Category: Nursing

this order i a soap note about lower back pain as a chief complaint, please use the template that I provide bellow and the medication used are also attached.

Instructions:
Consider performing a health history on someone that may not be able to provide you with answers, such as an infant, child, an elderly person, a developmentally disabled individual, or patients who speak a language you do not know.
What strategies would you employ to obtain a complete health history?
Provide a rationale for why you think these strategies would be effective.
Please be sure to validate your opinions and ideas with citations and references in APA format.
The post and responses are valued at 20 points. Please review post and response expectations. Please review the rubric to ensure that your response meets criteria.
Objectives:
Applying interviewing techniques with a volunteer patient
Constructing a comprehensive subjective data set
Apply interviewing and exam techniques with simulation
Explore the beginnings of conducting a physical examination
Resources:


Bickley, L.S. (2023). Overview: Physical examination and history taking. Bates’ guide to physical examination and history-taking, 13thed. Revised. New York: Lippincott, Williams, & Wilkins. ISN-13:9781975210533
Chapter 4 – Health History
Chapter 8 – General Survey, Vital Signs and Pain
Chapter 9 – Cognition, Behavior, and Mental Status

*Please follow rubric instructions and assessment heading examples provided
The assessment – Applying Research Skills 
Chosen topic within Assessment : Limited Access to Healthcare – with a focus on transportation issues. 
*Please use peer reviewed journal articles within 3-5 years. Please cite throughout paper with proper references 
Below is all instructions to complete this assessment. Thank you. 

A professional paper on nurse burnout 
3-5 reference nursing reference articles in the last 5 years old. APA format style 

