Discuss the sampling plan that was used in your research article. Is there a different sampling plan that would have been better? How might you change the sampling plan to make this study more culturally applicable?
Nursing Research.
*Every discussion needs 2 references please.
2wk.
Choose a research article that relates to a problem at your facility. Discuss the problem, purpose, theoretical framework, and literature review for the study. Attach your research article to your post.
3wk
What method was used in the research article you chose? Discuss how the data were collected. Is there a way the design or method of data collection could have been done in a better way?
4wk.
Discuss the sampling plan that was used in your research article. Is there a different sampling plan that would have been better? How might you change the sampling plan to make this study more culturally applicable?
5wk.
How were the data analyzed in your research article? Now that you have reviewed the entire article, what other studies do you think need to be done in order to bring this solution into practice?
6wk.
How would you do a qualitative study about the topic you chose? What qualitative design would you use and how would you analyze the data?
7wk.
There are various methods of facilitating evidence-based practice within a facility. Which method would you use to introduce it at your facility?
8wk.
Reflect on what you have learned in this course. How has your opinion/attitude toward nursing research changed?
Pathology
*Every discussion needs 2 references please.
Wk2.
Jackie Johnson, a 35 y.o. African-American, married female, advertising executive, presents to the emergency department with complaints of chest pain. The pain is described as 8 on a scale ranging from 1 to 10, retrosternal, and sharp in nature. It radiates to the back, is worse with taking a deep breath, and is improved by leaning forward. On review of systems, she has noted a “flulike illness” over the last several days, including fever, rhinorrhea, and cough. She has no medical history and is taking no medications. She denies tobacco, alcohol, or drug use. On physical examination, she appears in moderate distress from pain, with a blood pressure of 125/85 mm Hg, heart rate 105 bpm, respiratory rate 18/min, and oxygen saturation of 98% on room air. She is currently afebrile. Her head and neck examination is notable for clear mucus in the nasal passages and a mildly erythematous oropharynx. The neck is supple, with shotty anterior cervical lymphadenopathy. The chest is clear to auscultation. Jugular veins are not distended. Cardiac examination is tachycardic with a three-component high-pitched squeaking sound. Abdominal and extremity examinations are normal.
In this discussion:
1. Provide and discuss this patient’s likely diagnosis with your colleagues.
2. Discuss your differential diagnosis clinical reasoning. Why do you support this “likely diagnosis?
3. Provide and discuss what the most common causes of this disease are, and which is most likely in this patient?
4. Identify the pathophysiologic mechanism for her chest pain.
5. Develop a plan of care post-discharge based upon your recommendations living arrangements and social supports.
Support your discussion with citations from the external literature and your textbook.
3wk
Darla Thomas, a 25 y.o. African-American previously well woman, presents to her primary care NP’s office with complaints of episodic shortness of breath and chest tightness. She has had the symptoms on and off for about 2 years but states that they have worsened lately, occurring two or three times a month. She notes that the symptoms are worse during the spring months. She has no exercise-induced or nocturnal symptoms. The family history is notable for a father with asthma. She is single and works as a secretary in a high-tech firm. She lives with a roommate, who moved in approximately 2 months ago. The roommate has a cat. The patient smokes occasionally when out with friends, drinks socially, and has no history of drug use. Examination is notable for mild end-expiratory wheezing. Pulmonary function tests are ordered to confirm the diagnosis.
In this discussion:
1. Discuss what you think this patient’s likely diagnosis is.
2. Identify the pathogenetic mechanisms that are responsible for this patient’s symptoms of wheezing, shortness of breath, and chest tightness.
3. What might you expect the results of her pulmonary function tests to be? Why?
4. Provide and discuss a plan of care for her. What would be your priority patient education outcomes? How would you achieve these outcomes?
Include citations from the text or the external literature in your discussions.
4wk.
Marisol Arroyo, age 23 y.o., and unmarried, accompanies her mother, Julia, who is a 68 y.o., divorced Hispanic female, to her appointment with her primary care NP. Both Marisol and her mother, who live together, have noted that her ever-present forgetfulness seems to be worsening. Just yesterday she walked to the corner store for a few items, which she obtained, but even though she had been to this store many times over the years, she found herself unable to get home without directions. Marisol also notes that her mother’s hygiene is changing, that she is becoming more and more quarrelsome, and that she forgets information she had been told as little as 10 minutes earlier. The patient’s in NP is ruling out whether this patient may have some form of dementia or delirium.
In this discussion:
1. Describe and discuss the unique pathophysiology of Dementia of the Alzheimer’s Type.
2. If this patient is diagnosed with Alzheimer’s dementia, describe and discuss with your colleagues a potential clinical course, and prognosis for her.
