centers for Medicare & Medicaid Services. (2021).

Coury, J., Schneider, J. L., Rivelli, J. S., Petrik, A. F., Seibel, E., DAgostini, B., Taplin, S. H., Green, B. B., & Coronado, G. D. (2017). BMC Health Services Research, 17(1), 411.

StatPearls. (2023).

World Health Organization. (2023).

Document:

Document:

Document:

Hematology & Cardiovascular

Lifestyle Factors as Shared Etiologic Drivers of Cardiovascular and Hematologic Disease.

Poor dietary habits, smoking, obesity, and stress have been identified as lifestyle factors that contribute significantly to the onset of both hematologic and Cardiovascular Diseases. These aspects have systemic effects that interfere with vascular integrity, distort coagulation pathways, and interfere with oxygen delivery (Raheli et al., 2024). Cardiovascular and hematologic systems are closely interrelated thus, injuries, including inflammation, oxidative stress, and endothelial dysfunction, tend to manifest themselves in both domains (Raheli et al., 2024). APNs have the opportunity to recognize these adjustable risks at an early stage, inform patients about them based on the evidence-based strategies, and take preventive measures that can diminish morbidity and mortality in the long term.

Pathophysiologic Processes that Impact Vascular Integrity and Coagulation.

Poor diets with a high level of saturated fats and refined sugars are known to favour hyperlipidemia, which in turn causes the development of endothelial rupture and atherosclerotic plaque formation (Schmidt-Trucksss et al., 2024). Smoking increases the speed at which oxidative stress occurs and decreases the availability of nitric oxide, leading to the hindrance of the vasodilation process and platelet hyperactivity (Raheli et al., 2024). Obesity also leads to a long-lasting pro-inflammatory condition that is characterized by increased levels of cytokines like interleukin-6 and tumor necrosis factor-alpha, which cause damage to vascular endothelium and thrombogenesis (Kajikawa & Higashi, 2022). Chronic stress stimulates the hypothalamic-pituitary-adrenal axis (Raheli et al., 2024), which raises the levels of cortisol and catecholamine, which raise blood pressure, interfere with glucose metabolism, and platelet aggregation, making the heart susceptible to cardiovascular diseases.

Effects on Oxygen Tissues and Hematology.

The same lifestyle aspects also affect the delivery of oxygen by changing the production and functioning of red blood cells. The deficiency of nutrient-poor diets may cause anemia due to the deficiency of iron (Turner et al., 2023), vitamin B12, or folate that will cause a low oxygen-carrying capacity. The carbon monoxide levels are augmented by smoking and make hemoglobin less responsive to oxygen, causing compensatory polycythemia (Sotiridis et al., 2025). The further worsening of hypoxemia is caused by the presence of obesity-related hypoventilation and obstructive sleep apnea, which causes the production of red blood cells under the influence of erythropoietin (Kajikawa & Higashi, 2022). Obesity-related chronic inflammation and stress-related anemia of chronic disease is caused by interference with iron utilization and inhibition of erythropoiesis.

Thromboembolism and Hematologic.

Endothelial injury and inflammation caused by lifestyle are predisposing factors to thromboembolic disorders. Venous thromboembolism is closely linked to smoking and obesity as a result of elevated blood viscosity, hyperactivity of platelets, and a decline in fibrinolysis (Zawadzka et al., 2025). An increase in fibrinogen during chronic stress and in metabolic syndrome also increases the formation of clots. These factors intersect with the cardiovascular pathology, hence the association between coronary artery disease, stroke, and the presence of a hematologic process such as polycythemia and hypercoagulable state (Kaddoura et al., 2025). These cumulative factors pose a great risk for the development of a life-threatening condition such as myocardial infarction and pulmonary embolism.

