Our Previous Samples

Assessing the Abdomen Gastroenteritis Sample Paper

A 47-year-old white male patient presents with generalized abdominal pain for three days. He has not taken any medication and rates the pain as a 5 out of 10. He however, notes that the pain was a 9 out of 10 during the initial stages. He has been able to eat but complains of nausea afterwards. Patient is a known diabetic who is also hypertensive. He has a history of gastrointestinal bleeding four years ago.

He is currently on Lisinopril, Amlodipine, Metformin and Lantus. The patient’s father is hypertensive and has type 2 diabetes mellitus. The mother is hypertensive, has hyperlipidaemia and gastroesophageal reflux disease. Patient denies any use of tobacco but is an occasional consumer of alcohol. He is married and has three children. His vitals are within the normal range apart from the blood pressure which is slightly elevated and the temperature which indicates a fever. The assessment shows left lower quadrant pain and the diagnosis made is gastroenteritis.

Necessary History

Subjective portion

It is necessary for the patient to characterize the onset of the pain. He should describe whether it had a sudden onset or whether it started gradually. The patient should also describe the character of the pain. It is important to know whether it is a stabbing pain, a burning pain or an intermittent pain (Bennett et. al, 2019). The patient should also describe if the pain was radiating to any other part of the body or if it was non-radiating. The patient should describe any other associated symptoms that accompanied the pain.

Further, it is crucial to know the timing of the pain. Is it worse at night, during the morning hours or during daytime? It is crucial to also find out what exacerbated the pain and what made it more bearable or relieved it. It is also critical to get a clear picture of the patient’s stool. Is it accompanied with any fresh blood or clots? It is also good to know if there is any mucus in the stool. It is also crucial to rule out other accompanying symptoms such as fever.

Objective portion

It is important to calculate the patient’s Body Mass Index (BMI). It is critical to describe any masses present on abdominal examination. Movement of the abdomen with respiration is also important to note. Lack of abdominal movement with irritation would highlight an irritation on the peritoneum indicating the presence of an infection. Presence of any distended veins on the abdomen would also be critical to highlight. The presence of any flank fullness indicating the presence of fluid would also be important to highlight.

The clinical assessment of gastroenteritis is supported by both the objective and the subjective information. The patient complaining of generalized abdominal pain and the presence of diarrhoea is a key feature of gastroenteritis. The elevated temperature of 99.8F indicates a fever which is also a symptom of gastroenteritis (Doggweiler et al., 2017). The hyperactive bowel movement sounds heard on auscultation are also a key presentation feature of gastroenteritis. Notably, the features that include diarrhoea, generalized abdominal pain which is localized in the left lower quadrant, fever and the hyperactive bowel sounds all support the diagnosis of gastroenteritis.

Diagnostic tests

            Stool test is effective to determine the cause of the gastroenteritis. A rapid stool test can aid in the detection of viruses such as rotavirus and norovirus which are among the commonest causes of gastroenteritis (Karampatsas et al., 2018). A stool sample can also help in ruling out the possibility of a bacterial or a parasitic infection. Presence of viruses such as the rotavirus can help in coming up with a conclusive diagnosis of gastroenteritis. Additionally, a complete blood count is also key in making a diagnosis. Elevated white blood cells indicate the presence of infection. Further white blood cell differential tests will help to determine the exact cause of the gastroenteritis. Elevated neutrophils will indicate that the most likely cause of the gastroenteritis is a bacterial infection while lymphocyte levels will be increased during viral infections.

Ultrasound scans, CT scans or X-rays may also be used to make a diagnosis. However, these tests are rarely done as the diagnosis of gastroenteritis is often made from the history. This imaging techniques may be critical in showing an inflammation of the stomach wall. This evidence, coupled with the diagnostic tests, will help in further justifying the clinical diagnosis made of gastroenteritis. I would accept the current diagnosis of gastroenteritis since the presenting symptoms of diarrhoea and localised abdominal pain are some of the symptoms of gastroenteritis. On examination, the fever, localised left lower quadrant pain and the hyperactive bowel sounds all support the diagnosis. Accompanying laboratory diagnostic tests would further support the diagnosis of gastroenteritis and give the probable cause of the gastroenteritis.

Differential Diagnosis

            The three possible conditions identified as the differential diagnosis for the patient include:

Amoebiasis is a parasitic infection of the large intestines caused by Entamoeba histolytica (Ghosh, Padalia, & Moonah, 2019). Amoebiasis normally presents with generalized abdominal pain, bloody diarrhoea and fever which may be confused with gastroenteritis. In most people, amoebiasis is asymptomatic but a few individuals develop the symptoms stated above among others. A travel history, especially to regions with poor sanitation and water, is key in establishing a diagnosis of amoebiasis.

1. Salmonella infections.

Salmonella infection is another differential diagnosis. This infection is caused by the salmonella bacteria commonly harboured in contaminated food and water (Gut et al., 2017). Some of the key symptoms of salmonella infection include diarrhoea accompanied with fever and chills. Abdominal pain is another presenting complaint. Some people hardly develop any symptoms. Those who develop symptoms usually develop them between six hours and six days of infection. The symptoms normally last between four to seven days.

• Food poisoning.

Food poisoning is another differential diagnosis. Abdominal pain, fever, diarrhoea, and nausea among others are some of the major symptoms of food poisoning (Mostafa et al., 2018). Food poisoning commonly results from ingestion of contaminated food containing viruses, bacteria, parasites and fungi or their resultant toxins. Signs and symptoms are normally visible after a few hours of ingestion of the contaminated food. Illness lasts from a few hours to a few days.

Conclusion

Due to increased cases of misdiagnosis, it is critical to get both subjective, objective and diagnostic data to confirm diagnosis. Misdiagnosis reduces the chance of the patient getting well as the medication being administered is not effective. This increases the patient’s stay in hospital and consequently increases the likelihood of development of drug resistant pathogens. It is therefore critical to make and confirm the diagnosis before initiating management and treatment. In the case scenario, diarrhoea, abdominal pain, nausea and fever all aid in the establishment of the diagnosis of gastroenteritis. Laboratory diagnostic tests can be done to further support the diagnosis.

References

• Bennett, M. I., Kaasa, S., Barke, A., Korwisi, B., Rief, W., & Treede, R. D. (2019). The IASP classification of chronic pain for ICD-11: chronic cancer-related pain. Pain, 160(1), 38-44. https://doi.org/10.1097/j.pain.0000000000001363
• Ghosh, S., Padalia, J., & Moonah, S. (2019). Tissue destruction caused by Entamoeba histolytica parasite: cell death, inflammation, invasion, and the gut microbiome. Current Clinical Microbiology Reports, 6(1), 51-57. https://doi.org/10.1007/s40588-019-0113-6
• Gut, A. M., Vasiljevic, T., Yeager, T., & Donkor, O. N. (2018). Salmonella infection–prevention and treatment by antibiotics and probiotic yeasts: a review. Microbiology, 164(11), 1327-1344. https://doi.org/10.1099/mic.0.000709
• Karampatsas, K., Osborne, L., Seah, M. L., Tong, C. Y., & Prendergast, A. J. (2018). Clinical characteristics and complications of rotavirus gastroenteritis in children in east London: A retrospective case-control study. PloS One, 13(3), e0194009. https://doi.org/10.1371/journal.pone.0194009
• Mostafa, A. A., Al-Askar, A. A., Almaary, K. S., Dawoud, T. M., Sholkamy, E. N., & Bakri, M. M. (2018). Antimicrobial activity of some plant extracts against bacterial strains causing food poisoning diseases. Saudi Journal of Biological Sciences, 25(2), 361-366. https://doi.org/10.1016/j.sjbs.2017.02.004

NURS 6512 Discussion: Assessing Musculoskeletal Pain Discussion Paper

Patient Information.

The patient is a 42-year-old male who reports to the health facility.

Chief complaint.

The man complains of lower back pain that he has been experiencing for the past one month.

History of Presenting Illness

            A forty-two-year-old male patient was well until about a month ago when he started experiencing lower back pain. He describes the pain as being located in his lower back region, a problem that began about a month ago and radiating to his left leg. It would be important to describe the character of the pain. Knowing whether it is a pounding, stabbing or sharp pain goes a long way in establishing a diagnosis.

The timing of the pain would also be important. It is worse during the day, at night or after completion of certain task. It would be important to highlight any exacerbating and relieving factors of the pain. Asking the pain to gauge the severity of his pain in accordance to the pain scale numbered one to ten would also be important to note while taking the history of the patient.

It is vital to look out for other associated symptoms commonly accompanying lower back pain. Weakness, numbness or any tingling sensation in the legs is important to note. It is vital that the patient points out the specific regions, if any, where he is experiencing weakness, numbness or a tingling sensation (Hartvigsen et al., 2018). Any associated fever along with the back pain would be critical to note as it would be an indicator of an infection. Problems controlling bowel and bladder movements are other commonly associated symptoms of lower back pain that are important to ask about and note.

Nerve roots involved

A lumbar radiculopathy also referred to as sciatica occurs following involvement of the nerve roots responsible for formation of the sciatic nerve. The nerve roots exiting from the lower lumbar and upper sacral regions involve L4, L5, S1, S2 and S3 (Berthelot et al., 2018). Lower back pain is usually the commonest presentation of a lumbar radiculopathy. The pain is often radiating to the back of the leg with sciatica commonly affecting one side of the body.

Testing for the nerve roots

            To test for the L4 nerve roots, one would test the loss of sensation in the dermatome supplied by L4. This includes the area around the thigh, knee, leg and foot anteromedially. It is important to also conduct the straight leg raise test, the femoral nerve stretch test, the knee reflex and to test the power of the muscle involved in ankle dorsiflexion to test for the credibility of the L4 nerve root.

The test for the L5 nerve root involves testing for the presence or absence of sensory sensation in the dermatome area supplied by L5. This area includes the buttocks, posterior and lateral aspects of the thigh, lateral part of the leg, dorsum of the foot, medial half of the sole including the first, second and third toes. It would also be advisable to conduct the straight leg raise test and test for the power of the muscle on hip abduction, dorsiflexion at the ankle, ankle eversion and extension of the big toe.

Testing for the S1 nerve roots involves testing for sensory loss in the dermatome area supplied by S1 (Tampin et al, 2020).. This includes the area around the lateral aspect of the foot, the heel and majority of the area of the sole. It would be important to carry out the straight leg raise test, ankle reflex and test for power of muscles involved in extension of the hip, knee flexion, plantarflexion at the ankle joint and ankle eversion.

Testing for dermatomes is usually done using a pin and cotton wool. The patient is asked to close their eyes and give response after stimulation by various stimuli. Dermatome testing should be conducted on specific dermatomes and the results compared with the opposite side. The pin prick test involves gently pricking the patient with a pin and asking for the patient’s feedback whether it is a sharp or a blunt pain. Light touch sensation test involves rubbing a piece of cotton wool against a specific area on the skin.

