hello, attached is the past paper (part 1) and the current assignment.

hello, attached is the past paper (part 1) and the current assignment.
NR449 Evidence-Based Practice RUA: Analyzing Published Research Guidelines Purpose The purpose of this paper is to interpret the two articles identified as most important to the group topic. Course outcomes: This assignment enables the student to meet the following course outcomes. CO 2: Apply research principles to the interpretation of the content of published research studies. (POs 4 and 8) CO 4: Evaluate published nursing research for credibility and clinical significance related to evidence-based practice. (POs 4 and 8) Due date: Your faculty member will inform you when this assignment is due. The Late Assignment Policy applies to this assignment. Total points possible: 200 points Preparing the assignment Follow these guidelines when completing this assignment. Speak with your faculty member if you have questions. Please make sure you do not duplicate articles within your group. The paper will include the following: Clinical Question (30 points/15%) Describe the problem: What is the focus of your group’s work? Significance of problem: What health outcomes result from your problem? Or what statistics document this is a problem? You may find support on websites for government or professional organizations. Purpose of the paper: What will your paper do or describe? ***Please note that although most of these questions are the same as you addressed in paper 1, the purpose of this paper is different. You can use your paper 1 for items 1 & 2 above, including any faculty suggestions for improvement provided as feedback. Use Evidence Matrix Table Template: Data Summary – (60 points/30%) Categorize items in the Evidence Matrix Table, including proper intext citations and reference list entries for each article. References (recent publication within the last 5 years) Purpose/Hypothesis/Study Question(s) Variables: Independent (I) and Dependent (D) Study Design Sample Size and Selection Data Collection Methods Major Findings (Evidence) Description of Findings (60 points/30%) Describe the data in the Evidence Matrix Table, including proper intext citations and reference list entries for each article. Compare and contrast variables within each study. What are the study design and procedures used in each study; qualitative, quantitative, or mixed method study, levels of confidence in each study, etc.? Participant demographics and information. Instruments used, including reliability and validity. How do the research findings provide evidence to support your clinical problem, or what further evidence is needed to answer your question? Next steps: Identify two questions that can help guide the group’s work. Conclusion (20 points/10%) Review major findings in a summary paragraph. Evidence to address your clinical problem. Make a connection back to all the included sections. Wrap up the assignment and give the reader something to think about. Format (30 points/15%) Correct grammar and spelling Include a title and reference page Use of headings for each section: Problem Synthesis of the Literature Variables Methods Participants Instruments Implications for Future Work Conclusion Adheres to current APA formatting and guidelines Include at least two (2) scholarly, current (within 5 years) primary sources other than the textbook 3-4 pages in length, excluding appendices, title, and reference pages For writing assistance, visit the Writing Center. Please note that your instructor may provide you with additional assessments in any form to determine that you fully understand the concepts learned. 2 Grading Rubric Criteria are met when the student’s application of knowledge demonstrates achievement of the outcomes for this assignment. Assignment Section and Required Criteria (Points possible/% of total points available) Highest Level of Performance High Level of Performance Satisfactory Level of Performance Unsatisfactory Level of Performance Section not present in paper Clinical Question (30 points/15%) 30 points 26 points 24 points 11 points 0 points Required criteria Describe the problem: What is the focus of your group’s work? Significance of problem: What health outcomes result from your problem? Or what statistics document this is a problem? You may find support on websites for government or professional organizations. Purpose of the paper: What will your paper do or describe? Includes 3 requirements for section. Includes 2 requirements for section. Includes 1 requirement for section. Present, yet includes no required criteria. No requirements for this section presented. Evidence Matrix Table: Data Summary (Appendix A) (60 points/30%) 60 points 56 points 47 points 25 points 0 points Required criteria Categorize items in the Matrix Table, including proper intext citations and reference list entries for each article. References (recent publication within the last 5 years) Purpose/Hypothesis/Study Question(s) Variables: Independent (I) and Dependent (D) Study Design Sample Size and Selection Data Collection Methods Major Findings (Evidence) Includes 7 requirements for section. Includes 6 requirements for section. Includes 5 requirements for section. Includes 4 or less requirements for section. No requirements for this section presented. Description of Findings (60 points/30%) 60 points 53 points 47 points 23 points 0 points Required criteria Describe the data in the Matrix Table, including proper intext citations and