Evidence-Based Lifestyle Interventions

There is strong evidence that lifestyle modification is a key pillar of the prevention of cardiovascular and hematologic disorders. Food habits like the Mediterranean diet lower inflammation, enhance lipid levels, and maintain sufficient levels of micronutrients. Quitting smoking has a rapid effect of improving the endothelial performance and decreasing the risk of thrombosis (Raheli et al., 2024). Exercise improves the levels of insulin sensitivity, oxygenation, and inflammation markers. Cortisol levels and blood pressure are reduced using strategies of stress reduction, such as mindfulness and cognitive-behavioral interventions (Babak et al., 2022).

The Role of the Advanced Practice Nurse

Mindful interviewing (MI) is an evidence-based and patient-centered communication model enhancing intrinsic motivation through assisting patients to explore and overcome resistance to change, which is crucial towards adoption and sustainability of healthier lifestyles (Oikarinen et al., 2024). Literature indicates that nurse-led counseling enhanced by motivational interviewing and behavior-change strategies contributes to better patients’ engagement, achievement of set goals, and healthy behavior such as improved nutrition, regular physical activity, and smoking cessation (Oikarinen et al., 2024). Continued interaction between the APN and the patient enables follow-up reinforcement of the progress, re-evaluation of the impediments, and modernization of personalized approaches that lead to a lasting behavioral change and improved clinical outcomes.

References

Babak, A., Motamedi, N., Mousavi, S. Z., & Ghasemi Darestani, N. (2022). Effects of mindfulness-based stress reduction on blood pressure, mental health, and quality of life in hypertensive adult women: A randomized clinical trial study. Journal of Tehran Heart Center, 17(3), 127133.

Kaddoura, R., Ahmed, D., Rudwan, A., Elyas, A., & Yassin, M. A. (2025). Acute coronary syndrome in essential thrombocythemia and polycythemia vera. Heart Views, 26(3), 175187.

Kajikawa, M., & Higashi, Y. (2022). Obesity and endothelial function. Biomedicines, 10(7), 1745.

Oikarinen, A. K., et al. (2024). Nurses’ experiences of competence in lifestyle counselling with adult patients in healthcare settings: A qualitative systematic literature review. Journal of Clinical Nursing.

Raheli, V., Perkovi, T., Romi, L., Perkovi, P., Klobuar, S., Pavi, E., & Raheli, D. (2024). The role of behavioral factors on chronic diseasesPractice and knowledge gaps. Healthcare, 12(24), 2520.

Schmidt-Trucksss, A., Lichtenstein, A. H., & Von Knel, R. (2024). Lifestyle factors as determinants of atherosclerotic cardiovascular health. Atherosclerosis, 395, 117577.

Sotiridis, A., Dardamanis-Aidonas, C., Makris, A., Loukas, I., Geladas, N., & Koskolou, M. (2025). Tobacco smoking: A stimulus for blood volume expansion. Respiratory Physiology & Neurobiology, 339, 104505.

Turner, J., Parsi, M., & Badireddy, M. (2023, August 8). Anemia. In StatPearls. StatPearls Publishing.

Zawadzka, P. S., Imiela, A. M., & Pruszczyk, P. (2025). The Interplay Between Obesity and Venous Thromboembolism: From Molecular Aspects to Clinical Issue. International Journal of Molecular Sciences, 26(21), 10292.

Instructions

The first part of the Nursing Process Project requires you to complete the Assessment section on the Nursing Process Project template. Follow these steps to complete this part of the project.

Step 1: Select a movie character to use as your fictitious client throughout the project. Any character will work for this project.

Step 2: Find a movie clip of this character performing an action or task to use for your assessment.

Step 3: Review the movie clip you selected to help you identify the content needed for the assessment.

• What do you notice about the character or the environment in the clip?
• What does the character look like?
• How would you describe the characters
  • Physical build
  • Voice
  • Hair, skin, etc.
  • Mobility
  • Hygiene
  • Nutritional status
• Does the character use any verbal or nonverbal cues that provide additional information you can use for your assessment?

Step 4: Complete the Assessment section of the . If a category is non-applicable, write NA in that section of the template.

Step 5: Submit your Nursing Process Project template completed through the Assessment section.

