WHAT- Describe the contemporary transitional factor with evidence.
WHY – Describe, discuss and analyse why the contemporary transitional factor occurs with evidence.
HOW – Discuss and analyse how the contemporary transitional factor a?ects nursing and quality patient care with evidence.
HOW – Discuss and analyse how the contemporary transitional factor should be addressed to provide positive outcomes for nursing and patient care, with evidence.

Case Study of Nursing tool
Case Study Of a nursing assessment tool (waterlow) and its use on a specific patient.

Define risk and risk management, and nursing tools involvement. Introduce Patient and why they are at risk from pressure ulcers. Discuss risk management and the things put in place to prevent risk, i.e protection and prevention of harm.
The importance of the risk assessment – cost, and improvement.
Disscuss the use of the tool in regards to the patient, and any other methods used along side tool. (observation, communication)
Critique the tool, why is it used in practice – what does literature say?
Compare what is being done with what literature says.
analyse effects on patient and organisation.
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Referencing Requirements:
Nice Guidelines Waterlow (1985)
Journals

Addresses course outcomes 1 and 4:

– recognize and explain how the scientific method is used to solve problems
– weigh evidence and make decisions based on strengths and limitations of scientific knowledge and the scientific method

Before starting this assignment you might want to revisit the Scientific Method Tutorial in the Science Learning Center under the Content area.

Researchers recently investigated whether or not coffee prevented the development of high blood sugar (hyperglycemia) in laboratory mice. The mice used in this experiment have a mutation that makes them become diabetic. Read about this research study in this article published on the Science Daily web-site New Evidence That Drinking Coffee May Reduce the Risk of Diabetes as well as the following summary:

A group of 11 mice was given water, and another group of 10 mice was supplied with diluted black coffee (coffee:water 1:1) as drinking fluids for five weeks. The composition of the diets and living conditions were similar for both groups of mice. Blood glucose was monitored weekly for all mice. After five weeks, there was no change in average body weight between groups. Results indicated that blood glucose concentrations increased significantly in the mice that drank water compared with those that were supplied with coffee. Finally, blood glucose concentration in the coffee group exhibited a 30 percent decrease compared with that in the water group. In the original paper, the investigators acknowledged that the coffee for the experiment was supplied as a gift from a corporation.

Then answer the following questions in your own words:

1. Identify and describe the steps of the scientific method. Which observations do you think the scientists made leading up to this research study? Given your understanding of the experimental design, formulate a specific hypothesis that is being tested in this experiment. Describe the experimental design including control and treatment group(s), and dependent and independent variables. Summarize the results and the conclusion (50 points)

2. Criticize the research described. Things to consider: Were the test subjects and treatments relevant and appropriate? Was the sample size large enough? Were the methods used appropriate? Can you think of a potential bias in a research study like this? What are the limitations of the conclusions made in this research study? Address at least two of these questions in your critique of the research study (20 points).

3. Discuss the relevance of this type of research, both for the world in general and for you personally (20 points).

4. Write answers in your own words with proper grammar and spelling (10 points).

5. Your work should be approximately 300 – 400 words, double-spaced. All of your references should be in APA format.

The original peer-reviewed research article that the above Science Daily article discusses can be found in the Content area. You may want to look at the peer-reviewed scholarly article for more detail (not required).

* Yamauchi et al. (2010). Coffee and caffeine ameliorate hyperglycemia, fatty liver, and inflammatory adipocytokine expression in spontaneously diabetic KK-Ay mice. Journal of Agricultural and Food Chemistry, 58 (9), 5597-5603. May 12, PMID: 20405946, ISSN: 1520-5118.

Avoid plagiarism

It is very important to write with your own words. If you do copy one or two sentences directly (use sparingly), use quotation marks (“) around the copied text. All information sources need to be included in the reference list and as in-text references. Plagiarism will be reported to the proper UMUC authority. Guidance on how to avoid plagiarism can be found here: UMUC’s How to Avoid Plagiarism

Chief complaint: medication refill ” I ran out of medicines”

HPI: E.D a 65-year-old AA male presents to the clinic for prescription refills. The patient also indicates that she has noticed shortness of breath which started about 4 months ago. The SOB gets worse with exertion, especially when she is walking fast and it is resolved when he is resting. He reports that she is also bothered by shortness of breath that wakes her up intermittently during her sleep. His symptoms of shortness of breath resolve after sitting upright on 3 pillows. He also has lower leg edema pitting 1+ which started 2 weeks ago. He also indicates that she often feels light headed at times with intermittent syncope episodes while going up a flight stairs, but it resolves after sitting down to rest. He has not tried any over the counter medications at home.

