Questions and Topics We Can Help You To Answer:
Paper Instructions:

How can you maintain a positive working culture and avoid a culture of blame? 

Questions and Topics We Can Help You To Answer:
Paper Instructions:

How is an employee's accountability measured in the health care industry?

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Paper Instructions:

How does accountability apply to ethical considerations in leadership and management?

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What does a checks-and-balances process look like in a successful organization?

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Paper Instructions:

Why is accountability important in the health care industry?

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Paper Instructions:

I chose hypertension as my healthcare problem. 

Choose a health problem that you may commonly see in primary care nurse practitioner practice. Describe the health problem and recommended medical management for it. Research published clinical practice guidelines and evaluate the practice guideline you have selected based on the components listed in the Clinical Practice Guideline Template below.

Clinical Practice Guideline Prompts:

HEALTHCARE PROBLEM IDENTIFIED: Briefly describe the health problem you have identified. Include a discussion of morbidity, mortality, epidemiology and pathophysiology related to this health problem

PRACTICE GUIDELINE: Describe the clinical practice guideline used for this problem. Reflect on the questions included. Expand on your answer using support from evidence

    Does the clinical practice guideline adequately address the health problem? Describe.
    Is this practice guideline based on current evidence (within 5 years)? What is the strength of this evidence?
    Does this clinical practice guideline adequately direct the healthcare provider in the management of a patient with this problem?
    How effective is this clinical guideline in the management of patients with this healthcare problem? Think about how you would assess the effectiveness of patient management.

ANALYSIS: Think about future healthcare needs of patients with this problem, changing demographics, and changes in healthcare policies. Address these questions.

    Does this clinical practice guideline need revision(s)? Please explain your answer in detail.
    If you were going to revise this clinical practice guideline, what would you change? What evidence would you use to base your changes on?
    How might changes in US demographics and healthcare reform affect this clinical practice guideline?
    What strategies would you use to increase the likelihood that a new or modified clinical practice guideline would be adopted and used in clinical practice?

EVALUATION How would you determine its effectiveness of this revised clinical practice guideline in directing care for patients with the identified health problem? Outline the steps you might employ.

LEARNING POINTS (3-5 bullet points outlining key learning in this case.)

REFERENCES (APA formatting, current within past 5 years.)

Expectations

    Due: Monday, 11:59 pm EST
    Length: 8 pages minimum, 12 pages maximum not including the title page, abstract, and reference pages
    Format: APA formatted paper - you can opt to use the prompts or a version of the prompt for headers, but do not copy the prompts directly into your paper
    Research: APA formatting, current within past 5 years

Questions and Topics We Can Help You To Answer:
Paper Instructions:

Mr. Perez is a 76-year-old Mexican American who was recently diagnosed with a slow heartbeat requiring an implanted pacemaker. Mr. Perez has been married for 51 years and has 6 adult children (three daughters aged 50, 48, and 42; three sons aged 47, 45, and 36), 11 grandchildren; and 2 great grandchildren. The youngest boy lives three houses down from Mr. and Mrs. Perez. The other children, except the second-oldest daughter, live within 3 to 10 miles from their parents. The second-oldest daughter is a registered nurse and lives out of state. All members of the family except for Mr. Perez were born in the United States. He was born in Monterrey, Mexico, and immigrated to the United States at the age of 18 in order to work and send money back to the family in Mexico. Mr. Perez has returned to Mexico throughout the years to visit and has lived in Texas ever since. He is retired from work in a machine shop.

Mr. Perez has one living older brother who lives within 5 miles. All members of the family speak Spanish and English fluently. The Perez family is Catholic, as evidenced by the religious items hanging on the wall and prayer books and rosary on the coffee table. Statues of St. Jude and Our Lady of Guadalupe are on the living room table. Mr. and Mrs. Perez have made many mandas (bequests) to pray for the health of the family, including one to thank God for the healthy birth of all the children, especially after the doctor had discouraged them from having any more children after the complicated birth of their first child. The family attends Mass together every Sunday morning and then meets for breakfast chorizo at a local restaurant frequented by many of their church’s other parishioner families. Mr. Perez believes his health and the health of his family are in the hands of God.

The Perez family lives in a modest four-bedroom ranch home that they bought 22 years ago. The home is in a predominantly Mexican American neighborhood located in the La Loma section of town. Mr. and Mrs. Perez are active in the church and neighborhood community. The Perez home is usually occupied by many people and has always been the gathering place for the family. During his years of employment, Mr. Perez was the sole provider for the family and now receives social security checks and a pension. Mrs. Perez is also retired and receives a small pension for a short work period as a teacher’s aide. Mr. and Mrs. Perez count on their nurse daughter to guide them and advise on their health care.