The straight leg raise test is a neurodynamic test conducted to asses mechanical movement of the neurological tissues and their sensitivity to mechanical stress (Parashkevova et al., 2019). Testing is conducted on both lower limbs with the normal limb being assessed first. Patient lies in a supine position with the hip medially rotated and the knee extended. The physician then elevates the patient’s limb by the posterior ankle with the knee maintained in full extension continuously until the patient complains of discomfort at the back or posterior surface of the leg.

The femoral nerve stretch test is a test used to asses the sensitivity to stretch of the soft tissue located at the dorsal aspect of the leg. The patient is asked to lie down while the physician lies on the affected side to stabilize the pelvis and hinder any anterior rotation using one hand. The physician then proceeds to extend the hip while maintaining the knee at flexion. The physician can encompass a few alterations to the test position to be able to pick out the nerve involved.

Differential Diagnosis

            Some of the causes of lower back pain include: sciatica, lumbar herniated disc, piriformis syndrome and arachnoiditis (Thompson et al., 2020). Sciatica often arises from a herniated disc. This results in compression of the nerve roots of the sciatic nerves that runs from the lower back down to the lower limbs. Patients will normally present with lower back pain that is normally radiating to the back of the leg. A burning sensation, muscle weakness and bladder and bowel incontinence are among other presentations.

A lumbar herniated disc is a ruptured disc at the lower back normally arising as a result of a tear resulting in consequent pushing out of the nucleus out of the spinal disc. The protruding disc pushes against a spinal nerve resulting in severe pain, numbness and in some instances weakness. The pain is exacerbated by standing, coughing or sneezing and there is consequent reduction of reflexes at the knee and ankle joint.

Piriformis syndrome results from compression of the sciatic nerve by the piriformis muscle. It results in associated pain radiating to the lower leg, tingling and numbness in the gluteal region. Arachnoiditis, an inflammation of the arachnoid covering the spinal cord nerves, can also result in lower back pain radiating to the legs as the commonly affected nerves are in that region.

            The Agency of Healthcare and Research and Quality lists back pain as a common occurrence affecting eight out of every ten individuals. It further goes to highlight that back pain can range from a dull, constant ache to a sudden, sharp pain (Herman et al., 2019). Acute back pain lasts a few days to weeks becoming chronic if it persists for a duration longer than three months. Over the counter medication and adequate rest are the remedies for most back pain with medical attention required if back pain persists.

Physical Exam.

Any physical exam begins with inspection. It is important to note the shape of the spine. Appreciate the normal curvature of the spine. The absence of lumbar lordosis is commonly associated with lower back pain. Palpation is the next step. Palpating the spinal region to elicit any tenderness helps to prove or rule out pain from the vertebra. Palpation of the para-spinal region to elicit tenderness proves muscle involvement. The next step is to conduct specialized tests.

Special manoeuvres.

Provocative tests are done to elicit any tenderness and pain. If these tests are positive, there is likelihood that the irritation on the nerve is as a result of mechanical interference resulting from a vertebral bone or herniated disc. Some of the special manoeuvres include the straight leg raise test, the tripod sign and femoral stretch test. Neurological exam including motor, sensory and reflex exam can also be done. The major nerve roots examined are L4, L5 and S1 as they are the commonly affected nerve roots.

References

• Berthelot, J. M., Laredo, J. D., Darrieutort-Laffite, C., & Maugars, Y. (2018). Stretching of roots contributes to the pathophysiology of radiculopathies. Joint Bone Spine, 85(1), 41-45. https://doi.org/10.1016/j.jbspin.2017.01.004
• Hartvigsen, J., Hancock, M. J., Kongsted, A., Louw, Q., Ferreira, M. L., Genevay, S., & Woolf, A. (2018). What low back pain is and why we need to pay attention. The Lancet, 391(10137), 2356-2367. https://doi.org/10.1016/s0140-6736(18)30480-x
• Herman, P. M., Broten, N., Lavelle, T. A., Sorbero, M. E., & Coulter, I. D. (2019). Health care costs and opioid use associated with high-impact chronic spinal pain in the United States. Spine, 44(16), 1154-1161. https://doi.org/10.1097/brs.0000000000003033
• Parashkevova, P., Deleva, R., Mincheva, P., & Andreev, A. (2019). A Study on Use of Neurodynamic Tests among Neurorehabilitation Professionals. Journal of IMAB–Annual Proceeding Scientific Papers, 25(1), 2438-2442. http://dx.doi.org/10.5272/jimab.2019251.2438
• Tampin, B., Slater, H., Jacques, A., & Lind, C. R. (2020). Association of quantitative sensory testing parameters with clinical outcome in patients with lumbar radiculopathy undergoing microdiscectomy. European Journal of Pain, 24(7), 1377-1392. https://doi.org/10.1002/ejp.1586
• Thompson, J., Merrill, R. K., Qureshi, S. A., & Leven, D. M. (2020). Compression of the S1 Nerve Root by an Extradural Vascular Malformation: A Case Report and Discussion of Atypical Causes of Lumbar Radiculopathy. International Journal Of Spine Surgery, 14(1), 96-101. https://doi.org/10.14444/7013

NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach Example

Preventive nursing focuses on the early detection of an illness and implementing interventions to stop the illness from occurring or progressing. In a hypothetical case scenario, a nurse had a hard time diagnosing surgical site infection using the warning signs of infection NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach. The patient only had erythema and swelling at the incision site without fever, discharge, or pain.

His desire to prevent surgical site infection from occurring in his patient led to his doubt that the signs were not adequate to say for sure that his patient started to have a surgical site infection (SSI). SSIs are a major cause of long patient hospital stays, mortality, morbidity, and increased cost of treatment (Iskandar et al., 2019). Annually, there are more than 100000 cases of surgical site infections (National Healthcare Safety Network, 2022).

SSIs surveillance and prevention have been some of the strategies used to intervene to prevent the outcome of SSIs. This paper aims to formulate a clinical question, identify potential sources, and explain their findings to answer the clinical question NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach.

Definition of Practice Issue

The scenario above involves a situation where the nurses need clinical or scientific evidence to make informed decisions about the patient. To ensure proper patient surveillance, he will need to identify and prevent SSI early in this patient.

An alternative way to diagnose SSI is through laboratory investigations. Like other infections, SSIs can cause inflammation that can be detected through blood testing. C-reactive protein (CRP) assays have been a good marker for inflammation in the body NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach.

Its assay can suggest inflammation in the body in the setting of SSIs. However, surgery is also an iatrogenic process that can cause inflammation (Chijioke, 2019). As such, the use of CRP in SSI surveillance requires clinical evidence. The benefits of using this protein marker in surgical site infection can be ascertained through evidence-based practice.

Clinical Question

Having defined the clinical issue, the second phase of the John Hopkins EBP model is to research for evidence. This started with the formulation of a practice question. The practice question was formulated in a PICOT format NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach.

The PICO question stated: “In postoperative adult patients (P), is C-Reactive Protein assay (I) compared with the use of clinical signs (C) more accurate in early diagnosis of surgical site infections (O)? In this PICO question, the population includes adult patients who have had significant surgeries during their inpatient stay in the hospital. The intervention is laboratory testing that measures the serum amount of CRP during this period after the surgery.

The comparison intervention will use clinical signs of inflammation, such as tenderness, discharge, swelling, redness, and hotness. The time element will not be included in this clinical practice question NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach.

PICO approach will benefit the exploration of the clinical issue by providing the search terms and phrases. Using the PICO question will improve the specificity of the literature search, thus improving its relevance and credibility (Eriksen & Frandsen, 2018).

The conceptual clarity before the search will also improve through PICO as all elements, including comparisons, are declared before literature acquisition. The population, problem, and interventions are defined, thus making the framework of the literature search clearer. Therefore, the returned search results will be high-quality, high-level evidence (Eldawlatly et al., 2018). Finally, using PICO questions will reduce the time required to complete the search.

Evidence-based Sources

A literature search was performed from the Cochrane Library, Cumulated Index to Nursing and Allied Health Literature (CINAHL), and PubMed databases. These sources are authoritative and contain peer-reviewed resources, including but not limited to journal articles and books.

After the literature search, articles were manually selected, and three sources were presented to attempt to answer the PICO question. The four resources selected were articles by Kim et al. (2021), Malheiro et al. (2020), Okui et al. (2022), and Shetty et al NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach. (2022). These resources were credible because they were current, relevant, authoritative, accurate, and objective research articles (Kurpiel, 2022).

Their credibility made them fit to be used to answer the PCIO question. The credibility assessment was performed using the criteria from the CRAAP test. This test assesses the currency, relevance, authority, accuracy, and purpose of an evidence-based source. NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach

Findings from the Articles

The article by Shetty et al. (2022) was from a prospective cohort study involving 51 orthopedic patients. This study found that fifteen patients developed surgical site infections and that CRP rose in all patients after surgery. However, the rise levels differed in both groups after the third post-op day (POD). The rise was gradual, and the difference between the two groups was statistically significant. Therefore, CRP is a good marker of SSI but only after the second day of the postoperative period.

Kim et al. (2021) excluded patients with comorbidities from their study that involved post-operative patients who underwent posterior lumbar fusion or decompression. Their observational study found a rise in all patients who had these surgeries. However, by POD7, CRP levels had been decreasing in some patients, of which 43% did not develop SSIs, and increasing in some patients who eventually developed SSIs. The serial CRP level change rate had a sensitivity of 90.9% and a specificity of 68.1% in SSI detection. Therefore, additional clinical patient monitoring is also important.

Okui et al. (2022) found that, on average, patients were being diagnosed with SSI between POD5 and POD9. Patients with poorer outcomes, such as SSI diagnosis, longer hospital stays, and low survival rates, had higher CRP levels by the 14th postoperative day. Early diagnosis with SSI was associated with severe SSI and outcomes. Therefore, early SSI detection is essential for patient care outcomes, and CRP levels can be good markers

Malheiro et al. (2020) compared various factors that would be used to predict the risk of infection, such as post-surgical antibiotic use, positive culture test,  CRP values, body temperature, leukocyte count, surgical re-intervention, admission to the emergency room, and hospital readmission among patients who had undergone colorectal surgeries and cholecystectomies.

The study found that antibiotic use and CRP values had the highest sensitivities for SSI risk. These two factors are, therefore, sensitive to the prediction of SSIs and thus good SSI surveillance markers NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach.

The sources by Malheiro et al. (2020) and Kim et al. (2021) were the most credible because they additionally addressed other confounders, thus suitable for inference making. Additionally, they had the highest sample sizes making their findings more powerful due to increased accuracy. The other sources were also credible, nevertheless.

Relevance of the Findings

The four sources presented more or less related findings and addressed one common intervention, the CRP value use. Each source addressed the various elements of the PICO but only partially. The most addressed element was population and intervention. Only one source (Kim et al., 2021) addressed the comparison intervention.