reference list entries for each article. Compare and contrast variables within each study. What are the study design and procedures used in each study; qualitative, quantitative, or mixed method study, levels of confidence in each study, etc.? Participant demographics and information. Includes 6 requirements for section. Includes 5 requirements for section. Includes 4 requirements for section. Includes 3 or less requirements for section. No requirements for this section presented. Assignment Section and Required Criteria (Points possible/% of total points available) Highest Level of Performance High Level of Performance Satisfactory Level of Performance Unsatisfactory Level of Performance Section not present in paper Instruments used, including reliability and validity. How do the research findings provide evidence to support your clinical problem, or what further evidence is needed to answer your question? Next steps: Identify two questions that can help guide the group’s work. Conclusion (20 points/10%) 20 points 18 points 15 points 8 points 0 points Required criteria Review major findings in a summary paragraph. Evidence to address your clinical problem. Make a connection back to all the included sections. Wrap up the assignment and give the reader something to think about. Includes 3 requirements for section. Includes 2 requirements for section. Includes 1 requirement for section. Present, yet includes no required criteria. No requirements for this section presented. Format (30 points/15%) 30 points 26 points 23 points 11 points 0 points Required criteria Correct grammar and spelling Include a title and reference page Use of headings for each section: Problem Synthesis of the Literature Variables Methods Participants Instruments Implications for Future Work Conclusion Adheres to current APA formatting and guidelines Includes at least two (2) scholarly, current (within 5 years) primary sources other than the textbook 3-4 pages in length excluding appendices, title, and reference pages Includes 7 requirements for section. Includes 6 requirements for section. Includes 5 requirements for section. Includes 4 or less requirements for section. No requirements for this section presented. Total Points Possible = 200 points Appendix A EVIDENCE MATRIX TABLE Article References Purpose Hypothesis Study Question(s) Variables Independent(I) Dependent(D) Study Design Sample Size & Selection Data Collection Methods Major Finding(s) 1 Smith, L. (2013). What How do educational support D-Dietary Quantitative N- 18 Focus Groups Support and education (SAMPLE should I eat? A focus for groups effect dietary modifications modifications Convenience improved compliance with ARTICLE) those living with diabetes. in patients with diabetes? I-Education sample-selected dietary modifications. Journal of Nursing from local support Education, 1(4), 111-112. group in Pittsburgh, PA 1 2 3 4 5 © 2022 Chamberlain University. All Rights Reserved NR449_RUA_Analyzing_Published_Research_v4_JUL22 3
hello, attached is the past paper (part 1) and the current assignment.
Health History NR 304 Health History/Physical Assessment RUA Sarah-Ann Archibong, Gideon Boachie, Ghislaine Diebo, Christina Sabu Chamberlain College of Nursing NR304: Health Assessment II April, 2022 Professor Sevcik \\ This paper is to demonstrate how to utilize a health history form with physical assessment to gather information about a patient’s health to determine areas that need to be addressed and plan a needs assessment to implement teachings to the patient. Below are the health history/physical assessment findings. 1. Biographical Data Name: Bethany Osamade Ogbeifun Phone: 832-706-9538 Address: 4592 Chapel Street, Houston Texas 77002 Birthdate:10-17-1996 Birthplace: Chino, California Age:25 Gender: Female Marital Status: Single Occupation: Human resources coordinator Race/Ethnic Origin: Black non-hispanic Employer: NES Fircroft 2. Source and Reliability Patient’s statements. 3. Reason for Seeking Care Sickle cell crisis 4. Present Health or History of Present Illness Sickle cell 5. Past Health Describe general health: My health is okay currently, but I hope that it gets better. Childhood illnesses: Sickle cell Accidents or injuries: None Serious or chronic illnesses: Sickle cell (5 months) Hospitalizations: Memorial Herman- katy, sickle cell crisis Operations: Appendectomy 20yrs Obstetric history: Gravida:0 Term:0 Preterm: 0 Ab/incompletes:0 Children living: 0 Course of pregnancy: N/A Immunizations: Covid, measles, mumps, rubella, meningitis Last examination date: Physical-02-22 Dental-08-20 Vision- 02-18 Allergies: _Pollen, dust Reaction, Stuffy nose, sore throat, red eyes Current Medications: Folic Acid, Pregabalin 6. Family History – Specify Which Relative(s) Heart disease: None Allergies: None High blood pressure Mother, aunt, uncle Asthma: Brother, sister Stroke: None Obesity: None Diabetes: None Alcohol/drug addition: Aunt, and uncle, brother Blood disorders: Sister, cousins, aunt Mental illness: None Breast/ovarian cancer: None Suicide: None Cancer (other): None Seizure disorder None Sickle cell: Sister, cousins, aunt kidney disease: Aunt (father’s side) Arthritis: None Tuberculosis: Half-brother, uncle Construct genogram below Describe circled items General Overall Health State: present wt (gain or loss, period of time, by diet or other factors), fatigue, weakness or malaise, fever, chills, sweats or night sweats. Patient noted no loss of weight, no fever, weakness, fever, chills, or sweats Skin: history