NUR 211 – Nursing Process Project: Assessment Rubric

NUR 211 – Nursing Process Project: Assessment Rubric

Criteria	Ratings	Pts
This criterion is linked to a Learning OutcomeAssessment	8 ptsOutstandingAssessment is thorough and includes all relevant topics. Questions provided are utilized.6 ptsGoodAssessment is thorough and includes most relevant topics. Questions are used to a degree. 4 ptsProficientAssessment is provided but has missing relevant topics. Questions provided are minimally used.2 ptsNeeds ImprovementAssessment is lacking significant information. Questions provided are not utilized.0 ptsUnacceptableAssessment is absent or severely lacking appropriate information.	8 pts
This criterion is linked to a Learning OutcomeScholarly/Professional Composition	2 ptsOutstandingExpert level of writing with little to no errors.1.5 ptsGoodGood level of writing with minimal (<2) errors. 1 ptsProficientAverage level of writing with some (3-5) errors.0.5 ptsNeeds ImprovementBelow average level of writing with significant (>5) errors.0 ptsUnacceptableLevel of writing is far below what is expected for scholarly/professional composition.	2 pts

Total Points: 10

Topic: Polypharmacy and Adverse Drug Reactions in Elderly Patients

identify four to five research articles that relate to your topic. These are the articles that you will use to write the literature review for your research project.

• Choose articles with both qualitative and quantitative research design (No more than 3 from one type)
• All articles must be full text, peer-reviewed, and LESS than 10 years old (published 2015 or later)
• Submit ONE summary of your individual articles using the template below.

Below is a list of best resources for scholarly articles:

• CINAHL
• American Journal of Nursing
• Clinical Trials
• PubMed Central
• Sage Research Methods
• Medline with Full Text
• UpToDate

follow this description and rubric. MUSTTTT READ CSREFULLY BEFORE YOU BEGIN.

Discussion Board Requirements

The Online Discussion Board is designed to stimulate class dialogue that would normally take place in a face-to-face didactic setting. Participation in the Discussion Board serves as a learning strategy to help demonstrate student knowledge of course content. Each Discussion Board post will be assessed using a rubric. In addition to reviewing the grading criteria in the rubric, please note the following Discussion Board post expectations, which must all be met to earn full weekly discussion credit:

must post at least 25 word inm initial

• APA Requirements:
  Each post must have a reference and in-text citations. When thinking about what information needs to be cited, unless you did the actual research to discover the information, you must cite it.

Initial Discussion Board posts:

When writing your initial scholarly post (the one that answers the discussion prompt question) you must discuss the question and support your information with the text as well as an outside scholarly resource. Post a well-developed, scholarly response to Initial Discussion Board Prompts Craft comprehensive academic thoughts on the academic topic that are at least 25 words.

• A well-developed post is meaningful, clearly demonstrates relevance to the topic, reflects critical thinking and your knowledge of the material, demonstrates synthesis of the subject matter, extends the discussion by building on previous posts, and includes proper source citations, when applicable. Posts limited to I agree, Great posting, or Thank you will not be assessed as well-developed and will therefore not be considered a contribution to the number of required weekly posts.

Discussion Questions: Exploring the Federal Emergency Management Agency’s (FEMA) Role in Disasters and Nursing Implications

Research and Analyze: Research a past natural disaster of your choice (https://www.fema.gov/disaster/declarations).

• Describe how FEMA supported the community and coordinated disaster response efforts. Share specific examples of their contributions to preparedness, relief, and recovery.

Preparedness and Collaboration:

• What other local, national, or international agencies partnered with FEMA to support the affected community? Provide examples of their roles and contributions.

Nursing Implications and Community Health Needs:

• What were the primary health concerns and community needs resulting from the disaster? Consider injuries, traumas, and mental health impacts.

Post-Disaster Health Risks:

• Identify potential diseases or health conditions that may arise following the disaster.
• Outline specific measures to protect both yourself and the community from these risks. Include examples of infection control, health education, or public health interventions.

In your peer responses, help expand the discussion by proposing additional disaster preparedness and response strategies.

Reply to at least two peers; one reply should address a peer who researched a different disaster than yours.