Healthcare organizations accredited by the Joint Commission are required to conduct a root cause analysis (RCA) in response to any sentinel event, such as the one described in the scenario attached below. Once the cause is identified and a plan of action established, it is useful to conduct a failure mode and effects analysis (FMEA) to reduce the likelihood that a process would fail. As a member of the healthcare team in the hospital described in this scenario, you have been selected as a member of the team investigating the incident.
SCENARIO
It is 3:30 p.m. on a Thursday and Mr. B, a 67-year-old patient, arrives at the six-room emergency department (ED) of a sixty-bed rural hospital. He has been brought to the hospital by his son and neighbor. At this time, Mr. B is moaning and complaining of severe pain to his (L) leg and hip area. He states he lost his balance and fell after tripping over his dog.
Mr. B was admitted to the triage room where his vital signs were B/P 120/80, HR-88 (regular), T-98.6, and R-32, and his weight was recorded at 175 pounds. Mr. B. states that he has no known allergies and no previous falls. He states, “My hip area and leg hurt really bad. I have never had anything like this before.” Patient rates pain at 10 out of 10 on the numerical verbal pain scale. He appears to be in moderate distress. His (L) leg appears shortened with swelling (edema in the calf), ecchymosis, and limited range of motion (ROM). Mr. B’s leg is stabilized and then is further evaluated and discharged from triage to the emergency department (ED) patient room. He is admitted by Nurse J. Nurse J finds that Mr. B has a history of impaired glucose tolerance and prostate cancer. At Mr. B’s last visit with his primary care physician, laboratory data revealed elevated cholesterol and lipids. Mr. B’s current medications are atorvastatin and oxycodone for chronic back pain. After Mr. B’s assessment is completed, Nurse J informs Dr. T, the ED physician, of admission findings, and Dr. T proceeds to examine Mr. B.
Staffing on this day consists of two nurses (one RN and one LPN), one secretary, and one emergency department physician. Respiratory therapy is in-house and available as needed. At the time of Mr. B’s arrival, the ED staff is caring for two other patients. One patient is a 43-year-old female complaining of a throbbing headache. The patient rates current pain at 4 out of 10 on numerical verbal pain scale. The patient states that she has a history of migraines. She received treatment, remains stable, and discharge is pending. The second patient is an eight-year-old boy being evaluated for possible appendicitis. Laboratory results are pending for this patient. Both of these patients were examined, evaluated, and cared for by Dr. T and are awaiting further treatment or orders.
After evaluation of Mr. B, Dr. T writes the order for Nurse J to administer diazepam 5 mg IVP to Mr. B. The medication diazepam is administered IVP at 4:05 p.m. After five minutes, the diazepam appears to have had no effect on Mr. B, and Dr. T instructs Nurse J to administer hydromorphone 2 mg IVP. The medication hydromorphone is administered IVP at 4:15 p.m. After five minutes, Dr. T is still not satisfied with the level of sedation Mr. B has achieved and instructs Nurse J to administer another 2 mg of hydromorphone IVP and an additional 5 mg of diazepam IVP. The physician’s goal is for the patient to achieve skeletal muscle relaxation from the diazepam, which will aid in the manual manipulation, relocation, and alignment of Mr. B’s hip. The hydromorphone IVP was administered to achieve pain control and sedation. After reviewing the patient’s medical history, Dr. T notes that the patient’s weight and current regular use of oxycodone appear to be making it more difficult to sedate Mr. B.
Finally, at 4:25 p.m., the patient appears to be sedated, and the successful reduction of his (L) hip takes place. The patient appears to have tolerated the procedure and remains sedated. He is not currently on any supplemental oxygen. The procedure concludes at 4:30 p.m.,and Mr. B is resting without indications of discomfort and distress. At this time, the ED receives an emergency dispatch call alerting the emergency department that the emergency rescue unit paramedics are enroute with a 75-year-old patient in acute respiratory distress. Nurse J places Mr. B on an automatic blood pressure machine programmed to monitor his B/P every five minutes and a pulse oximeter. At this time, Nurse J leaves Mr. B’s room. The nurse allows Mr. B’s son to sit with him as he is being monitored via the blood pressure monitor. At 4:35 p.m., Mr. B’s B/P is 110/62 and his O2 saturation is 92%. He remains without supplemental oxygen and his ECG and respirations are not monitored.
Nurse J and the LPN on duty have received the emergency transport patient. They are also in the process of discharging the other two patients. Meanwhile, the ED lobby has become congested with new incoming patients. At this time, Mr. B’s O2 saturation alarm is heard and shows “low O2 saturation” (currently showing a saturation of 85%). The LPN enters Mr. B’s room briefly, resets the alarm, and repeats the B/P reading.
Nurse J is now fully engaged with the emergency care of the respiratory distress patient, which includes assessments, evaluation, and the ordering of respiratory treatments, CXR, labs, etc.
At 4:43 p.m., Mr. B’s son comes out of the room and informs the nurse that the “monitor is alarming.” When Nurse J enters the room, the blood pressure machine shows Mr. B’s B/P reading is 58/30 and the O2 saturation is 79%. The patient is not breathing and no palpable pulse can be detected.
A STAT CODE is called and the son is escorted to the waiting room. The code team arrives and begins resuscitative efforts. When connected to the cardiac monitor, Mr. B is found to be in ventricular fibrillation. CPR begins immediately by the RN, and Mr. B is intubated. He is defibrillated and reversal agents, IV fluids, and vasopressors are administered. After 30 minutes of interventions, the ECG returns to a normal sinus rhythm with a pulse and a B/P of 110/70. The patient is not breathing on his own and is fully dependent on the ventilator. The patient’s pupils are fixed and dilated. He has no spontaneous movements and does not respond to noxious stimuli. Air transport is called, and upon the family’s wishes, the patient is transferred to a tertiary facility for advanced care.
Seven days later, the receiving hospital informed the rural hospital that EEG’s had determined brain death in Mr. B. The family had requested life-support be removed, and Mr. B subsequently died.
Additional information: The hospital where Mr. B. was originally seen and treated had a moderate sedation/analgesia (“conscious sedation”) policy that requires that the patient remains on continuous B/P, ECG, and pulse oximeter throughout the procedure and until the patient meets specific discharge criteria (i.e., fully awake, VSS, no N/V, and able to void). All practitioners who perform moderate sedation must first successfully complete the hospital’s moderate sedation training module. The training module includes drug selection as well as acceptable dose ranges. Additional (backup) staff was available on the day of the incident. Nurse J had completed the moderate sedation module. Nurse J had current ACLS certification and was an experienced critical care nurse. Nurse J’s prior annual clinical evaluations by the manager demonstrated that the nurse was “meeting requirements.” Nurse J did not have a history of negligent patient care. Sufficient equipment was available and in working order in the ED on this day.
REQUIREMENTS
Your submission must be your original work. No more than a combined total of 30% of the submission and no more than a 10% match to any one individual source can be directly quoted or closely paraphrased from sources, even if cited correctly. An originality report is provided when you submit your task that can be used as a guide.
You must use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate your work. Each requirement below may be evaluated by more than one rubric aspect. The rubric aspect titles may contain hyperlinks to relevant portions of the course.
A. Explain the general purpose of conducting a root cause analysis (RCA).
1. Explain each of the six steps used to conduct an RCA, as defined by IHI.
2. Apply the RCA process to the scenario to describe the causative and contributing factors that led to the sentinel event outcome.
B. Propose a process improvement plan that would decrease the likelihood of a reoccurrence of the scenario outcome.
1. Discuss how each phase of Lewin’s change theory on the human side of change could be applied to the proposed improvement plan.
C. Explain the general purpose of the failure mode and effects analysis (FMEA) process.
1. Describe the steps of the FMEA process as defined by IHI.
2. Complete the attached FMEA table by appropriately applying the scales of severity, occurrence, and detection to the process improvement plan proposed in part B. Note: You are not expected to carry out the full FMEA.
D. Explain how you would test the interventions from the process improvement plan from part B to improve care.
E. Explain how a professional nurse can competently demonstrate leadership in each of the following areas:
• promoting quality care
• improving patient outcomes
• influencing quality improvement activities
1. Discuss how the involvement of the professional nurse in the RCA and FMEA processes demonstrates leadership qualities.
F. Acknowledge sources, using in-text citations and references, for content that is quoted, paraphrased, or summarized.
G. Demonstrate professional communication in the content and presentation of your submission.