The findings presented by Kim et al. (2021), Okui et al. (2022), and Shetty et al. (2022) are useful in addressing the appropriateness of the intervention from the PICO. Their findings explain to the clinician when to do CRP values and which patients. The other source by Malheiro et al. (2020) is too general for the PICO question despite using the largest sample size in their study. The source by Kim et al. (20210 remains the most credible in solving the clinical practice issue.

Conclusion

The clinical issue involved a scenario where the use of clinical signs in the early detection of surgical site infection was unreliable. Therefore, using CRP values to screen for SSIs early in the postop period was a new intervention that would require evidence-based answers. This activity adopted the John Hopkins EBP model to seek evidence-based answers to the clinical issue.

A PICO question was used to improve search accuracy and provide conceptual clarity to the search. The four sources selected based on their credibility answered the PICO question in parts. Of the four sources, one source was outstanding because it was the most credible in that it additionally addressed the comparison intervention.

Therefore, the use of the PICO question is a valuable intervention in the EBP process as literature search and drawing a conceptual framework for literature acquisition depend on it.

NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach References

Chijioke, A. C. (2019). Evaluation of Serial C-Reactive Protein as a Predictor of Surgical Site Infection Following Emergency Laparotomy in Children in Ile-Ife, Nigeria. World Journal of Surgery and Surgical  Research, 2, 1138.

Eldawlatly, A., Alshehri, H., Alqahtani, A., Ahmad, A., Al-Dammas, F., & Marzouk, A. (2018). The appearance of Population, Intervention, Comparison, and Outcome as a research question in the title of articles of three different anesthesia journals: A pilot study. Saudi Journal of Anaesthesia, 12(2), 283. https://doi.org/10.4103/sja.sja_767_17

Eriksen, M. B., & Frandsen, T. F. (2018). The impact of patient, intervention, comparison, outcome (PICO) as a search strategy tool on literature search quality: a systematic review. Journal of the Medical Library Association: JMLA, 106(4), 420–431. https://doi.org/10.5195/jmla.2018.345

Iskandar, K., Sartelli, M., Tabbal, M., Ansaloni, L., Baiocchi, G. L., Catena, F., Coccolini, F., Haque, M., Labricciosa, F. M., Moghabghab, A., Pagani, L., Hanna, P. A., Roques, C., Salameh, P., & Molinier, L. (2019). Highlighting the gaps in quantifying the economic burden of surgical site infections associated with antimicrobial-resistant bacteria. World Journal of Emergency Surgery, 14(1). https://doi.org/10.1186/s13017-019-0266-x

Kim, M. H., Park, J.-H., & Kim, J. T. (2021). A reliable diagnostic method of surgical site infection after posterior lumbar surgery based on serial C-reactive protein. International Journal of Surgery: Global Health, 4(5), e61–e61. https://doi.org/10.1097/gh9.0000000000000061

Kurpiel, S. (2022, April 13). Research guides: Evaluating sources: The CRAAP test. https://researchguides.ben.edu/c.php?g=261612&p=2441794

Malheiro, R., Rocha-Pereira, N., Duro, R., Pereira, C., Alves, C. L., & Correia, S. (2020). Validation of a semi-automated surveillance system for surgical site infections: Improving exhaustiveness, representativeness, and efficiency. International Journal of Infectious Diseases: IJID: Official Publication of the International Society for Infectious Diseases, 99, 355–361. https://doi.org/10.1016/j.ijid.2020.07.035

National Healthcare Safety Network. (2022, January). Surgical Site Infection Event (SSI). Cdc.gov. https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf

Okui, J., Obara, H., Shimane, G., Sato, Y., Kawakubo, H., Kitago, M., Okabayashi, K., & Kitagawa, Y. (2022). The severity of early diagnosed organ/space surgical site infection in elective gastrointestinal and hepatopancreatobiliary surgery. Annals of Gastroenterological Surgery, 6(3), 445–453. https://doi.org/10.1002/ags3.12539

Shetty, S., Ethiraj, P., & Shanthappa, A. H. (2022). C-reactive protein is a diagnostic tool for postoperative infection in orthopedics. Cureus, 14(2), e22270. https://doi.org/10.7759/cureus.22270

NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach Instructions

Create a 3-5-page submission in which you develop a PICO(T) question for a specific care issue and evaluate the evidence you locate, which could help to answer the question. PICO(T) is an acronym that helps researchers and practitioners define aspects of a potential study or investigation. It stands for:

• P – Patient/population/problem.
• I – Intervention.
• C – Comparison (of potential interventions, typically).
• O – Outcome(s).
• T – Time frame (if time frame is relevant).

The end goal of applying PICO(T) is to develop a question that can help guide the search for evidence (Boswell & Cannon, 2015). From this perspective, a PICO(T) question can be a valuable starting point for nurses who are starting to apply an evidence-based model or EBPs.

By taking the time to precisely define the areas in which the nurse will be looking for evidence, searches become more efficient and effective. Essentially, by precisely defining the types of evidence within specific areas, the nurse will be more likely to discover relevant and useful evidence during their search.

You are encouraged to complete the Vila Health PCI(T) Process activity before you develop the plan proposal. This activity offers an opportunity to practice working through creating a PICO(T) question within the context of an issue at a Vila Health facility. These skills will be necessary to complete Assessment 3 successfully. This is for your own practice and self-assessment and demonstrates your engagement in the course.

DEMONSTRATION OF PROFICIENCY

By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:

• Competency 1: Interpret findings from scholarly quantitative, qualitative, and outcomes research articles and studies.
  • Explain the findings from articles or other sources of evidence.
• Competency 2: Analyze the relevance and potential effectiveness of evidence when making a decision.
  • Identify sources of evidence that could be potentially effective in answering a PICO(T) question.
  • Explain the relevance of the findings from chosen sources of evidence to making decision related to a PICO(T) question.
• Competency 3: Apply an evidence-based practice model to address a practice issue.
  • Define a practice issue to be explored via a PICO(T) approach.
• Competency 5: Apply professional, scholarly communication strategies to lead practice changes based on evidence.
  • Communicate using writing that is clear, logical, and professional with correct grammar and spelling using current APA style. Assessment #3 Instructions: PICO(T) Questions and an Evidence- Based Approach.

NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach Reference

Boswell, C., & Cannon, S. (2015). Introduction to nursing research. Burlington, MA: Jones & Bartlett Learning.

PROFESSIONAL CONTEXT for NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach

As a baccalaureate-prepared nurse, you will be responsible for locating and identifying credible and scholarly resources to incorporate the best available evidence for the purposes of enhancing clinical reasoning and judgement skills. When reliable and relevant evidence-based findings are utilized, patients, health care systems, and nursing practice outcomes are positively impacted.

PICO(T) is a framework that can help you structure your definition of the issue, potential approach that you are going to use, and your predictions related the issue. Word choice is important in the PICO(T) process because different word choices for similar concepts will lead you toward different existing evidence and research studies that would help inform the development of your initial question.

SCENARIO

For this assessment, please use an issue of interest from your current or past nursing practice. If you do not have an issue of interest from your personal nursing practice, then review the optional Case Studies presented in the resources and select one of those as the basis for your assessment.

Instructions for Completing NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach

For this assessment, select an issue of interest an apply the PICO(T) process to define the question and research it. Your initial goal is to define the population, intervention, comparison, and outcome. In some cases, a time frame is relevant and you should include that as well, when writing a question you can research related to your issue of interest.

After you define your question, research it, and organize your initial findings, select the two sources of evidence that seem the most relevant to your question and analyze them in more depth. Specifically, interpret each source’s specific findings and best practices related to your issues, as well explain how the evidence would help you plan and make decisions related to your question.

If you need some structure to organize your initial thoughts and research, the PICOT Question and Research Template document (accessible from the “Create PICO(T) Questions” page in the Capella library’s Evidence Based Practice guide) might be helpful. In your submission, make sure you address the following grading criteria:

• Define a practice issue to be explored via a PICO(T) approach.
• Identify sources of evidence that could be potentially effective in answering a PICO(T) question.
• Explain the findings from articles or other sources of evidence.
• Explain the relevance of the findings from chosen sources of evidence to making decision related to a PICO(T) question.
• Communicate using writing that is clear, logical, and professional with correct grammar and spelling using current APA style.

Example Assessment: You may use the following to give you an idea of what a Proficient or higher rating on the scoring guide would look like:

• Assessment 3 Example 1 [PDF].

ADDITIONAL REQUIREMENTS

Your assessment should meet the following requirements:

• Length of submission: Create a 3–5-page submission focused on defining a research question and interpreting evidence relevant to answering it. A title page is not required but you must include a reference list.
• Number of references: Cite a minimum of four sources of scholarly or professional evidence that support your findings and considerations. Resources should be no more than 5 years old.
• APA formatting: Format references and citations according to current APA style.
• NURS-FPX4030 Assessment 3 PICOT Questions and an Evidence-Based Approach

Portfolio Prompt: Remember to save the final assessment to your ePortfolio so that you may refer to it as you complete the final capstone course.

Resources: PICO(T) Process

• The resources below explore the PICO(T) process:
  • Abbade, L. P. F., Wang, M., Sriganesh, K., Jin, Y., Mbuagbaw, L., & Thabane, L. (2017). The framing of research questions using the PICOT format in randomized controlled trials of venous ulcer disease is suboptimal: A systematic survey. Wound Repair & Regeneration, 25(5), 892-900.

• • • This article presents a study that examined the use of PICO(T) questions to locate evidence related to specific types of resources and research.

• • Ho, G. J., Liew, S. M., Ng, C., Shunmugam, R., & Glasziou, P. (2016). Development of a search strategy for an evidence based retrieval service. PLoS One, 11(12), 1-14. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0167170

• • • This article presents a study comparing the use of PICO(T) questions in a literature search to other search strategies.

This first two chapters in the following text, of which the Capella library has limited copies, could be helpful in expanding your knowledge regarding the PICO(T) process.

• • Boswell, C., & Cannon, S. (2020). Introduction to nursing research. Jones & Bartlett Learning.

Resources: Communicating Research

• The resources below explore communicating research:
  • Bullington, J., Söderlund, M., Elisabeth Bos Sparén, Kneck, Å., Omérov, P., & Cronqvist, A. (2019). Communication skills in nursing: A phenomenologically-based communication training approach. Nurse Education in Practice, 39, 136-141.
    • This article presents the approach to communication in clinical situations and also discusses the barriers related to nurses sharing and communicating.

• • Gutiérrez-Puertas, L., Márquez-Hernández, V.,V., Gutiérrez-Puertas, V., Granados-Gámez, G., & Aguilera-Manrique, G. (2020). Educational interventions for nursing students to develop communication skills with patients: A systematic review. International Journal of Environmental Research and Public Health, 17(7), 2241.

• • • This article provides preliminary evidence of the effectiveness of interventions used to train nursing students in patient-centered communication. Although all the interventions obtained significant results in communication skills, it has not yet been determined which methodology is more effective.

PICOT QUESTION PROCESS

Creating a question using the PICOT elements will provide a framework for the research you need to conduct an evidence-based study or to make an evidence-based decision.