Mr. Perez visits a curandero for medicinal folk remedies. Mrs. Perez is the provider of spiritual, physical, and emotional care for the family. In addition, their nurse daughter is always present during any major surgeries or procedures. Mrs. Perez and her daughter the nurse will be caring for Mr. Perez during his procedure for a pacemaker.

Explain the significance of family and kinship for the Perez family.
Describe the importance of religion and God for the Perez family.
Identify two stereotypes about Mexican Americans that were dispelled in this case with the Perez family.
What is the role of Mrs. Perez in this family?


Submission Instructions:

Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.
You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.) 
All replies must be constructive and use literature where possible.

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Paper Instructions:

Jay and Sue Kim, ages 29 and 26 years and married for 2 years, immigrated from South Korea and settled in Los Angeles. They have lived in a small one-bedroom apartment since their arrival. Both graduated from the same Korean university with baccalaureate degrees in English literature. They have one child, Joseph, age 1 year. When they arrived in the United States, Jay was unable to find a job because of his poor proficiency in English, despite his major in English literature. He eventually obtained a job with a moving company through a church friend. Sue is not working because of their son. Although the Kim’s did not attend a church before immigration, they are now regularly attending a Korean Protestant church in their neighborhood.

Sue is pregnant again, determined by a home pregnancy kit, with their second child and concerned about the medical costs. They did not use any contraceptives because she was breastfeeding. Because of financial limitations, Sue did not initially have prenatal care with her first pregnancy. However, she did keep up with the Korean traditional prenatal practice, tae-kyo. Eventually, she received help from her church and delivered a healthy son. She is not sure whether she can get financial help from her church again but is confident that her second child will be healthy if she follows the Korean traditional prenatal practices.

Jay is concerned about job security because he recently heard from colleagues that the moving company might soon go bankrupt. Although Jay has not been satisfied with his current job (he thinks that he is overqualified), this news is still a cause for concern. Moreover, Sue’s recent pregnancy has made Jay more stressed, and he has started drinking alcohol. Joseph cannot stand up by himself and still wants to be breastfed. Although Sue has tried to give foods such as oranges, apples, steamed rice, and milk (because she is now pregnant), Joseph refuses to eat them and cries for breastfeeding. Joseph’s weight is low-normal for same-age babies.

Describe the Korean cultural practice tae-kyo. Is this practice congruent with allopathic recommendations for prenatal care?
How do food choices among Koreans differ with pregnancy and postpartum?
Describe cultural attitudes toward drinking among Koreans.
Identify two or three culturally congruent strategies a healthcare provider might use to address Jay’s drinking.


Submission Instructions:

Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.
You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.) 
All replies must be constructive and use literature where possible

Questions and Topics We Can Help You To Answer:
Paper Instructions:

Hyde Pfiefer, a retired 70-year-old German American, has lived in the United States for the last 50 years. A widower of 5 years, Mr. Pfiefer prepares his own meals following his wife’s recipes from the old country. Nine months ago, Mr. Pfiefer was told that his cholesterol is elevated, and he was instructed about a low-fat diet. His most recent test results show his values to be unchanged.

Discuss the meaning of food in the German culture.
Using the predominant health beliefs of people of German ancestry, how might you help Mr. Pfiefer reduce his cholesterol level?


Submission Instructions:

Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.
You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.) 
All replies must be constructive and use literature where possible.

Questions and Topics We Can Help You To Answer:
Paper Instructions:

For this Discussion, you will take on the role of a clinician who is building a health history for one of the following cases. Your instructor will assign you your case number.