of skin disease (eczema, psoriasis, hives), pigment or color change, change in mole, excessive dryness or moisture, pruritus, excessive bruising, rash or lesion. Patient reports having Eczema (diagnosed at 5yrs), patient reports having acne. Excessive dryness, and Rashes on her skin due to eczema. Hair: recent loss, change in texture. Patient noted no hair loss or change in texture Nails: change in shape, color, or brittleness. Health Promotion: Amount of sun exposure, method of self-care for skin and hair. No brittleness, change in shape or color noted in the patients’ nails Health Promotion: Increase amount and frequency of sun exposure and take more time for care of hair (self-care) and increase water intake. Head: any unusually frequent or severe headache, any head injury, dizziness (syncope), or vertigo. Patient reports occasional dizziness, Reported no previous head injuries, or vertigo. Eyes: difficulty with vision (decreased acuity, blurring, blind spots), eye pain, diplopia (double vision), redness or swelling, watering or discharge, glaucoma or cataracts. Health Promotion: wears glasses or contacts, last vision check, or glaucoma test, how coping with loss of vision, if any. Reports short sightedness stigmatism in left eye. Reports no glaucoma or cataract. NO eye pain, redness or swelling noted on assessment. Health Promotion: Patient does not wear glasses recommended that she does. Get vision checked regularly, and glaucoma test. Ears: earaches, infections, discharge and its characteristics, tinnitus, or vertigo. Health Promotion: hearing loss, hearing aid use, how loss affects daily life, any exposure to environmental noise, method of cleaning ears. Patient reports no earaches, frequent infections or characteristics or tinnitus or vertigo. Health Promotion: Be cautious of exposure to loud noises, practice safe ear cleaning techniques (do not use Q-tips) Nose and Sinuses: discharge and its characteristics, any unusually frequent or severe colds, sinus pain, nasal obstruction, nosebleeds, allergies or hay fever, or change in sense of smell. Occasionally bloody nasal discharge, Blood is dry. Occasional nose bleeds due to weather change. Patient reports no severe colds. Patient reports seasonal allergies, no change in sense of smell. Mouth and Throat: mouth pain, frequent sore throat, bleeding gums, toothache, lesion in mouth or tongue, dysphagia, hoarseness or voice change, tonsillectomy, altered taste. Health Promotion: pattern of daily dental care, use of prostheses (dentures, bridge), last dental checkup. Toothache, occasionally patients report toothache as a result of tooth being pulled. Health Promotion: Promote proper care of artificial teeth. Get regular dental checkups last checkup was 6 years ago. Neck: pain, limitation of motion, lumps or swelling, enlarged or tender nodes, goiter. Patient reports no neck pain or limitation of motion. No swelling or enlarged or tender nodes noted upon assessment. No goiter noted. Breast: pain, lump, nipple discharge, rash, history of breast disease, any surgery on breasts. No pain noted in the breast. No nipple discharge, no rash on chest reported. No history of breast disease or surgery on breasts. Axilla: tenderness, lump, or swelling, rash. Health Promotion: performs breast self-exam, including frequency and method used, last mammogram and results. No tenderness, swelling, lumps, or rashes noted on the axilla bilaterally. Health promotion: Recommend patient to perform self-examination of breast, Patient has reported never having a mammogram or breast examination done by a medical professional. Respiratory System: history of lung disease (asthma, emphysema, bronchitis, pneumonia, tuberculosis), chest pain with breathing, wheezing or noisy breathing, shortness of breath, how much activity produces shortness of breath, cough, sputum (color, amount), hemoptysis, toxin or pollution exposure. Health Promotion: last chest x-ray exam. Patient has no history of lung disease. Notes no chest pain when breathing, no wheezing or noisy breathing. Long periods of strenuous activity produce shortness of breath. (Workouts, running,) No toxin or pollution exposure. Health Promotion: Get regular chest x-ray exams, work on building stamina to increase the amount of strenuous activity that you can do (exercise regularly) Cardiovascular System: precordial or retrosternal pain, palpitation, cyanosis, dyspnea on exertion (specify amount of exertion it takes to produce dyspnea), orthopnea, paroxysmal nocturnal dyspnea, nocturia, edema, history of heart murmur, hyptersion, coronary artery disease, anemia. Health Promotion: date of last ECG or other heart tests and results. Patient experience chest pain rarely. Patient has history of hypertension, her mother, aunt and uncle all have hypertension, edema, or other heart related diseases. Health Promotion: Encourage patient to follow up and get checked regularly for her blood pressure. Encourage patients to schedule chest examinations, and ECGs and to get checked out if she experiences any abnormal chest pains. Peripheral Vascular System: coldness, numbness and tingling, swelling of legs (time of day, activity), discoloration in hands or feet (bluish red, pallor, mottling, associated with position, especially around feet and ankles), varicose veins or complications, intermittent claudication, thrombophlebitis, ulcers. Health Promotion: if work involves long-term sitting or standing, avoid crossing legs at the knees, wear support hose. Patient reports no feelings of