• Compare and contrast the challenges and responses.
• Offer constructive suggestions for strengthening disaster plans and processes based on your insights.

Support your answers with scholarly sources (references and citations).

Per FEMA: Emergency vs. Disaster
The terms emergency and disaster are often used interchangeably. This common use of terms can be confusing. It is easiest to understand the terms emergency and disaster as being at two ends of a scale, in which the size of an incident and the resources to deal with the incident are matched to varying degrees. Emergency at one end of the spectrum, emergencies are generally small-scale, localized incidents that are resolved quickly using local resources. However, small-scale emergencies can escalate into disasters when there has been inadequate planning and wasteful use of resources. At the other end of the spectrum, disasters are typically large-scale and cross geographic, political, and academic boundaries. Disasters require a level of response and recovery greater than local communities can provide.

the links i sent are required for you to use.

It is important that all employees can recognize common examples of good catches in healthcare that prevent patient harm before it reaches the patient. The following are five situations in which harm can likely occur when no action is taken.

1. Fall/Slip: Housekeeping mops up a coffee spill and forgets to place a wet floor caution sign. During an environment of care (EOC) safety rounding, an employee finds a wet floor sign and puts it in the hallway. This good catch prevented patients from slipping on a wet floor because of appropriate signage not in place during mopping.
2. Wrong Labeling: Smeared ink and faded print can make labels hard to read. Additionally, it can cause a recollect on laboratory specimens. An employee catching these mistakes and replacing improper labels before sending the specimen to the lab is considered a good catch and prevents a patient from experiencing an uncomfortable redraw.
3. Patient Privacy: A set of EKG strips with a patient’s private information is lying on a worktable. This is a threat to the HIPAA Security Rule that requires PHI to be always secured. If private information is left unattended, it could be viewed by another staff member, patient, or visitor who is unauthorized. An employee catching the exposed information and moving it before harm occurs is an example of a good catch.
4. Mobility Risk: Patients need to transfer and ambulate to maintain their strength while on bed rest. However, a pair of non-slip socksis left behind in a high-risk patient’s room as he or she takes a walk around the unit. A staff member notices the socks and notifies a supervisor to prevent patient injury.
5. Mealtime Assistance: A patient is on a pured, level-3 fluids diet order. This diet consists of foods that require less chewing. A nurse performing a routine check-in noticed he received a dinner roll on his lunch tray and removed it. This is a good catch that could have prevented complications with post-operative care.

Write a substantive 200- to 300-word response that includes the following prompt. Use an article that is 2020 and older. Make sure to use APA format as well.

• Explore the literature and share an article that relates to a great catch program and the effect it had on future patient safety.
• Share your thoughts on what prevents staff from speaking up on potential unsafe practices.

Use the IEM Rapid Intubation, and the information from the two articles below to create an infographic or poster that visually depicts the lung- ventilatory process. (Articles will be post a documents as well as the IEM rapid intubation)

StatPearls Acute Respiratory Distress Syndrome Links to an external site.

Up To Date Acute respiratory distress syndrome: Ventilator management strategies for adults Links to an external site.

Instructions

1. Design your infographic

Use visual elements and very few words to depict the key steps of the intubation process in a memorable way.

If you are making a general infographic, include contraindications for older populations.

Include visual elements that highlight your key points.

Describing, Diagnosing, & Treatment of Skin, Eye, & Ear Disorders

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Based on and experience, please answer the following questions:

1. Describe dermatitis, diagnostic criteria, and treatment modalities
2. Describe the drug therapy for Conjunctivitis and Otitis Media
3. Discuss Herpes Virus infections, patient presentation, and treatment
4. Describe the most common primary bacterial skin infections and the treatment of choice.

Submission Instructions:

• Your initial post should be at least 500 words, formatted and cited in the current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.
  • Each question must be answered individually as in bullet points. Not in an essay format.
  • Example: Question 1, followed by the answer to question 1; Question 2, followed by the answer to question 2; and so forth.