PICOT Elements:

(P) – Population, Patients or Problem: The sample of subjects used in a study, or the problem being addressed.

(I) – Intervention:  The treatment that will be provided to subjects enrolled in your study.

(C) – Comparison or Control:  Identifies an alternative intervention or treatment to compare. Many study designs refer to this as the control group. If an existing treatment is considered the ‘gold standard’, then it should be the comparison group. A control group is not required for every type of study.

(O) – Outcome: The clinical outcome that measures the effectiveness of the intervention.

(T) – Time: Duration of the data collection.  Some versions don’t include this element, and time may not be specified in cases where the question is focused on prediction or diagnoses.

PICOT Question Formats:

• Intervention: In _______ (P), how does _______ (I) compared to _______  (C) affect _______  (O) within _______ (T)?
• Prognosis/Prediction:  In _______ (P), how does _______ (I) compared to _______ (C) influence/predict _______ (O) over _______ (T)?
• Diagnosis or Diagnostic test:  In _______   (P) are/is _______   (I) compared to _______ (C) more accurate in diagnosing _______ (O)?
• Etiology:  Are _______ (P), who have _______ (I) compared to those without _______ (C) at _______ risk for/of _______ (O) over _______ (T)?
• Meaning:  How do_______ (P) with _______ (I) perceive _______ (O) during _______ (T)?

Example PICOT Questions:

• In acute care hospitals (P), how does having a rapid response team (I) compared with not having a response team (C) affect the number of cardiac arrests (O) during a three-month period (T)?
• In women with gestational diabetes (P), how does a monitored diet and exercise program over the course of pregnancy (I &T), compared to the use of metformin only (C) reduce the incidence of high birth weight babies(O)?
• In patients admitted for acute myocardial infarction (P), how well does the hospital’s new data model created from EMR data (I) compared to current practices (C) predict readmission rates (O) within 30 days after initial discharge (T)?
• For patients of a rural health clinic (P), does the use of text message reminders (I), compared with telephone calls (C) reduce the number of missed appointments (O) over a six month period (T)?

References:

• Melnyk, B.M., Fineout-Overholt, E., Stillwell, S. & Williamson, K. M. (2010). Evidence-Based Practice: Step by Step: The Seven Steps of Evidence-Based Practice. AJN, American Journal of Nursing, 110, 51-53.
• Posing the research question: Not so simple
• To make your case, start with a PICOT question
• What is your research question? An introduction to the PICOT format for clinicians.
• Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence-based practice in nursing & healthcare: A guide to best practice. (Not in library)

Assessment 2 Instructions Biopsychosocial Population Health Policy Proposal

• Develop a 2-4 page proposal for a policy that should help to improve health care and outcomes for your target population.

Introduction

Note: Each assessment in this course builds on the work you completed in the previous assessment. Therefore, you must complete the assessments in this course in the order in which they are presented.

Cost and access to care continue to be main concerns for patients and providers. As technology improves our ability to care for and improve outcomes in patients with chronic and complex illnesses, questions of cost and access become increasingly important. As a master’s-prepared nurse, you must be able to develop policies that will ensure the delivery of care that is effective and can be provided in an ethical and equitable manner.

As a master’s-prepared nurse, you have a valuable viewpoint and voice with which to advocate for policy developments. As a nurse leader and health care practitioner, often on the front lines of helping individuals and populations, you are able to articulate and advocate for the patient more than any other professional group in health care. This is especially true of populations that may be underserved, underrepresented, or are otherwise lacking a voice. By advocating for and developing policies, you are able to help drive improvements in outcomes for specific populations. The policies you advocate for could be internal ones (just within a specific department or health care setting) that ensure quality care and compliance. Or they could be external policies (local, state, or federal) that may have more wide-ranging effects on best practices and regulations.

Preparation

As you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. You are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as part of your assessment.

• • What are the relevant best practices from a population health standpoint (cultural competence, disease prevention, and interventions) for your chosen health issue and vulnerable population?

• • • How are these best practices relevant to your chosen health issue and vulnerable population?

• • • • Do the best practices make any reference to standards of care or benchmarks that should be achieved?
    • How could these best practices be leveraged to help inform or develop a policy and guidelines to improve care and outcomes for the vulnerable population you are working with?
  • How could technology be used to identify health concerns or collect data that could help health care practitioners determine which health care issues to focus on in a population?

• • • What are the relevant laws, regulations, or policies for employing any of the technology you might find useful?
  • What type of policy and guidelines would be most likely to ensure improvements in care and outcomes related to your chosen health issue and vulnerable population?

• • • Are there any policies in existence that could help inform your own policy development?
    • How might your proposed policy and guidelines influence the way in which care is accessed?
    • How might your proposed policy and guidelines influence the amount of access that is available?

Assessment 2 will build on the health issue, vulnerable population, and position that you started to develop in the first assessment. For Assessment 2, you will develop a proposal for a policy and a set of guidelines that could be implemented to ensure improvements in care and outcomes. Refer to the resource listed below:

• • Guiding Questions: Biopsychosocial Population Health Policy Proposal [DOC].

Scenario

The analysis of position papers that your interprofessional team presented to the committee has convinced them that it would be worth the time and effort to develop a new policy to address your specific issue in the target population. To that end, your interprofessional team has been asked to submit a policy proposal that outlines a specific approach to improving the outcomes for your target population. This proposal should be supported by evidence and best practices that illustrate why the specific approaches are likely to be successful. Additionally, you have been asked to address the ways in which applying your policy to interprofessional teams could lead to efficiency or effectiveness gains.

Instructions

For this assessment you will develop a policy proposal that seeks to improve the outcomes for the health care issue and target population you addressed in Assessment 1. If for some reason you wish to change your specific issue and/or target population, contact your FlexPath faculty.

The bullet points below correspond to the grading criteria in the scoring guide. Be sure that your submission addresses all of them. You may also want to read the Biopsychosocial Population Health Policy Proposal Scoring Guide and Guiding Questions: Biopsychosocial Population Health Policy Proposal [DOC] to better understand how each grading criterion will be assessed.

• • Propose a policy and guidelines that will lead to improved outcomes and quality of care for a specific issue in a target population.
  • Advocate the need for a proposed policy in the context of current outcomes and quality of care for a specific issue in a target population.
  • Analyze the potential for an interprofessional approach to implementing a proposed policy to increase the efficiency or effectiveness of the care setting to achieve high-quality outcomes.
  • Communicate proposal in a professional and persuasive manner, writing content clearly and logically with correct use of grammar, punctuation, and spelling.
  • Integrate relevant sources to support assertions, correctly formatting citations and references using APA style.

Example Assessment: You may use the assessment example, linked in the Assessment Example section of the Resources, to give you an idea of what a Proficient or higher rating on the scoring guide would look like.

Additional Requirements

• • Length of proposal: 2-4 double-spaced, typed pages, not including title page or reference list. Your proposal should be succinct yet substantive.
  • Number of references: Cite a minimum of 3-5 sources of scholarly or professional evidence that supports the relevance of or need for your policy, as well as interprofessional considerations. Resources should be no more than five years old.
  • APA formatting: The APA Style Paper Tutorial [DOCX] will help you in writing and formatting your analysis.

Competencies Measured

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

• • Competency 1: Design evidence-based advanced nursing care for achieving high-quality population outcomes.

• • • Propose a policy and guidelines that will lead to improved outcomes and quality of care for a specific issue in a target population.
  • Competency 2: Evaluate the efficiency and effectiveness of interprofessional interventions in achieving desired population health outcomes.

• • • Analyze the potential for an interprofessional approach to implementing a proposed policy to increase the efficiency or effectiveness of the care setting to achieve high quality outcomes.
  • Competency 3: Analyze population health outcomes in terms of their implications for health policy advocacy.

• • • Advocate the need for a proposed policy in the context of current outcomes and quality of care for a specific issue in a target population.
  • Competency 4: Communicate effectively with diverse audiences, in an appropriate form and style, consistent with organizational, professional, and scholarly standards.

• • • Communicate proposal in a professional and persuasive manner, writing content clearly and logically with correct use of grammar, punctuation, and spelling.
    • Integrate relevant sources to support assertions, correctly formatting citations and references using APA style.

Resources: Access to Care

• PRINT

https://courserooma.capella.edu/webapps/blackboard/content/listContent.jsp?course_id=_358031_1&content_id=_10919381_1

• Brooks, E., Dailey, N. K., Bair, B. D., & Shore, J. H. (2016) Listening to the patient: Women veterans’ insights about health care needs, access, and quality in rural areas. Military Medicine, 181(9), 976-981.
• Caldwell, J. T., Ford, C. L., Wallace, S. P., Wang, M. C., & Takahashi, L. M. (2016). Intersection of living in a rural versus urban area and race/ethnicity in explaining access to health care in the United States. American Journal of Public Health, 106(8), 1463-1469.
• Linder, J. A. & Levine, D. M. (2016). Health care communication technology and improved access, continuity, and relationships: The revolution will be Uberized. JAMA Internal Medicine, 176(5), 643-644.
• Peretz, P. J., Islam, N., & Matiz, L. A. (2020). Community health workers and covid-19 — addressing social determinants of health in times of crisis and beyond.The New England Journal of Medicine, 383(19), e108-e108.

Silverstein, M., Hsu, H. E., & Bell, A. (2019). Addressing social determinants to improve population health: The balance between clinical care and public health. JAMA: The Journal of the American Medical Association, 322(24), 2379-2380

NURS 6512 Lab Assignment: Assessing the Abdomen Sample Paper

Abdominal Pain

The subjective portion of the note consists of the following information: the patient is a woman currently complaining of severe abdominal cramping. Significant information that should be included in the subjective note include when did the pain begin? How did it begin; was it gradual or sudden? What is the progress of the pain; is it becoming worse or better? (Dains et al., 2019). What is its character; is it a dull pain, sharp, burning, stabbing or stinging pain? Is the pain radiating or non-radiating? If it is the radiating type, where does it radiate from and to where?

Are there any other symptoms associated with the pain, such as nausea and vomiting? What relieves the pain; does medication, lying in a certain position or sitting in a particular posture alleviate the pain? What increases the pain; does standing, walking or sitting in a certain way augment the pain? What is the timing of the pain? Is it continuous or discontinuous, does the pain come more often during particular times of the day? Does the pain interfere with daily activities such as work, in such a manner that she is unable to continue with her duties?

The objective portion of the note consists of this information: while she had been diagnosed with diverticulitis, a CT scan revealed pancreatic growth that turned out to be pancreatic cancer. Additional information that would be significant should include whether the patient was treated of similar symptoms. In case the response is positive, the nurse should seek information as to what tests were conducted on the patient and what the diagnosis was at the time. Also, the care management approach used in her case would be helpful.

A focused adnominal history would assist in minimizing chances of misdiagnosis. The questions relevant would be how long ago did the pain start? Was the onset gradual or sudden and how severe was the pain on a scale of 1 to 10? Does the pain prevent the patient from engaging in daily tasks/responsibilities? Does she awake from sleep due to the pain? It is also important to know what has been the course of the pain since it started. Is it getting worse or better? When was the last bowel movement? Has she ever had the pain before; if so what was diagnosed, how was it treated?