3. Describe and discuss your plan of care for this patient with both short-term and long-term plans considering current social supports and health-care access.
Include citations from the text or the external literature in your discussion posts.
5wk.
Louis Johnson, a 48 y.o., gay, partnered, Caucasian male presents to the emergency department with unremitting right flank pain. He denies dysuria or fever. He does report significant nausea without vomiting. He has never experienced anything like this before. On examination he is afebrile, and his blood pressure is 160/80 mm Hg with a pulse rate of 110/min. He is writhing on the gurney, unable to find a comfortable position. His right flank is mildly tender to palpation, and abdominal examination is benign. Urinalysis is significant for 1+ blood, and microscopy reveals 10–20 red blood cells per high-power field. Nephrolithiasis is suspected, and the patient is intravenously hydrated and given pain medication with temporary relief.
In this discussion:
1. Discuss with your colleagues the pathophysiological development of nephrolithiasis.
2. Provide a rationale for whether this patient should be further evaluated for renal surgery at this time.
3. Describe and discuss your plan of care for this patient until he leaves the hospital and for the first two weeks following discharge.
Include citations from the text or the external literature in your discussions.
6wk.
Luv Taub, a 32-year-old, married Hmong woman, presents to her primary care NP complaining of a persistent burning sensation in her chest and upper abdomen. The symptoms are worse at night while she is lying down and after meals. She enjoys many years of cooking and eating “hot and spicy foods” common in her culture. She has tried drinking hot cocoa to help her sleep. She is a smoker and frequently relies on benzodiazepines for insomnia. She notes a sour taste in her mouth every morning. Physical examination is normal.
In this discussion:
1. Discuss this patient’s likely diagnosis.
2. Describe the pathophysiology of this disorder.
3. Discuss a plan of care for this patient.
4. What is the anticipated prognosis for this patient? What lifestyle factors might alter her short- and long-term outcomes?
7wk.
1.Leonard Mays, a 58 y.o., Caucasian, homeless man with long-standing insulin-treated type 2 diabetes has been diagnosed with right lower extremity cellulitis. He has taken a prescribed oral antibiotic for the past week but has not noticed much improvement. For the last 2 days, he has complained of intermittent fevers and chills, nausea with poor oral intake, and proximally spreading erythema over his right leg. On the evening ofadmission, a worker at the homeless shelter notices that he is markedly confused and calls 911. In the emergency room, he is oriented only to his name. The patient is tachypneic, breathing deeply at a rate of 24/min. He is febrile at 38.8°C. He is normotensive, but his heart rate is elevated at 112 bpm. On examination, this patient is a delirious, unkempt man with a fruity breath odor. His right lower extremity is markedly erythematous and exquisitely tender to palpation. Serum chemistries reveal glucose of 488 mg/dL, potassium of 3.7 mg/dL, and sodium of 132 m/dL. Urine dip-stick is grossly positive for ketones.
In this discussion:
1. Describe and discuss with your colleagues the pathophysiology of ketoacidosis in this diabetic patient. What is causing his altered mental status?
2. Describe the pathogenetic mechanism of his respiratory pattern.
3. Describe and discuss a plan of care for this patient during his first few days in the hospital.
4. Describe a plan of care for him at discharge (he will likely be admitted to the “medical floor” of the homeless shelter, which has the services of an NP three times per week and an RN four times per week). Include plans for at least one population-focused intervention.
Include citations from the text or the external literature in your discussions.
8wk.
Julio Pardea, a 31 y.o., Hispanic male injection drug user, who is homeless, presents to the ED with a chief complaint of shortness of breath. He describes a 1-month history of intermittent fevers and night sweats associated with a nonproductive cough. He has become progressively more short of breath, initially only with exertion, but now he feels dyspneic at rest. He appears to be in moderate respiratory distress. His vital signs are abnormal, with fever to 39°C, heart rate of 112 bpm, respiratory rate of 20/min, and oxygen saturation of 88% on room air. Physical examination is otherwise unremarkable but notable for the absence of abnormal lung sounds. Chest x-ray film reveals a diffuse interstitial infiltrate characteristic of pneumocystis pneumonia, an opportunistic infection.
In this discussion:
1. Describe and discuss with your colleagues the underlying disease most likely responsible for this patient’s susceptibility to pneumocystis pneumonia.
2. Describe and discuss the immunosuppression caused by this underlying disease.
3. Describe and discuss the natural history of this disease and some of the common clinical manifestations seen during its progression.
4. Describe your plan of care for this patient following his hospitalization (he will likely be admitted to the “medical respite floor,” of a local homeless shelter, which has the services of an NP three times per week—with on-call weekend consultation, and an RN, Monday through Friday).
Include citations from the text or the external literature in your discussions.
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