coldness, numbness, or tingling in the legs. No swelling of the legs noted. No discoloration, noted in the hands or feet. No varicose veins or claudication, thrombophlebitis, or ulcers. Health Promotion: Encourage patients to move legs regularly when sitting for a prolonged period of time (sitting at work) suggest the use of support hose and avoiding crossing legs when sitting. Gastrointestinal System: appetite, food intolerance, dysphagia, heartburn, indigestion pain (associated with eating) other abdominal pain, pyrosis (esophageal and stomach burning sensation with sour eructation), nausea and Patient reports that appetite is Not great. Patient eats 1-2 times a day, has occasional indigestion because of irregular eating schedule, Patient has Stomach ulcers, and has had appendicitis, (appendix was removed). Patient notes no history of irregular bowel movements, or changes in stool. No black stool, constipation, or diarrhea reported. vomiting (character), vomiting blood, history of abdominal disease (ulcer, liver or gallbladder, jaundice, appendicitis, colitis), flatulence, frequency of bowel movements, any recent change, stool characteristics, constipation, or diarrhea, black stools, rectal bleeding, rectal conditions, hemorrhoids, fistula). Health Promotion: use of antacids or laxatives. Health Promotion: If the patient experiences constipation, use laxatives. Recommend that patient consumes balanced diet with fiber to ensure regular bowel movements. Urinary System: frequency, urgency, nocturia (number of times awakens at night to urinate, recent change), dysuria, polyuria or oliguria, hesitancy or straining, narrowed stream, urine color (cloudy or presence of hematuria), incontinence, history of urinary disease (kidney disease, kidney stones, urinary tract infections, prostate); pain in flank, groin, suprapubic region or low back. Health Promotion: measures to avoid or treat urinary tract infection, use of Kegel exercises) Patient notes Urine Yellowish on occasion only occurs When patient repots dehydration. Patient reported no cloudiness, or hesitancy when urinating. No pain during urination, or discoloration of urine. Health Promotion: Encourage patient to practice hygienic bathroom habits, to prevent urinary tract infection. Encourage patient to stay hydrated to promote regular urination. Male Genital System: penis or testicular pain, sores or lesions, penile discharge, lumps, hernia. Health Promotion: Performs self-testicular exam? How frequently? N/A Female Genital System: menstrual history (age of menarche, last menstrual period, cycle and duration, any amenorrhea or menorrhagia, premenstrual pain or dysmenorrhea, intermenstrual spotting), vaginal itching, discharge and its characteristics, age at menopause, menopausal signs or symptoms, postmenopausal bleeding. Health Promotion: last gynecologic checkup, last Pap test and results. Patients’ menarche age 9. last menstrual cycle as of the time of interview was 12th of March duration 5 days. No premenstrual pain or spotting reported. Patient reports no vaginal itching, or irregular discharge. Discharge colored clear and sticky in texture. No signs of menopause. Health Promotion: Encourage patient to get gynecological checkup. Patient did not remember last pap smear or the results. Sexual Health: Presently in a relationship involving intercourse? Are aspects of intercourse enjoyable for you and your partner? Any dyspareunia (for female), any changes in erection or ejaculation (for male), use of contraceptive, is contraceptive method satisfactory? Use of condoms, how frequently? Aware of any contact with partner who has sexually transmitted infection (gonorrhea, herpes, chlamydia, venereal warts, HIV/AIDS, syphilis)? Patient reported not currently being involved in a relationship involving intercourse. Patient reports not experiencing dyspareunia, patient does not use oral contraceptives, uses condoms “it works well enough”. Patient is not aware of any contact with a partner that has sexually transmitted infections. Patient has no sexually transmitted infections. Musculoskeletal System: history of arthritis or gout. In the joints, pain, stiffness, swelling? (Location, migratory nature), deformity, limitation of motion, noise with joint motion. In the muscles: any pain, cramps, weakness, gait problems or problems with coordinated activities. In the back: any pain (location and radiation to extremities), stiffness, limitation of motion, or history of back pain or disk disease. Health Promotion: how much walking per day? What is the effect of limited range of motion on daily activities, such as on grooming, feeding, toileting, dressing? Any mobility aids used? Patient reports Pain and stiffness in all her joints. Noted noise with joint movement, cramps and weakness in muscles, Back pain all over the back. No deformity observed or gait problems, patient is coordinated, and has no history of disk disease. Patient uses no mobility aids Health Promotion: Patient barely walks per day, Encourage increased movement for patient. Neurologic System: history of seizure disorder, stroke, fainting, blackouts. In motor function: weakness, tic or tremor, paralysis, coordination problems. In sensory function: numbness and tingling (paresthesia). In cognitive function: memory disorder (recent or distant, disorientation). In mental status: any nervousness, mood change, depression, or any history of mental health dysfunction or hallucinations. Patient has no history of seizure disorders, stroke, or fainting. Patient