After studying , discuss the following:

It is very important for all mental health professionals to take very detailed and thorough historical information from their patients. This information should include an adequate social history, complete medical history, and a full mental status examination with a probable treatment plan.

• Describe three reasons it is important to gather detailed and extensive information from any patient before you counsel him/her or make medication suggestions. Use evidence-based research to support your position.
• Define malingering. Discuss two ways to differentiate between malingering and a DSM5 diagnosis. Use evidence-based research to support your position.

Submission Instructions:

• Your initial post should be at least 500 words, formatted, and cited in current APA style with support from at least 2 academic sources.
• PMHNP Discussion Rubric
  

  PMHNP Discussion Rubric

  Criteria	Ratings	Pts
  This criterion is linked to a Learning OutcomeIdentification of Main Issues, Problems and Concepts	4 to >3.0 ptsDistinguishedPost substantively accurate. Identifies and demonstrates a sophisticated understanding of the issues, problems, and concepts surrounding the assignment. Provides exceptional and thought-provoking analysis that directly addresses details and/or examples of the main topic.3 to >2.0 ptsExcellentPost is mostly related to the topic. Demonstrates understanding of most of the issues, problems, and concepts surrounding the assignment. It provides some supporting details and/or examples. Analyses not as clear as they could be.2 to >0.0 ptsFairDemonstrate limited understanding of most of the issues, problems, and concepts surrounding the assignment. No details and/or examples are given.0 ptsPoorPost is off-topic, incorrect and/or irrelevant to the issues, problems, and concepts surrounding the assignment. Analyses are not well organized or clear.	4 pts
  This criterion is linked to a Learning OutcomeAPA Formatting Guidelines	2 ptsDistinguishedThe reference page contains at least the required current scholarly academic reference and text reference. Follows APA guidelines of components: double space, 12 pt. font, abstract, level headings, hanging indent and in-text citations.1 ptsExcellentReferences page contains one current scholarly academic resource and text reference. Follows most APA guidelines of components: double space, 12 pt. font, abstract, level headings, hanging indent, and in-text citations.0.5 ptsFairReferences page contains one current or outdated scholarly academic resource. Many errors of APA guidelines: double space, 12 pt. font, abstract, level headings, hanging indent, and in-text citations0 ptsPoorReferences page contains no current scholarly academic resources, only internet webpages or no reference page. Lack of APA guidelines for references provided or in-text citations.	2 pts
  This criterion is linked to a Learning OutcomeWriting Mechanics	2 ptsFull MarksRules of grammar, usage and punctuation are followed; spelling is correct.1 ptsExcellentFew grammatical errors, but sentences could be clearer and more precise.0.5 ptsFairPaper contains few grammatical, punctuation and spelling errors.0 ptsPoorPaper contains numerous grammatical, punctuation, and spelling errors.	2 pts
  This criterion is linked to a Learning OutcomeResponse to Peers	2 ptsDistinguishedConstructively responded to two other posts and either extended, expanded, or provided a rebuttal to each.1 ptsExcellentConstructively responded to one other post and either extended, expanded, or provided a rebuttal.0 ptsPoorProvided no response to a peer’s post.	2 pts

  10

• The Diagnostic & Statistical Manual Of Mental Disorders (DSM) & Psychiatric Interviewing
  

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  Read and watch the lecture resources & materials below early in the week to help you respond to the discussion questions and to complete your assignment(s).(Note: The citations below are provided for your research convenience. You should always cross-reference the current APA guide for correct styling of citations and references in your academic work.)

  Read

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5). American Psychiatric Pub.
  • MacKinnon, R. A., Michels, R., & Buckley, P. J. (2015).
    • Chapter 15: The Psychosomatic Patient
  • St. Thomas University. (2022). DSM 5 and psychiatric interviewing [slides].
    

  Watch

  • Dream Schema Media. (2011, October 18). Understanding the MSE – Lisa (w/- commentary).
  • ADMSEP. (2019). Clinical simulation initiative eModules: The psychiatric interview. Association of Directors of Medical Student Education in Psychiatry.
    • (Note: Complete the entire module)