The focused physical examination will commence with noting the general appearance. Visceral pain often makes patients restless and uncomfortable. An assessment of the vital signs is also mandatory (Dains et al., 2019). The nurse should check out for shallow respirations, tachypnea or tachycardia. Documented weight loss should be noted since the patient has a neoplasm. The nurse should observe the abdominal musculature for features of rigidity, the coloring of the abdominal skin and note any abdominal distention. An auscultation for bowel sounds, percussion for tones and guarding and palpation for masses will also assist in forming a definitive diagnosis for this patient. For this patient, the differential diagnoses include diverticulitis, hernia, costochondritis, Crohn disease, irritable bowel syndrome, esophagitis, uterine fibroids, dysmenorrhea or recurrent UTI.

The assessment is supported by the subjective and objective information. Since the patient complains of chronic pain, conditions presenting with acute pain such as pancreatitis, appendicitis, peritonitis and intestinal obstruction are unlikely. The nurse may rule out these conditions from the differential diagnosis. Also, symptoms such as diarrhea and vomiting may be present in Crohn disease and irritable bowel syndrome. Therefore, their absence may drive the care provider to other conditions. Signs such as tachycardia, tachypnea and shallow breathing if present may indicate presence of metabolic acidosis, where the patient tries to compensate using the respiratory system (LeBlond et al., 2014).

Shallow breathing may further indicate airway obstruction by another underlying illness like pneumonia. Absent bowel sounds are indicative of conditions such as paralytic ileus or partial or total duodenectomy, ileectomy or jejunectomy. Palpation will reveal presence of underlying intraabdominal masses (Ball et al., 2019). In this patient, the growth noted on the pancreas is likely to be palpable. Percussion of the abdomen for this case may not yield positive results unless the spleen and the liver are enlarged. In hepatosplenomegaly, a dull note on percussion may be elicited. Percussion will yield a tympanic note also owing to absence of ascetic fluid in the patient.

Several diagnostic tests will be relevant for this patient. Serum lipase levels should be tested. Serum lipase levels are elevated in pancreatic tumors, and the test is more specific than serum amylase levels. While both lipase and amylase are pancreatic enzymes the later is also found in the saliva. Also, a biopsy of the pancreas for histology, cytology and histocytopathology would assist in the diagnosis. Histocytopathology would note the presence of neoplastic cells and characterize them as malignant or non-malignant (Bharucha et al., 2016). Immunohistochemistry will identify specific tumor markers and give the appropriate medical name of the pancreatic growth. In addition, an MRI of the abdomen will outline the structure and orientation of organs involved (Coylar, 2015), which would provide a visual analysis of the extent of growth and possible metastases. Determining the extent of the tumor assists in staging. Early stage tumors may be managed by chemoradiotherapy or surgical management depending on the tumor type and the patient’s body habitus.

I would accept the current diagnosis of diverticulitis if supported by X-RAY evidence. In addition to the diverticulitis, the patient has pancreatic growth as proven by the CT-Scan. Pancreatic tumor should be part of the diagnosis. Differential diagnoses for this patient include hernia, irritable bowel syndrome and parasitic infection of bowels (Koop et al., 2016; Martelli & Lee, 2016; Bharucha et al., 2016). Hernia presents with pain that may increase on coughing. Hernias may also increase visibly in size when the patient coughs. Parasitic infections would be an unlikely cause since they are rare in developed nations as compared to the developing world.

References

• Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
• Bharucha, A. E., Chakraborty, S., & Sletten, C. D. (2016). Common functional gastroenterological disorders associated with abdominal pain. Mayo Clinic Proceedings, 91(8), pp. 1118-1132. https://doi.org/10.1016/j.mayocp.2016.06.003
• Colyar, M. R. (2015). Advanced practice nursing procedures. Philadelphia, PA: F. A. Davis.
• Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.
• Koop, H., Koprdova, S., & Schürmann, C. (2016). Chronic abdominal wall pain: a poorly recognized clinical problem. Deutsches Ärzteblatt International, 113(4), 51. https://dx.doi.org/10.3238%2Farztebl.2016.0051
• LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic examination (10th ed.). New York, NY: McGraw Hill Medical.
• Martelli, M. G., & Lee, J. Y. (2016). Parasitic Infection of the Gallbladder: Cystoisospora belli Infection as a Cause of Chronic Abdominal Pain and Acalculous Cholecystitis. Journal of the Mississippi State Medical Association, 57(6), 174-176

Assessment-Dashboard Metrics Evaluation Sample Paper

Healthcare institutions endeavor to improve care quality and safety and reduce costs through periodic evaluation and intervention. A major organizational assessment method is through dashboards. Comparing the dashboard metrics helps healthcare institutions note the underperforming areas and provokes the development of interventions to improve them. Dashboards can be internally or externally prepared.

Internal dashboards help organizations evaluate their performance over time, while external dashboards help them compare their performance against other institutions and national standards. Internal dashboards are the best in determining an institution’s progress over time, and they can also be compared against set benchmarks to show the institution’s performance relative to other organizations. Mercy Medical Center is the hospital of interest.

It is Villa Health-Affiliated and a renowned hospital for its quality care, as reflected in its various achievements such as outstanding patient experiences, high safe surgery ratings, and best emergency services (Vila Health, n.d.). Mercy Medical Center’s diabetes dashboard metrics are the focus of this assessment. It will also evaluate its performance, relevant local, state, and federal policy challenges in meeting the benchmarks, and develop an ethical intervention to address the poorly performing benchmarks.

Mercy Medical Center Dashboard Metrics Evaluation

The services offered by a healthcare institution may differ depending on the population characteristics. Mercy Medical Center is a large institution serving over 20,000 individuals. The hospital serves 2371 over 65 years, 6099 aged 45-64, 14732 aged 21-44, and 12 126 under 20 years (Vila Health, n.d.). The ethnic and racial distribution from the largest to the smallest group is as follows: whites 28537, Asians 3822, Hispanic Latino 2890, African Americans 1601, interracial 1016, American Indian 4333, and other ethnicities 11611. The region’s total population is 36192, and the gender distribution is 17957 males and 18235 females. Race, age, and gender are important factors in diabetes management.

Mercy Medical Center’s public diabetes dashboard is evaluated quarterly, and the institution evaluates its performance for each quarter. The data is presented based on gender, age, and race and includes the number and percentage changes relative to the total number of diabetic patients. 2019’s last quarter statistics were as follows: 355 whites (63%), 34 Asians (6%),73 American Indians (13%), 17 African Americans (3%), 11 other races (2%), and 73 did not respond (Vila Health, n.d.). Of these, 214 patients were males (38%), while 347 (62%) were female, and two did not respond to the gender question.

Among them, 118 were below 20 years, 51 were between 21 and 44, 214 were between 45 and 64, and 180 patients were 65 years and above (Vila Health, n.d.). The government requires individuals to attend an annual diabetic foot, eye, and HbA1c examination. The rates of HbA1c have been dropping gradually, and the number of diabetic foot exams has been relatively low. These rates are relatively low and cause concern, judging from the number of new patients for the last quarter. There are several areas of missing information.

The total number of patients available makes it difficult to calculate the percentage of patients attending diabetic foot, eye, and HbA1c examinations. In addition, other diabetes interventions vital to diabetes monitoring, such as diabetes complications and their categories that help show the actual impact of the benchmarks, are missing.

Benchmarks Set Forth by Local, State, & Federal Laws

Benchmarking is an important way of evaluating performance. Comparing the organization’s performance against the national and state-set standards will help gauge the organization’s success in meeting healthcare needs. These standards help maintain high-quality care and spearhead quality improvement processes in healthcare institutions. Institutions can borrow ideas from other organizations succeeding in various benchmarks to improve care delivery, quality, and patient safety associated with the benchmark of choice.

The Agency for Healthcare Research and Quality is responsible for preparing national quality standards for various healthcare conditions. AHRQ relies on data sources such as the National Committee on Quality Assurance, DART Net, and SAFTINet, large data organizations with high efficiency, specialization, and reliability (AHRQ, 2021). The agency liaises with other bodies responsible for specific conditions, such as the American Heart Association (stroke and heart disease) and the American Diabetes Association (diabetes), to collect and analyze data vital in preparing these benchmark dashboards.

AHRQ prepares annual reports that contain specific dashboards for managing various healthcare conditions and certain conducts within the hospital. The National Healthcare Quality and Disparities Report is a comprehensive document prepared each year to reflect the data collected and analyzed and the inferences made by the AHRQ. The national diabetes quality measures by the NHQDR feature the national benchmarks for diabetes on dilated eye and foot exams and HbA1c tests.

AHRQ (n.d.) notes that these benchmarks are results from top-performing institutions, and other institutions can gauge their performance using them. NHDQR (2019) report states that more than 79.5% of diabetic patients should take the HgbA1c test twice annually, more than 84% of patients should take annual diabetic foot tests, and more than 75.2% of patients should take annual eye exams (AHRQ, n.d.). These percentages are set from the results of the best-performing healthcare institutions. These tests are integral to detecting patient complications early and intervening before injury results in the patient.

Challenge Posed by Meeting Prescribed Benchmarks

Meeting the prescribed benchmarks would pose a challenge to healthcare staffing. Diabetes patients place a significant burden on the healthcare workers’ workload. Winter et al. (2020) note that a global healthcare staff shortage affects most hospitals. Meeting the benchmark will increase the number of patients attending the hospital, further aggravating the shortage of healthcare staff due to the increased demand.

Available staff in hospitals with staff shortages focus more on completing the assigned tasks than ensuring quality care. It is thus easy for them to overlook some items, such as annual checkups, despite their potential to influence diabetes patient outcomes. Understaffing increases error incidences, interferes with work productivity, and promotes high employee fatigue and burnout, high employee turnover, and poor patient outcomes (Winter et al., 2020).

The few staff can also overlook the comprehensive and keen patient assessment. Pankhurst & Edmonds (2018) state that staff shortage leads to decreased staff efficiency and reliance; hence, it is easy to overlook details such as changes in HbA1c test variations, wounds and minor injuries, and slight changes in visual acuity when attempting to complete the many tasks.

Patient education is a vital aspect of diabetes management. With inadequate staff, there is limited time to emphasize the importance of these follow-ups, leading to low patient turnout. Understaffing would thus affect the quality of care and increase patient safety issues. Healthcare staff shortages are a global pandemic, and very few hospitals have nurses and physicians close to the recommended health worker-to-patient ratio (Winter et al., 2020). The problem affects government and private institutions. A major assumption is that Mercy Medical Center is also affected by the global healthcare staff shortage.

HbA1c tests are integral in determining the effectiveness of interventions in managing blood glucose levels within acceptable limits. Imai et al. (2021) state that tests help with interventions such as changes in patient therapy, patient education, and family involvement in cases of self-care deficit. HbA1c tests help detect complications and impaired glucose regulation early; thus, healthcare providers intervene early to prevent complications.