hronic diseases and their management are quickly becoming one of the largest elements of primary care. The chronic care model has been used widely for many years in a variety of settings. Though many providers have struggled to implement the chronic care model in a way that is cost effective, there is now significant evidence that the Chronic care model is effective in both chronic care management and in practice improvement. This is a formative assignment that accounts for 40% of the subject marks. Marks are assigned for the elements of the chronic care Model, you need to choose one of the chronic diseases in Saudi Arabia, Then. Implementing the chronic care model for improvements a chronic disease in community. It is expected that you complete 750 words with no less than 5 references attached. You can present your results in a table format or text with subheadings.   

Please add in a couple slides that Present specific, evidence-based strategies to overcome communication barriers and enhance interprofessional collaboration to improve disaster recovery efforts. I have attached full instructions (DOC 5 PDF) but you just have to add a couple slides for the criteria that is missed. I have also attached the instructors feedback so you know what is missing from the powerpoint. 

5.    Describe the shape of histograms–whether they have normal distribution or negatively or positively skewed distribution (must compare a mean and median to determine the normality of distribution). Write a few sentences about the distribution of variables, producing histograms.
6.    Write up a summary of the data as it would be reported in a research study. Create a table to organize and report the descriptive data for the five variables. 
For question 5, please read one or two additional research articles to see how the researchers developed a table to report such descriptive data (you can also see the research article titled “Stressors related to Depression among Elderly Korean Immigrants, p. 55, posted on D2L, which may be helpful when you write your descriptive data obtained in this CPK study).  