reports no tics, tremors, paralysis, or coordination problems. NO numbness, or tingling noted. Patient has no history of memory disorder, mood change, depression, mental health dysfunction, or hallucinations. Hematologic System: bleeding tendency of skin or mucous membranes, excessive bruising, lymph node swelling, exposure to toxic agents or radiation, blood transfusion and reactions. Patient has sickle cell disease. But has no tendency of bleeding through the skin or mucous membranes. Patient notes no excessive bruising, lymph node swelling, exposure to toxic agents or radiation, or blood transfusion reactions. Endocrine System: history of diabetes or diabetic symptoms (polyuria, polydipsia, polyphagia), history of thyroid disease, intolerance to heat or cold, changes in skin pigmentation or texture, excessive sweating, relationship between appetite and wt, abnormal hair distribution, nervousness, tremors, need for hormone therapy. Patient has no history of diabetes, thyroid disease, intolerance to heat or cold, changes in skin pigmentation or texture. Patient reports no excessive sweating and a good relationship between her appetite and her weight. Patient notes no abnormal hair distribution, nervousness, or tremors. Functional Assessment (including Activities of Daily Living Self-Esteem/Self-Concept: Education (last grade completed, other significant training): Masters, Financial status: Patient notes that Income is inadequate to support both health concerns and lifestyle. Value-belief system: Patient practices Christianity, and believes that a personal strength or accomplishment is getting her degrees despite her health challenges Self-care behaviors: taking Bath, patient notes that she is unable to do much because of her financial situation. Patient enjoys spending time with people, she feels safe around. Activity and Exercise: daily profile, usual pattern of a typical day: Minimal physical activity, sits at desk and uses computer Leisure activities: Swimming, Movies, ping-pong, out to eat (ordering food in) Exercise pattern: Patient does not exercise often. Her main physical activity is walking short distances. (To the mail) Sleep and Rest: sleep patterns, daytime naps and any sleep aids used: Irregular, cannot stay asleep or can’t get to sleep. Prescribed zolpidem but does not take it regularly, notes naps in the daytime Other self-care behaviors: Nutrition and Elimination: Who buys food? Patient does Who prepares food? Patient does Finances adequate for food? Patient notes that finances are adequate for food Who is present at mealtime: Patient eats alone Other self-care behaviors: patient states that she has none Personal Habits: daily intake of caffeine (coffee, tea, colas): Patient reports dinking Iced tea, does not drink coffee often Smoke cigarettes? No Number of packs per day: N/A Daily use for how many years? N/A Age started: N/A Ever tried to quit? N/A How did it go? N/A Drink alcohol? Yes, Date of last alcohol use: 03-26-22 Perception of Own Health: how do you define health? “How well your body and mind are running” View of own health now? The patient states that her view on health has changed in that she became more aware of the importance of mental health. What are your concerns? The patient states that she is concerned that she will not be able to accomplish things because of her sickness. What do you expect will happen to your health in future? Patient states that she will either get a “Bone marrow transplant, or die” Your health goals: The patient’s main health goal is not worrying that her health will get in the way of doing things that she wants to do Health Assessment: General Survey: Patient’s physical appearance is consistent with chronological age, there are no signs of acute distress, patient’s facial expression is, and relaxed. patients’ mood is calm, and the effect is pleasant; patient speech is clear and coherent dress is appropriate for the weather and patient is alert and oriented times 4 to person plays timing situation. There were no visible assist devices noted on the patient. Skin and Nails: Patients skin color is appropriate for ethnicity and even throughout, there are no lesions wounds or incisions noted on the patient has one piercing bilaterally. patient skin is warm and dry and even throughout there is no signs of tenting when assessing skin turgor patient nail color is appropriate for race, they are flat and smooth. And patience capillary refill is less than two seconds on all 10 fingers. There are no signs of clubbing on the patient’s fingers and there was no edema noted Head, Face, and Neck: There are no signs of lesions or infestations on the patient’s hair, her appears clear and distribution is even throughout. Head is normal cephalic and symmetrical facial features are symmetrical neck is symmetrical and head is positioned midline, the trachea is midline and there are no masses is noted. Upon assessment cranial nerve 5 trigeminal is intact, cranial nerve seven facial is intact, and cranial nerve 11 spinal accessory is intact. Ears, Nose, and Mouth: upon inspection the external ear is symmetrical, color is appropriate for us in city there was no redness noted, there are no lesions or wounds on the external structure of the ear. Upon inspection of the external auditory meatus there were no signs of discharge swelling or redness. After assessing cranial nerve eight acoustic it was determined that the nerve is intact. The external structure of the nose is intact the shape is symmetrical and