Imai et al. (2021) also note that patients with strict adherence to HbA1c tests have better outcomes and effectiveness in glycemic control. Failure to monitor HbA1c leads to complications such as persistent high blood glucose, peripheral neuropathies, and stroke. It thus decreases care quality and interferes with patient safety, hence poor population health. HbA1c tests and results monitoring are thus integral.

Ethical Intervention for the Underperforming Benchmark

The stakeholder group to take action is the healthcare leaders. The leaders prepare policies and can easily organize and provide resources for any intervention in the healthcare institution. Diabetes management requires the input of various professionals, including nurses, doctors, ophthalmologists, and laboratory technicians, and these professionals interact with the patients to varying degrees. The chosen intervention, staff education, is an integral step in ensuring that patients understand the importance of HbA1c tests and other metrics in diabetes management. The main goal is to increase the patient’s knowledge and promote healthy behavior. Researchers note that staff training increases their confidence, the immediacy of action, quality healthcare decisions, and patient safety and promotes better staff work experiences (Torani et al., 219).

Ethics in healthcare are integral. Respecting autonomy and fidelity are the basis for developing the intervention. The main goal is to increase the patients’ knowledge to make the right decisions (Lambrinou et al., 2019). Patients also participate in healthcare decisions when they understand their implications. The education will also remind the nurses of the importance of carrying out the tests and encourage them to meet the requirements when managing these patients. The education will increase their faithfulness when assessing and educating these patients to ensure adherence to the diabetes management requirements. Comprehensive education will also help improve other standards, such as vaccination requirements not included in this dashboard.

Most initiatives and emphasis on healthcare interventions are initiated by healthcare providers, thus sensitizing the nurses to the benchmarks and reminding them of the importance of teaching patients. Reminding nurses will help manage the underperforming benchmark and prevent further complications while ensuring the interventions do not stretch the existing healthcare resources. Other interventions that can supplement the intervention include preparing learning material such as handouts and online resources, and referring patients to them will further increase their information and create the need and urgency to adhere to the recommendations of HbA1c tests (Ghisi et al., 2021).

Conclusion

Dashboard evaluation helps in healthcare performance and quality improvement. These healthcare dashboards help determine progress and show the hospital’s performance to other institutions and the nationally set standards. Mercy Medical Center’s diabetes dashboard metrics show the need for interventions to improve HbA1c tests. The tests are poorly done compared to the nationally set standards. The lack of statistics on the total number of patients makes it difficult to calculate actual percentages. Moreover, eye exams and diabetic foot exams are also performing poorly, and there is room for improvement. The intervention to improve the underperforming dashboard metric is based on various ethical principles, including autonomy, respect for persons, and fidelity. Staff training will help improve the underperforming benchmark and overall diabetes management.

References

• Agency for Healthcare Research and Quality. (n.d.). National Healthcare Quality and Disparities Report 2021. The National Diabetes Quality Measures. Accessed 30th June 2022 from https://nhqrnet.ahrq.gov/inhprdr/national/benchmark/table/diseases_and_conditions/diabetes
• Agency for Healthcare Research and Quality. (n.d.). Practice Facilitation Handbook, Module 7. Measuring and Benchmarking Clinical Performance. AHRQ. Agency for Healthcare Research and Quality. Accessed 30th June 2022 from https://www.ahrq.gov/ncepcr/tools/pf-handbook/mod7.html
• Ghisi, G. L. D. M., Seixas, M. B., Pereira, D. S., Cisneros, L. L., Ezequiel, D. G. A., Aultman, C., Sandison, N., Oh, p., & da Silva, L. P. (2021). Patient education program for Brazilians living with diabetes and prediabetes: findings from a development study. BMC Public Health, 21(1), 1-16. https://doi.org/10.1186/s12889-021-11300-y
• Imai, C., Li, L., Hardie, R. A., & Georgiou, A. (2021). Adherence to guideline-recommended HbA1c testing frequency and better outcomes in patients with type 2 diabetes: a 5-year retrospective cohort study in Australian general practice. BMJ Quality & Safety, 30(9), 706-714. http://dx.doi.org/10.1136/bmjqs-2020-012026
• Lambrinou, E., Hansen, T. B., & Beulens, J. W. (2019). Lifestyle factors, self-management and patient empowerment in diabetes care. European Journal Of Preventive Cardiology, 26(2_suppl), 55-63. https://doi.org/10.1177/2047487319885455
• Pankhurst, C. J. W., & Edmonds, M. E. (2018). Barriers to foot care in patients with diabetes as identified by healthcare professionals. Diabetic Medicine, 35(8), 1072–1077. https://doi.org/10.1111/dme.13653

Assessment 4 Instructions Final Care Coordination Plan

For this assessment, you will evaluate the preliminary care coordination plan you developed in Assessment 1 using best practices found in the literature.

NOTE: You are required to complete this assessment after Assessment 1 is successfully completed.

Care coordination is the process of providing a smooth and seamless transition of care as part of the health continuum. Nurses must be aware of community resources, ethical considerations, policy issues, cultural norms, safety, and the physiological needs of patients. Nurses play a key role in providing the necessary knowledge and communication to ensure seamless transitions of care. They draw upon evidence-based practices to promote health and disease prevention to create a safe environment conducive to improving and maintaining the health of individuals, families, or aggregates within a community. When provided with a plan and the resources to achieve and maintain optimal health, patients benefit from a safe environment conducive to healing and a better quality of life.

This assessment provides an opportunity to research the literature and apply evidence to support what communication, teaching, and learning best practices are needed for a hypothetical patient with a selected health care problem.

Demonstration of Proficiency

By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:

• Competency 1: Adapt care based on patient-centered and person-focused
  • Design patient-centered health interventions and timelines for a selected health care
• Competency 2: Collaborate with patients and family to achieve desired
  • Describe priorities that a care coordinator would establish when discussing the plan with a patient and family member, making changes

based upon evidence-based practice.

• Competency 3: Create a satisfying patient
  • Use the literature on evaluation as a guide to compare learning session content with best practices, including how to align teaching sessions to the Healthy People 2020
• Competency 4: Defend decisions based on the code of ethics for
  • Consider ethical decisions in designing patient-centered health

• Competency 5: Explain how health care policies affect patient-centered
  • Identify relevant health policy implications for the coordination and continuum of
• Competency 6: Apply professional, scholarly communication strategies to lead patient-centered
  • Apply APA formatting to in-text citations and references, exhibiting nearly flawless adherence to APA
  • Organize content so ideas flow logically with smooth transitions; contains few errors in grammar/punctuation, word choice, and

Preparation

In this assessment, you will evaluate the preliminary care coordination plan you developed in Assessment 1 using best practices found in the literature.

To prepare for your assessment, you will research the literature on your selected health care problem. You will describe the priorities that a care coordinator would establish when discussing the plan with a patient and family members. You will identify changes to the plan based upon EBP and discuss how the plan includes elements of Healthy People 2020.

Instructions

Note: You are required to complete Assessment 1 before this assessment. For this assessment:

• Build on the preliminary plan, developed in Assessment 1, to complete a comprehensive care coordination

Document Format and Length

Build on the preliminary plan document you created in Assessment 1. Your final plan should be a scholarly APA formatted paper, 5–7 pages in length, not including title page and reference list.

Supporting Evidence

Support your care coordination plan with peer-reviewed articles, course study resources, and Healthy People 2020 resources. Cite at least three credible sources.

Grading Requirements

The requirements, outlined below, correspond to the grading criteria in the Final Care Coordination Plan Scoring Guide, so be sure to address each point. Read the performance-level descriptions for each criterion to see how your work will be assessed.

• Design patient-centered health interventions and timelines for a selected health care
  • Address three health care
  • Design an intervention for each health
  • Identify three community resources for each health
• Consider ethical decisions in designing patient-centered health interventions.

• Consider the practical effects of specific
• Include the ethical questions that generate uncertainty about the decisions you have

• Identify relevant health policy implications for the coordination and continuum of
  • Cite specific health policy provisions.
• Describe priorities that a care coordinator would establish when discussing the plan with a patient and family member, making changes based upon evidence-based practice.

• Clearly explain the need for changes to the plan

• Use the literature on evaluation as a guide to compare learning session content with best practices, including how to align teaching sessions to the Healthy People 2020 document.

• Use the literature on evaluation as guide to compare learning session content with best
• Align teaching sessions to the Healthy People 2020

• Apply APA formatting to in-text citations and references, exhibiting nearly flawless adherence to APA format.
• Organize content so ideas flow logically with smooth transitions; contains few errors in grammar/punctuation, word choice, and spelling

Additional Requirements

Before submitting your assessment, proofread your final care coordination plan to minimize errors that could distract readers and make it more difficult for them to focus on the substance of your plan.

14 to >13.0 pts

LACHANDA BROWN: Hello

Assessment of Nutrition in Children NURS 6512

CASE STUDY ASSIGNMENT: ASSESSMENT OF NUTRITION IN CHILDREN

When seeking to identify a patient’s health condition, advanced practice nurses can use a diverse selection of diagnostic tests and assessment tools; however, different factors affect the validity and reliability of the results produced by these tests or tools. Nurses must be aware of these factors in order to select the most appropriate test or tool and to accurately interpret the results.

Not only do these diagnostic tests affect adults, body measurements can provide a general picture of whether a child is receiving adequate nutrition or is at risk for health issues. These data, however, are just one aspect to be considered. Lifestyle, family history, and culture—among other factors—are also relevant. That said, gathering and communicating this information can be a delicate process.

For this Assignment, you will  consider examples of children with various weight issues. You will explore how you could effectively gather information and encourage parents and caregivers to be proactive about their children’s health and weight.

TO PREPARE

• Review this week’s Learning Resources and consider factors that impact the validity and reliability of various assessment tools and diagnostic tests. You also will review examples of pediatric patients and their families as it relates to BMI.
  • Based on the risks you might identify consider what further information you would need to gain a full understanding of the child’s health. Think about how you could gather this information in a sensitive fashion.
  • Consider how you could encourage parents or caregivers to be proactive toward the child’s health.

THE ASSIGNMENT

Assignment (3–4 pages, not including title and reference pages):

Assignment: Child Health Case:
Include the following:

• An explanation of the health issues and risks that are relevant to the child you were assigned.
• Describe additional information you would need in order to further assess his or her weight-related health.
• Identify and describe any risks and consider what further information you would need to gain a full understanding of the child’s health. Think about how you could gather this information in a sensitive fashion.
• Taking into account the parents’ and caregivers’ potential sensitivities, list at least three specific questions you would ask about the child to gather more information.
• Provide at least two strategies you could employ to encourage the parents or caregivers to be proactive about their child’s health and weight.

BY DAY 6 OF WEEK 3

Submit your Assignment.