He never filled her prescriptions that he received at her checkup 6 months ago, she did not think it was important.

PMH:

Primary Hypertension

Previous history of MI 1 year ago

Surgeries:

1 year ago-Left Anterior Descending (LAD) cardiac stent placement

Allergies: Penicillin

Vaccination History:

He receives an annual flu shot. Last flu shot was this year

Has not had a Td in over 10 years

Has not had the herpes zoster vaccine

Social history:

High school graduate, married and no children. He drinks one 4-ounce glass of red wine daily. He is a former smoker that stopped 3 years ago.

Family history:

Both parents are alive. Father has history of MI and valvular heart disease; mother alive and cardiac history is unknown. He has one brother who is alive and has history of MI 5 years ago at age 52.

ROS:

Constitutional: Lightheaded and faint with exertion.

Respiratory: Shortness of breath with exertion. + Orthopnea

Cardiovascular: + 2 pitting leg edema for 3 weeks.

Psychiatric: Pt sated not taking medications for 6 months – “ran out and did not get refills”

Physical examination:

Vital Signs

Height: 5 feet 1 inches Weight: 163 pounds BMI: 31 obesity, BP 157/87 T 98.0 po P 110 R 22, non-labored

HEENT: Normocephalic/Atraumatic, Bilateral cataracts; PERRL, EOMI; No teeth loss seen. Gums no redness.

NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.

LUNGS: + Mild Crackles on inspiratory phase no clearing with cough. Equal breath sounds. Symmetrical respiration. No respiratory distress.

HEART: Normal S1 with S2 during expiration. An S4 is noted at the apex; + systolic murmur noted at the right upper sternal border without radiation to the carotids. Pulses are 2+ in upper extremities and 2+ in pedal pulses bilaterally. 2+ pitting edema to her knees noted bilaterally

ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.

GENITOURINARY: No CVA tenderness bilaterally. GU exam deferred.

MUSCULOSKELETAL: + Heberden’s nodes at the DIP joints, hands. + Crepitus, bilateral knees. Slow gait but steady. No Kyphosis.

PSYCH: Normal affect. Cooperative.

SKIN: No rashes. + Dry skin. Skin intact.

Labs:: Hgb 13.2, Hct 38%, K+ 4.0, Na+137, Cholesterol 225, Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98

A:

Primary Diagnosis:

Congestive Heart Failure (CHF) (150.9)

Secondary Diagnoses:

Primary Hypertension (I10)

Obesity (E66):

Osteoarthritis (OA) (715.90)

Differential Diagnosis:

Peripheral Vascular Disease (PVD) (173.9)

P:

Medications:

Tylenol 650 mg PO Q4 hours as needed for arthritis pain

Labs: UA; Brain natriuretic peptide (BNP); LFTs and TSH.

12-lead EKG, Chest X-ray; Initial 2D echo with Doppler; Ankle-brachial index

Referrals: may refer based on lab results

Follow up: return to office in 2 weeks

Additional lab results:

Echo results 1 week ago: Left ventricular EJ Fraction decreased to 30 %

BNP – no available

Questions: As an NP student, need to determine the medications for CHF/ASCVD

According to the ACC/AHA Guidelines, what medications should this patient be prescribed? Does he need medication given his history of MI? Write her complete prescriptions using the prescription writing format.

answer: please use this medication

I suggest an ACE inhibitor for this patient and not the above medications.

I would start Lisinopril 5 mg po daily and lasix 20 mg po daily and potassium supplement 10 meq po daily.
I would consider Xopenex 0.63 % use in inhaler nebulizer treatment every 4 to 6 hours as needed.

Please tell me why ?