midline on the face there are no signs of lesions or infections on the nose there was no swelling or inflammation noted upon assessment of the internal structure there was no deformity, asymmetry, or inflammation noted the nares are patent bilaterally and there is no tenderness noted. The patient’s lip color is appropriate for ethnicity and moist. The tongue is pink and moist, the gums buccal mucosa, and palette are pink and moist. The teeth are white and aligned and there are no signs of redness or drainage on the pharynx. upon assessment cranial nerves nine glossopharyngeal, ten Vagus, and 12 hypoglossal are intact are intact Eyes: upon inspection of the external ocular structures there are no signs of discharge redness or lesions, there is no infestation or lesions on the eyebrows, eyelids, or eyelashes. The conjunctiva or pink and moist, and this Clara is white with no signs of color change. The pupils are equal in size round reactive to light, and accommodation. Upon assessment cranial nerve 3 ocular motor, 4 trochlear, and six abducens are intact there is no nystagmus noted. Respiratory: Skin color on the chest is evenly colored and warm, chest rises and falls symmetrically, and breathing is even unlabored. There is no use of accessory muscles noted and upon auscultation Breath sounds are equal and clear bilaterally on both the anterior and the posterior chest. The A/P to Transverse diameter is 1:2. there is no scoliosis, kyphosis, or lordosis noted. And there are no adventitious breath sounds, crackles, or wheezing noted Cardiovascular: The patients’ face and lips are normally colored, there are no signs of discoloration such as cyanosis or erythema. there are no signs of jugular vein distention, and upon palpation the carotid arteries have a + 2, regular rate and rhythm bilaterally. Upon auscultation there was no bruits noted. There’s no signs of pallor, cyanosis, or erythema noted in the hands, fingers, and legs. there is no edema noted in the hands and legs. Upon auscultation the patient’s heart sounds are normal, they have regular rate and rhythm, and there are no murmurs hurt. Peripheral Vascular: Upon assessment there are no signs of jugular vein distention, the skin color is appropriate, capillary refill is less than 10 seconds on all 10 digits on the hands and feet, there is no signs of clubbing. And her distribution is even, there’s no signs of edema, ulcers, or open areas on the patients’ extremities. Upon palpation the radial pulse has a plus two strength regular rate and rhythm bilaterally. The dorsalis pedis pulse has a regular rate and rhythm plus one bilaterally, and the posterior tibialis has regular rate and rhythm plus two strengths bilaterally. Gastrointestinal, Urinary: Upon inspection the patient contour is flat, and the abdomen is symmetrical, there is 1 scar noted on the lower right quadrant. There is no rash noted on the abdomen, and no lesions noted. Upon auscultation the bowel sounds are normoactive in all four quadrants. Upon palpation there is no tenderness, distention, guarding, masses, or rigidity noted in all four quadrants. Neurological: Patient mental status is good; they are alert and oriented times four to person place time and situation. Patient speech is clear and coherent. Their affect is pleasant. Cranial nerves one through 12 are intact in both sensory and motor. Patient gate is steady and rhythmic, and coordination is present bilaterally. Musculoskeletal: Upon inspection the joints are symmetrical, and the muscles appear to be the same on both sides. The patient’s range of motion is +5 bilaterally on both upper and lower extremities. There are no abnormalities in the curvature of the patient spine. And the patient gate is steady, rhythmic, and effortless. Patient skin temperature is normal muscle strength is plus five bilaterally. There’s crepitation noted in the patient shoulder. Upon assessment sensory function of the lower extremities are intact. Psychosocial The patient’s family is outside the United States, she lives alone here. Since she has no family or relatives here, everything she needs and wants is met by herself. Even her family is giving her both emotional and mental support to the best ability. She does not have enough financial support for her health concerns and her personal needs, the small circle of her close friends always tries to provide the support they can by making her happy and comfortable. Even though no one accompanies her to hospital visits, her friends always try to check on her through calls and drop by her house for some time. She has faith in God, he believes that he will provide the healing that her body needs. Also, she has an excellent healthcare team that always provides the support she needs. Her healthcare team and her close circle of friends are her support system both mentally and emotionally. Collaborative The patient has been living with sickle cell disease since her childhood. Even though this illness is limiting her from accomplishing certain things in her life, she hopes that one day her health will get better. That hope drove her to move forward with her treatment and began attending every appointment with her doctor to improve her health status. She works closely with her health care team. Her doctor recommends eating a balanced diet, taking a folic acid supplement, exercising with care, and staying hydrated. Also, the doctor suggested that she avoid eating undercooked chicken and eggs, and emotional and physical stress. The patient began to incorporate