One of the most important roles of an advanced professional nurse is leading change to improve healthcare delivery or outcomes through evidence-based innovation in practice. In this assessment, you will demonstrate competency as a nurse innovator by discussing disruptive innovation, identifying the benefits and challenges of analyzing big and small data, and proposing an evidence-based disruptive innovation to enhance healthcare for a designated population. To successfully complete the assessment, you will demonstrate competency in essential elements of innovation such as disruption, the role of nurse innovator, and incorporating the use of data to change healthcare practices to improve outcomes. You will also demonstrate competency in how to search, appraise, level, and synthesize peer-reviewed, scholarly evidence that supports your proposed disruptive innovation in practice.
Here is the rubric of the questions that need to be answered in each section:
Use the attached “Evidence-Based Innovation Plan Template” located in the attached documents section to complete this assessment.
A. Discuss 2 examples of disruptive innovation that improved healthcare outcomes. Provide scholarly source(s).
B. Discuss how an MSN-prepared nurse innovator demonstrates one of the nursing roles described in the “WGU Nursing Programs Conceptual Model” located in Supporting Documents. The discussion should be detailed, with at least one example, and should specifically focus on one of the three nursing roles included in the WGU Nursing Programs Conceptual Model:
• Nurse as Detective
• Nurse as Scientist
• Nurse as Manager of the Healing Environment
C. Discuss the use of big data and technology in nursing innovation by doing the following:
1. Describe one benefit and one challenge of using big data to support innovation.
2. Discuss how the American Nurses Association (ANA) Code of Ethics guides ethical utilization of big data in developing innovative practices. The discussion should include 1 scholarly source.
3. Describe an example of a new technology or technology enhancement that resulted in improved outcomes in a healthcare organization.
D. Discuss a disruptive innovation by doing the following:
1. Describe a proposed disruptive innovation and how the innovation will improve healthcare outcomes in a specific healthcare organization.
2. Describe the healthcare organization in which the disruptive innovation is proposed, including the type of organization, urban or rural setting, and population served.
3. Discuss how the disruptive innovation in D1 supports a goal or strategy related to improvement in the healthcare delivery or health outcomes of the selected healthcare organization.
E. Provide scholarly evidence for your disruptive innovation by doing the following:
1. Complete the Relevant Sources Summary Table located in the Evidence-Based Innovation Plan Template to appraise 5 relevant peer-reviewed scholarly sources using the “WGU Evidence Leveling Tool” located in Supporting Documents. The sources must be published in the last five years.
2. Synthesize the findings of all the 5 peer-reviewed scholarly sources from E1, including identification of themes.
Note: Refer to Unit 3 Appraising and Synthesizing the Evidence in the course materials (p. 29). Suggested length 1–2 pages.
3. Discuss how the evidence supports the disruptive innovation described in D1.
Note: Refer to Essential Reading Chapter 5: “Literature Reviews: finding and Critically Appraising Evidence” in the course materials (p. 29).
F. Reflect on the role of nurse innovator by doing the following:
1. Discuss how developing an evidence-based disruptive innovation proposal to improve healthcare outcomes has changed your understanding of the advanced professional nurse role.
2. Describe 2 strategies a nurse innovator would use to support a culture of disruptive innovation in a healthcare organization.
G. Acknowledge sources, using in-text citations and references, for content that is quoted, paraphrased, or summarized.

Chronic diseases and their management are quickly becoming one of the largest elements of primary care. The chronic care model has been used widely for many years in a variety of settings. Though many providers have struggled to implement the chronic care model in a way that is cost effective, there is now significant evidence that the Chronic care model is effective in both chronic care management and in practice improvement. This is a formative assignment that accounts for 40% of the subject marks. Marks are assigned for the elements of the chronic care Model, you need to choose one of the chronic diseases in Saudi Arabia, Then. Implementing the chronic care model for improvements a chronic disease in community. It is expected that you complete 750 words with no less than 5 references attached. You can present your results in a table format or text with subheadings.
pleas talk about   diabetes