LEARNING RESOURCES

Assessment of Nutrition in Children NURS 6512 Required Readings

• Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2023). Seidel’s guide to physical examination: An interprofessional approach (10th ed.). St. Louis, MO: Elsevier Mosby.
  • Chapter 3, “Examination Techniques and Equipment”
    This chapter explains the physical examination techniques of inspection, palpation, percussion, and auscultation. This chapter also explores special issues and equipment relevant to the physical exam process.
  • Chapter 8, “Growth and Nutrition”
    In this chapter, the authors explain examinations for growth, gestational age, and pubertal development. The authors also differentiate growth among the organ systems.

• Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Student checklist: Health history guide Download Student checklist: Health history guide. In Seidel’s guide to physical examination (9th ed.). St. Louis, MO: Elsevier Mosby.
  Credit Line:  Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.
• Centers for Disease Control and Prevention. (2021, April 9). Childhood overweight & obesity. http://www.cdc.gov/obesity/childhood/
  This website provides information about overweight and obese children. Additionally, the website provides basic facts about obesity and strategies to counteracting obesity.
• Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.
  Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.
  • Chapter 1, “Clinical Reasoning, Evidence-Based Practice, and Symptom Analysis”
    This chapter introduces the diagnostic process, which includes performing an analysis of the symptoms and then formulating and testing a hypothesis. The authors discuss how becoming an expert clinician takes time and practice in developing clinical judgment.

• Nyante, S. J., Benefield, T. S., Kuzmiak, C. M., Earnhardt, K., Pritchard, M., & Henderson, L. M. (2021). Population?level impact of coronavirus disease 2019 on breast cancer screening and diagnostic procedures. Cancer, 127(12), 2111–2121. https://doi.org/10.1002/cncr.33460
• Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). History subjective data checklist. In Mosby’s guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby.
  Credit Line: Mosby’s Guide to Physical Examination, 7th Edition by Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2011 by Elsevier. Reprinted by permission of Elsevier via the Copyright Clearance Center.

• Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.
  • Chapter 2, “The Comprehensive History and Physical Exam” (Previously read in Week 1)
  • Chapter 5, “Pediatric Preventative Care Visits” (pp. 91 101)

Assessment of Nutrition in Children Example

In considering the case of a 2-year-old girl of normal weight who resides with her obese mother and normal-weight father, it is important to delve into the various health issues and risks she may encounter. This scenario presents a unique blend of genetic, environmental, and behavioral factors that could influence the child’s future health. This family dynamic presents a multifaceted view of health risks and considerations, primarily influenced by genetic, environmental, and behavioral factors. Genetically, a child may inherit a predisposition to obesity from her mother despite having a normal weight during infancy (Cavalli & Heard, 2019). This genetic factor underscores the importance of vigilance in her health management as she grows.

Environmentally, the child’s exposure to her mother’s obesity could influence her own health behaviors. Dietary habits within the household, driven by the mother’s choices, might lean towards unhealthy patterns, posing a risk to the child’s nutritional status. Conversely, the presence of a father with a normal weight provides an opportunity for balanced dietary and lifestyle modeling. Behaviorally, the child is at a critical stage where habits are formed. The mixed health status of her parents could lead to inconsistent health behaviors, which, according to Milne-Ives et al. (2020), emphasizes the need for structured guidance in her diet and physical activity. Additionally, the psychosocial aspect of living with an obese parent could impact the child’s self-esteem and body image, making supportive and positive family dynamics crucial.

Additional information is needed in several key areas to further assess the 2-year-old girl’s weight-related health. Firstly, a detailed family health history would be essential, especially concerning any chronic diseases like diabetes, heart conditions, or obesity-related complications in both the maternal and paternal lineage. This information would offer insights into the genetic predispositions the child might have. Secondly, understanding the dietary habits of the household is crucial. Details about the types of foods regularly consumed, meal patterns, portion sizes, and the balance of nutrients would provide a clearer picture of a child’s nutritional intake (Sheldrick et al., 2019), which is crucial in this case. Information about the mother’s eating habits, given her obesity, would be particularly relevant in assessing the potential influence on the child’s diet.

Physical activity levels are also important. Data on how often the child engages in physical play, the types of activities she participates in, and the overall sedentary versus active time spent daily would help evaluate her physical health and development needs. According to Sheldrick et al. (2019), a child’s developmental milestones and current growth metrics, such as weight-for-age and height-for-age ratios, are vital. These would help determine if she is on track with expected growth patterns for her age. Additionally, understanding the family’s socio-economic status could provide context, as it often influences access to healthy food options and recreational activities. Lastly, information on the family’s general attitude and knowledge about health, nutrition, and physical activity would help assess the likelihood of the child adopting healthy lifestyle habits.

Several risks are primarily related to potential genetic predispositions and environmental influences on the child’s health. The child may be at a higher risk of developing obesity due to genetic factors, given her mother’s obesity. Additionally, the family’s dietary and lifestyle habits could significantly influence the child’s long-term health, with potential risks including poor nutrition, inadequate physical activity, and the development of unhealthy eating behaviors. To fully understand the child’s health, collecting more information in a sensitive and non-intrusive manner is necessary. Detailed family health history, particularly concerning obesity-related conditions (Sheldrick et al., 2019), would be crucial for this case.

Understanding the family’s daily dietary practices, meal routines, and physical activity patterns would provide insight into the child’s lifestyle. Monitoring the child’s developmental milestones and growth parameters would also be essential to assess her physical development accurately. Gathering this information could be approached sensitively through regular pediatric consultations where the healthcare provider can gently inquire about family health history, dietary habits, and lifestyle practices. Using routine health check-ups as an opportunity for education and guidance on nutrition and physical activity can also be beneficial. Engaging with the family in a supportive, non-judgmental manner is key to encouraging openness and cooperation and ensuring the child’s health is monitored and supported effectively.

Specific Questions

1. Nutritional Inquiry: Could you tell me about your child’s favorite foods and meals? What does a typical day of eating look like for her?
2. Activity Level: What activities or games does your child enjoy? How does she like to spend her playtime?
3. Family Health Patterns: Are there any common health concerns or conditions in your family history that you think we should be aware of for your child’s overall health?

Strategies

One effective approach is to focus on family-centric health education. This involves engaging the family in discussions about the importance of healthy eating and physical activity tailored to their specific situation. The family can be guided towards healthier eating habits by providing practical advice on preparing balanced meals that meet both the child’s growth needs and the mother’s health requirements (Patel et al., 2021). Additionally, suggesting family-oriented physical activities that everyone can participate in, like evening walks or weekend outings to the park, can foster a positive environment for the child’s physical development.

Another strategy is to leverage the role of the normal-weight father as a positive influence. Encouraging him to lead by example in adopting healthy behaviors can have a ripple effect on the entire family. This could include involving the father more in meal planning and preparation, emphasizing the importance of his role in shaping the child’s dietary habits. Similarly, initiating family-wide lifestyle changes, such as setting aside time for joint physical activities or play, benefits the child and provides an opportunity for the obese mother to engage in healthier behaviors (Milne-Ives et al., 2020). By fostering an inclusive and supportive family environment, these strategies aim to encourage long-term, sustainable changes that will positively impact the child’s health and well-being.

Assessment of Nutrition in Children NURS 6512 References

Cavalli, G., & Heard, E. (2019). Advances in epigenetics link genetics to the environment and disease. Nature, 571(7766), 489–499. https://doi.org/10.1038/s41586-019-1411-0

Konttinen, H. (2020). Emotional eating and obesity in adults: the role of depression, sleep and genes. Proceedings of the Nutrition Society, 79(3), 283-289. https://doi.org/10.1017/S0029665120000166

Milne-Ives, M., Lam, C., De Cock, C., Van Velthoven, M. H., & Meinert, E. (2020). Mobile apps for health behavior change in physical activity, diet, drug and alcohol use, and mental health: systematic review. JMIR mHealth and uHealth, 8(3), e17046. https://doi.org/10.2196/17046

Patel, B. P., Hadjiyannakis, S., Clark, L., Buchholz, A., Noseworthy, R., Bernard-Genest, J., & Hamilton, J. K. (2021). Evaluation of a pediatric obesity management toolkit for health care professionals: A quasi-experimental study. International Journal of Environmental Research and Public Health, 18(14), 7568. https://doi.org/10.3390/ijerph18147568

Sheldrick, R. C., Schlichting, L. E., Berger, B., Clyne, A., Ni, P., Perrin, E. C., & Vivier, P. M. (2019). Establishing new norms for developmental milestones. Pediatrics, 144(6). https://doi.org/10.1542/peds.2019-0374

Shadow Health Support and Orientation Resources

Use the following resources to guide you through your Shadow Health orientation as well as other support resources:

• Shadow Health. (2021). Welcome to your introduction to Shadow HealthLinks to an external site.. https://link.shadowhealth.com/Student-Orientation-Video
• Shadow Health. (n.d.). Shadow Health help deskLinks to an external site.. Retrieved from https://support.shadowhealth.com/hc/en-us
• Shadow Health. (2021). Walden University quick start guide: NURS 6512 NP students. Download Walden University quick start guide: NURS 6512 NP students. https://link.shadowhealth.com/Walden-NURS-6512-Student-Guide
• Document: Shadow Health Nursing Documentation Tutorial Download Shadow Health Nursing Documentation Tutorial(Word document)

Required Media

Taking a Health History

[music playing]

NARRATOR: Nurses play a critical role in gathering information and assessing a patient’s health.

MARIANNE SHAUGHNESSY: The health assessment is one of the most critically important pieces of our patient interaction.

NARRATOR: With more demands on their time, this critical step can suffer.

MARIANNE SHAUGHNESSY: Certainly, practicing nurses are extremely busy people. But if you rush through a health interview or a patient interview, chances are good there’s going
to be information you’re going to miss. And if that information is missed, the consequences could be dire for the patient.

NARRATOR: Doctor Marianne Shaughnessy shares her expertise on how to conduct an in-depth health assessment interview, and provides a demonstration of effective strategies. [music playing]

MARIANNE SHAUGHNESSY: Capturing all health-related information in a systematic way,
documenting that information, creates a foundation, a database, for us to build upon. In fact, all members of the healthcare team can utilize the nursing database if it’s well-constructed and contains the information necessary to then build a plan for managing a patient’s health in conjunction with the patient over the course of time. [knock knock]

MS. HUDGENS: Come in.

MARIANNE SHAUGHNESSY: Ms. Hudgens?

MS. HUDGENS: Yes.

MARIANNE SHAUGHNESSY: Good morning. My name is Marianne Shaugnessy. I’m a nurser practitioner, and I’ll be doing your history and physical this morning.

MS. HUDGENS: Good, thank you.

MARIANNE SHAUGHNESSY: It’s nice to meet to you.

MS. HUDGENS: Nice meeting you.

MARIANNE SHAUGHNESSY: When I walked into the room, I was able to immediately
established a rapport with the patient by speaking with her cordially but professionally. When starting an interview with a patient, it’s very important to try and establish an environment that is conducive to communication. We’ve all been in doctors’ offices with exam rooms that have paper thin walls where you can hear noise on either side.