all the advice from her healthcare team. Since she cannot do excessive exercise, she began to walk a short distance like walking to her mailbox and started to take care of her mental health. She always tried to be in a close and safe circle of friends who are comfortable. She has great trust in her healthcare team at Memorial Herman, where she is seeking care from. Developmental Considerations Patient is a 25-year-old African -American woman. She is currently in the young adulthood category of the Erickson stages of development. This stage is characterized by a love relationship in the form of intimacy and isolation. This is the stage where the young adult must develop intimate relationships or suffer feelings of isolation. The patient is currently single and this places her in the isolation group. Even though the patient did not disclose the reason for being single during the interview, sickle cell patients are often faced with problems with choosing compatible life partners. Cultural Considerations People of African descent are more predisposed to sickle cell disease than any other race. It is estimated that “SCD occurs among about 1 out of every 365 Black or African-American births and that about 1 in 13 Black or African-American babies are born with sickle cell trait (SCT)” (CDC, 2020). Even though patient does not live with any member of the immediate family, she fellowships with the local church at least every Sunday. She claims going to church has been one of her sources of comfort. Apart from the church, she also receives support from old school friends who are always there in times of her crisis moments. Needs Assessment: The two-health education for our patient would be to schedule a yearly visit with her gynecologist, and also how to avoid hypertension as it an issue with some members of her family. The patient’s mother, mother’s sister, and mother’s brother have been diagnosed with hypertension. Hypertension can have a hereditary connection, so it is crucial to educate the patient on habits to help avoid developing it. Upon the health assessment, the patient stated that she did not remember her last pap smear or her previous results, it is important that the patient understands that she must visit her gynecologist yearly. According to Mrowka, the patient must implement some modification to her diet (adapting a low salt and fat diet), she must avoid smoking as well as having a regular exercise routine (Mrowka, 2018). Our patient also lacks motivation to exercise, so by receiving education on the benefits of being physically active to reduce the risk of developing hypertension, it will spark some motivation in her. The ACOG (American College of Obstetricians and Gynecologists) recommends visiting a gynecologist at least once a year. Based on our patient’s age, she should be having regular visits to a well-woman clinic for assessment such as yearly mammography, pap smear, and general monitoring of any cancers. Since the patient does not have family close to her, she can utilize her friend to motivate her into getting active together. It is usually easier and more fun when including a workout partner. Reflection: This assignment was similar to what we have learned in class. The real difference was having to put it into practice. Even though the patient was someone that I knew getting over the initial awkwardness took some time. Some of the enablers that I experienced while completing this health history and completing the health assessment were the fact that the patient is someone that I knew, and I am someone that she trusts. This made her a lot more willing to go along with what an asked her to do and be cooperative. In a similar way being familiar with the patient also worked as a hindrance for me. As I mentioned before there was an initial awkwardness and signs for the patient being uncomfortable sharing her personal information with someone, she considers a friend; but to overcome that awkwardness I let the patient know what she would be asked a head of time, I started with questions that weren’t difficult for her, and I ensured her that she would feel comfortable and sure that her information would not be misused. Some unanticipated challenges that I encountered during the assessment was the ability to interview the patient at the time when I was scheduled to interview the patient. She was checked into the hospital because she went into crisis. So, it was hard to get ahold of her to get the health history and perform the assessment. The patient was very cooperative, so I believe that I got all of the information that I needed. In the future when getting the health history and assessment I would change my approach by getting rid of all of my nerves so that I do not cause the patient any more anxiety than they must already be feeling telling someone their history. References CDC.(2020).Data & Statistics on Sickle Cell Disease. Available in https://www.cdc.gov/ncbddd/sicklecell/data.html Jarvis, C. (2016). Physical examination et health assessment. St. Louis, MO: Elsevier. Medical News Today (2017). Gynecologists: When to visit and what to expect. Available in https://www.medicalnewstoday.com/articles/288354 Mrowka, R. (2018). Modifiers of hypertension. Acta Physiological, 224(3). doi:10.1111/apha.13184 Orenstein G.A. (2021), Lewis L. Erikson’s Stages of Psychosocial Development. [Updated 2021 Nov 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556096/ 3
hello, attached is the past paper (part 1) and the current assignment.
Ethics of Euthanasia in the terminally ill patient Name University NR 442: Community Health Professor Date Ethics of Euthanasia in the terminally ill patient According to Persson et al. (2020), euthanasia is a complex topic when considering the dilemma and professional aspects of the act. It involves terminating an individual’s life to eliminate their suffering; for euthanasia to occur, the patient or caregivers should support the act, especially when the patient is highly suffering or in pain. Euthanasia is supported by those believing that people should make decisions regarding their lives. In the medical profession, practitioners help patients and caregivers to make informed decisions about their lives, including when ending life is the best option. From a moral perspective, euthanasia involves killing people, which is wrong since human life is unique, and death can be avoided by providing quality care. This paper will review the ethical perspective of euthanasia and arguments for critically ill patients. Clinical question Terminally ill patients are severe emotional, mental, and physical suffering; continuous care to such patients increases suffering, healthcare costs, and low quality of life. An example, an individual with stage four cancer that has emphasized all body parts is exposed to pain and suffering due to medication used, medical operations, and care required. Such patients advocate for euthanasia, where their lives are ended with dignity, and their suffering is reduced drastically. Euthanasia is often justifiable since later-stage cancer is incurable and there is a lot of distress. For medical professionals, euthanasia poses an ethical dilemma since the purpose of the healthcare industry is to protect lives and eliminate suffering. On the other hand, patient autonomy is among the healthcare pillars since people have the right to decide when they should die. Critics argue euthanasia is used when the healthcare systems are compromised since professionals should do everything possible to prevent lives. Euthanasia leads to loss of lives which is against healthcare goals; the vulnerable population life poor are more likely to suffer if they cannot afford hefty healthcare costs they opt for death. The significance of the problem is the disconnection between the aims of the healthcare industry and ethics. Healthcare practitioners are supposed to eliminate suffering and promote quality of life; however, death is not the ultimate solution to the current healthcare issues in the country. Continued euthanasia use for terminally ill patients will reduce the efficiency of healthcare facilities and research. For example, if covid19 cure was killing the patients to eliminate their suffering, the vaccine would not get produced. Therefore, death from stage four cancer solution does not mean the problem is solved; people require more research and new healthcare approaches to save lives. According to Penn Medicine, between .3 and 4.5 deaths in US facilities occur due to euthanasia, especially for cancer patients. The PICOT question is “For terminally ill patients (P), how to make the application of euthanasia (I) different than offering a palliative care© without making euthanasia available to improve the quality of life and eliminate pain (O) within the life-ending duration (T). This paper aims to investigate the role of palliative care, unlike the euthanasia option, to ensure ethics in healthcare are considered, especially in promoting and restoring quality of life. The application of euthanasia is a short-term solution that is not applicable in all situations. Levels of evidence The question asked is on the role of palliate care, unlike the euthanasia option that leads to losing lives. Healthcare workers should offer continuous care to patients, unlike offering them a cheaper alternative that involves ending lives. Modern medicine and technology have been invented to improve people’s life and lower the effort required when completing jobs. With euthanasia, hard work and regard for safety are ignored, which has negative impacts on the efforts of historical healthcare scientists. The qualitative study will provide the evidence to complete the research questions. The quantitative approach involves an examination of the opinion, experiences, and feelings of terminally ill patients and caregivers before euthanasia. To address the ethical dilemma, a quantitative study will be used to understand palliative care perspectives and their significance in improving the quality of life. Search Strategy Some search terms used include terminally ill, patient’s consent, euthanasia, critically ill patients, death decision for patients, and palliative care. During the search process, the databases used to obtain information includes the Cochrane Library, PubMed site, and CU library database. The PubMed library provided results on ethics in the decision-making process; the CU database was about the role of palliative care for terminally ill patients. Cochrane Library provided mixed results of studies from previous authors regarding the part of palliative care and why patients prefer euthanasia. The refinement strategies included reducing the limit to six years, using English-only studies, and using filters to get studies only conducted in the US. Relevant articles The first study by Pesut et al. (2020) explains the role of medical assistance for critically ill patients. Canada was the first nation to legalize the process in 2016, and other countries have adopted it to reduce patients’ suffering, especially during terminal illness. Authors support the process since it is painless and used to address incurable conditions. The second study by Gómez-Vírseda & Gastmans (2022) is about whether euthanasia can be used to address dementia cases which is a clinical issue since healthcare practitioners provide care and restore well-being which is against ending a patient’s life. On the other hand, patients have the right to determine when to die in dignity, especially when extensive suffering and conditions are irreversible. Conclusion In conclusion, euthanasia poses an ethical dilemma for healthcare practitioners since the role of the healthcare industry is protecting life and eliminating pain and suffering in a patient’s life. However, patients have the right to determine when they should die in dignity, especially in critical conditions where healthcare cannot be restored. Experts consider euthanasia a shortcut that leads to the loss of lives; At the same time, traditional scientists strived through research to protect health; euthanasia will lead to laziness and more deaths that could have been avoided or delayed through palliative care. References Gómez-Vírseda, C., & Gastmans, C. (2022). Euthanasia in persons with advanced dementia: a dignity-enhancing care approach. Journal of Medical Ethics, 48(11), 907-914. http://dx.doi.org/10.1136/medethics-2021-107308 Persson, K., Selter, F., Neitzke, G., & Kunzmann, P. (2020). Philosophy of a “good death” in small animals and consequences for euthanasia in animal law and veterinary practice. Animals, 10(1), 124. https://www.mdpi.com/616034 Pesut, B., Greig, M., Thorne, S., Storch, J., Burgess, M., Tishelman, C., … & Janke, R. (2020). Nursing and euthanasia: A narrative review of the nursing ethics literature. Nursing ethics, 27(1), 152-167. https://journals.sagepub.com/doi/pdf/10.1177/0969733019845127