We’d like to try and avoid that as much as possible by providing an environment in which a patient feels safe to open up and talk, and has a reasonable expectation that it’ll be private. Good morning. You walk into a room, sit down, calmly relax and establish eye contact. That sends a message to a patient that you have all the time in the world for them, and as nurses that’s rarely actually the case.

It’s also important, if you can, to make sure to be on eye-level with the patient, and to try and avoid the superior position, where you are looking down on a patient. We started with some very global, open-ended questions. So what brings you in today?

MS. HUDGENS: Well, we haven’t had insurance for awhile. My husband was laid off, but we have insurance now, so I just wanted to kind of cover a couple of things, get a physical.

MARIANNE SHAUGHNESSY: Great. OK. Have you been feeling well? Find out first what’s
on the patient’s mind, because that’s why they’re there, and it’s critical to address the issues of importance in the patient’s mind, whether or not those issues actually may be the most
life-threatening issues. We move the interview from open-ended questions to closed-ended
questions, and by that I mean asking the patient to embellish or talk more about a particular concern.

OK, then I need to ask you about some exposure in your early years. The reason that the
history was so in-depth is because it’s important to capture not only what the patient is telling you they want to address when they come in for an appointment, but also to do some routine surveillance and screening to capture issues that patients may not even be aware of. Do you have any history of anemia in the past?

MS. HUDGENS: No, I haven’t.

MARIANNE SHAUGHNESSY: OK. OK. Have you been having any problems with fatigue?

MS. HUDGENS: No, there’s been stress, but other than the stress, really, no fatigue.

MARIANNE SHAUGHNESSY: Weakness?

MS. HUDGENS: No, I’ve been OK.

MARIANNE SHAUGHNESSY: So your energy levels are normal?

MS. HUDGENS: Yes.

MARIANNE SHAUGHNESSY: All right. Have you noticed any problems with unusual bruising?

MS. HUDGENS: Bruising? No.

MARIANNE SHAUGHNESSY: No? OK. And your periods are regular?

MS. HUDGENS: Well, I’m 48 so they’re becoming irregular a little bit, and I’m a little bit heavier. I have a family history of uterine fibroids, and I think that might be coming up with me, too.

MARIANNE SHAUGHNESSY: OK. In terms of this particular interview, the patient brought up a
number of significant points, primarily concerns about anemia, which ordinarily could be caused by any number of things, and it wasn’t until I began to question her about her aspirin use that I became very suspicious that her anemia may actually be caused by a GI bleed as opposed to iron deficiency anemia, which is so very common in women. Are you taking any medication?

MS. HUDGENS: No, not at this time.

MARIANNE SHAUGHNESSY: None whatsoever?

MS. HUDGENS: No.

MARIANNE SHAUGHNESSY: How about over the counter?

MS. HUDGENS: Over the counter [inaudible] aspirins or Tylenol when I get a headache
or leg aches, or–

MARIANNE SHAUGHNESSY: You’re not simply asking a question, and accepting a yes or no answer, and moving on to the next question because it’s very important to follow up with probing questions when a patient reports a positive finding. Do you take aspirin or do you take Tylenol?

MS. HUDGENS: Usually just aspirin.

MARIANNE SHAUGHNESSY: OK. How many times a week are you taking it?

MS. HUDGENS: About two time– a couple of times a week.

MARIANNE SHAUGHNESSY: And how much do you take?

MS. HUDGENS: Just the two that the label says. If I need–

MARIANNE SHAUGHNESSY: Regular adult strength, right?

MS. HUDGENS: Yes.

MARIANNE SHAUGHNESSY: OK. So you’re taking probably 650 milligrams, two 325 milligram tabs.

MS. HUDGENS: OK. MARIANNE SHAUGHNESSY: OK, twice a week. OK. We’re going to need
talk a little bit more about that aspirin, especially in light of your anemia. The most common
mistake that’s made is rushing through it, because we all have multiple demands on our time at any given moment.

Certainly practicing nurses are extremely busy people, but if you rush through a health interview, or a patient interview, chances are good there’s going to be information you’re going to miss, and if that information is missed, the consequences could be dire for the patient. If you take your time, use a systematic approach, and probe the positive responses
for additional information, nine times out of 10 you’ll capture all the information you need in order to help complete a comprehensive database and have a structure, then, for advancing
management and treatment strategies.

Please forgive my note taking, I’m just trying to organize the information as it’s coming in. When you’re performing a health assessment, there’s going to be a certain degree of note taking. You have to. Patients are divulging a lot of information. Once you get into the habit
of taking a health assessment, you can actually reduce your note taking to a minimum. However, a little bit of note taking is fine. You want to make sure not to lose the eye contact that you’ve established with the patient, because that goes a long way toward building rapport. It’s perfectly fine, as you get to know a person, to relax a little bit and have a cordial and friendly interchange.

MS. HUDGENS: My younger sister had the melanoma when she was in her 30s. She worked at the lake with me several years.

MARIANNE SHAUGHNESSY: Ah. Lifeguards, were you?

MS. HUDGENS: Well, close to it, yes.

MARIANNE SHAUGHNESSY: However, it’s very important for the professional nurse to maintain a professional demeanor, and make sure that the questions that she’s asking patients, the responses that she’s recording, and additional questions that she’s asking stay within the realm of professional nursing practice.

MS. HUDGENS: My husband said that there’s a spot on my back that looks a little funny. I’ve had other moles taken off before and they were never cancerous, but I just wanted to have that checked out.

MARIANNE SHAUGHNESSY: The baccalaureate prepared nurse has advanced skills in terms of capturing depth of information. For example, when this morning’s patient told me that she had a history of sun exposure, and now had a lesion of concern on her back, that led to probing questions about the history of early sun exposure and prior mole identification and removal. Also looking for pathologies of lesions that had been removed in the past. Let’s talk a little bit about the mole on your back. Do you have– you mentioned that you had some moles removed previously.

MS. HUDGENS: Yes.

MARIANNE SHAUGHNESSY: And how long ago are we talking?

MS. HUDGENS: I had one removed off of my leg just about four years ago.

MARIANNE SHAUGHNESSY: Mmhm. And the pathology on that, do you–?

MS. HUDGENS: They said it was fine. There was no problems with it.

MARIANNE SHAUGHNESSY: OK.

MS. HUDGENS: But my sister does have– did have a history of melanoma, and so I’m always worried about it.

MARIANNE SHAUGHNESSY: OK. Let’s talk a little bit about your sun exposure.

MS. HUDGENS: I grew up in Phoenix.

MARIANNE SHAUGHNESSY: You did?

MS. HUDGENS: Yes, and lots of time on the water, lot of sunburns. I spent a couple of summers working at the lake, and didn’t take care of it very well.

MARIANNE SHAUGHNESSY: And you only apply sunscreen if you’re going to be going outside?

MS. HUDGENS: Yes.

MARIANNE SHAUGHNESSY: OK. What number do you use?

MS. HUDGENS: 15.

MARIANNE SHAUGHNESSY: OK. Well, for somebody like you we would recommend that
you actually go up to 30 or above and every day.

MS. HUDGENS: OK.

MARIANNE SHAUGHNESSY: It’s very important to take every opportunity to pull in health promotion strategies. In this interview, we utilized not only the opportunity to educate the patient about SPF, but also weight loss, diet, exercise. I take every opportunity to work health promotion strategies into every interaction with a patient whenever I can. Would you like to try and lose some weight?

MS. HUDGENS: Yes.

MARIANNE SHAUGHNESSY: OK. Well, we can talk more about that, because I can provide you with some– a recommended diet for you to follow if you’re interested in doing that. When you’re dealing with sensitive issues in general, the communication strategies really do come into play. It’s very important to watch the tone of your voice so that you’re not in any way conveying a judgment, but allowing them to openly communicate and share with you what
sensitive issues they feel comfortable disclosing. OK, and your fourth pregnancy?

MS. HUDGENS: The fourth pregnancy I was 23, and that did end in a termination. My husband was laid off at the time, so we chose to terminate the pregnancy.

MARIANNE SHAUGHNESSY: OK. I think one thing that I would caution RNs about is you know that the time you need to set aside to do an interview with a younger person is going to be significantly different from the time you need to set aside to do with an older person. In the world of gerontology, it wouldn’t be unusual at all for an interview like that to go upwards of 45 minutes, and would include a lot more questions about functional assessment, day to day activities, cognitive status, and things like that that can impact the life of a senior.

If you work in a setting where you have patients from a number of different cultures, you learn very quickly what the issues are surrounding health care, patient interviewing, physical exams, how someone is either willing or unwilling to disrobe for a man or woman in the room,
about their comfort level with making eye contact.

All of those things are very setting-dependent, but the nurse who’s working, no matter where, has to be aware that some of these influences can come into play at any time and keep the radar up for when those issues may come into play, because the most important thing is making sure that the patient is comfortable. We’re going to go back to the review of systems. I’m going to go from head to toe.

MS. HUDGENS: OK.

MARIANNE SHAUGHNESSY: All right? And we’re going to start with your general, overall health. Have you noticed in the last six months any changes in your weight?

MS. HUDGENS: No. MARIANNE SHAUGHNESSY: The review of systems is the close of the interview. It’s a final opportunity to capture any issues that may have been missed to that point in the interview. The laws vary according to state in terms of mandatory reporting
for domestic violence, but it’s critically important to make sure and ask that screening
question, which I asked at the end of the interview.

And the last question is are there any times that you don’t feel safe at home? That’s a very globally worded question, but it allows the door to be opened. OK, you’re afraid of falling. OK. OK, I have to– I ask that question of everyone only because you never know.

I always conclude an interview by asking a patient, is there anything else you wanted to discuss that we have not yet discussed? The reason for this is I’m trying to avoid what we typically refer to as a doorknob agenda item, meaning when you’ve completed the interview, given the patient a gown, and asked them to undress for the physical exam, as you’re moving
toward the door, as you place your hand on the doorknob, a patient will sometimes say, oh, yes, there’s one more thing.

Now, before we wrap up the interview, are there any other issues that you want to talk about that we have not yet discussed?

MS. HUDGENS: No, I think that’s all.

MARIANNE SHAUGHNESSY: OK. All right, then. Well, we’re going to go ahead and proceed to your physical exam, then.

MS. HUDGENS: OK, great. Thank you.

MARIANNE SHAUGHNESSY: So once the interview is complete, it guides your physical examination. By talking to a patient, you can identify 90% of what your physical exam is going to need to be. Students are very, very focused on learning techniques that are involved
in physical exam, and they sometimes tend to ignore the interview. But the interview is probably the most critical component. That’s where you start– with what the patient tells you.

Somewhat ironic, I think, that most of the physical assessment textbooks really do emphasize
the physical assessment aspect much more so than the interview, when the interview actually plays such a critical role in establishing where things go moving forward in terms of physical exam techniques that are chosen from that point forward, and from specific systems
that a provider may need to pay special attention to.

That information is captured in the interview, and in the health history. There’s always a great deal of professional satisfaction derived from capturing information, from making someone