“I had a severe headache yesterday with difficulty to speak”
A 64-year-old African American female who reports having a severe pulsatile diffuse headache yesterday with sudden difficulty to talk with last for about two hours. She did not seek medical attention. This morning she woke up with no problems but is here today due her husband advise.
Atrial Fibrillation, Hypertension. Is allergic to Non-steroidal Anti-inflammatory drugs Aspirin
Losartan 50 mg
Xarelto 15 mg BID
Feels Palpitations, joint pain with yesterday’s episode
Objective Data
B/P 131/80; temperature 98.2°F;  (RR) 18;  (HR) 84, irregular; oxygen saturation (PO2) 96%;
well-developed female, no acute distress
Atraumatic, normocephalic, PERRLA, EOMI, conjunctiva and sclera clear; nares patent, nasopharynx clear, good dentition.
CTA AP&L
Irregular heartbeat with normal rate
No tenderness normoactive bowel sounds x 4;
Noncontributory
intact without lesions masses or rashes.
No obvious deficits and CN grossly intact II-XII
Once you received your case number, answer the following questions:

What other subjective data would you obtain?
What other objective findings would you look for?
What diagnostic exams do you want to order?
Name 3 differential diagnoses based on this patient presenting symptoms?
Give rationales for your each differential diagnosis.
What teachings will you provide?

Questions and Topics We Can Help You To Answer:
Paper Instructions:

For this Discussion, you will take on the role of a clinician who is building a health history for one of the following cases. Your instructor will assign you your case number.

“I have pain in my belly”
A 25-year-old female presents to the emergency room (ER) with complaints of severe abdominal pain for 2 weeks . The pain is sharp and crampy It hurts if I run, sit down hard, or if I have sex
Patient denies

Birth control
NKA
Nausea and vomiting, Last menstrual period 5 days ago, New sexual partner about 2 months ago, No condoms, he hates them No pain, blood or difficulty with urination
Objective Data
B/P 138/90; temperature 99°F;  (RR) 20; (HR) 110, regular; oxygen saturation (PO2) 96%; pain 5/10 
acute distress and severe pain
Atraumatic, normocephalic, PERRLA, EOMI, conjunctiva and sclera clear; nares patent, nasopharynx clear, good dentition. Piercing in her right nostril and lower lip.

CTA AP&L
S1S2 without rub or gallop
• INSPECTION: no masses or thrills noted; no discoloration and skin is warm to; no tattoos or piercings; the abdomen is nondistended and round
• AUSCULTATION: bowel sounds (BS) are normal in all four quadrants, no bruits noted
• PALPATION: on palpation, the abdomen is tender to touch in four quadrants; tenderness noted on light palpation, deep palpation reveals no masses, spleen, and liver unremarkable
• PERCUSSION: tympany heard in all quadrants, no dullness noted in the abdominal area
• EXTERNAL: mature hair distribution; no external lesions on labia
• INTROITUS: slight green-gray discharge, no lesions
• VAGINAL: normal rugae; a moderate amount of green discharge on vaginal walls
• CERVIX: nulliparous os with small amount of purulent discharge from os with positive cervical motion tenderness (CMT)
• UTERUS: ante-flexed, normal size, shape, and position
• ADNEXA: bilateral tenderness with fullness; both ovaries without masses
• RECTAL: deferred
• VAGINAL DISCHARGE: green in color
no cyanosis, clubbing or edema
intact without lesions masses or rashes
No obvious deficits and CN grossly intact II-XII
Once you received your case number, answer the following questions:

What other subjective data would you obtain?
What other objective findings would you look for?
What diagnostic exams do you want to order?
Name 3 differential diagnoses based on this patient presenting symptoms?
Give rationales for your each differential diagnosis.


Submission Instructions:

Your instructor will assign you your case number and you will post on the case number you have been assigned.
You will reply to the other two case studies (One of each).
Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.
You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.) 
All replies must be constructive and use literature where possible.

Questions and Topics We Can Help You To Answer:
Paper Instructions: 

For this Discussion, you will take on the role of a clinician who is building a health history for one of the following cases.
“I have pain during intercourse and urination”
A 19-year-old female reports to you that she has “sores” on and in her vagina for the last three months.
She tries to practice safe sex but has a steady boyfriend and figures she doesn’t need to be so careful since she is on the birth control pill

states “I have sores and bumps on the inner creases of my thighs and pelvic area”. “There is yellowish discharge from the sores that comes and goes”
Objective Data
temperature: 100.2°F; pulse 92; respirations 18; BP 122/78; weight 156 lbs, 25 lbs overweight; height 5′3″
patient appears to have good hygiene; minimal makeup, pierced ears, no tattoos; well nourished (slightly overweight); no obvious distress noted
Atraumatic, normocephalic, PERRLA, EOMI, conjunctiva and sclera clear; nares patent, nasopharynx clear, good dentition. Piercing in her right nostril and lower lip.
within normal limits, appropriate lung sounds auscultated, clear and equal bilaterally
S1S2 without rub or gallop
• INSPECTION: no dimpling or abnormalities noted upon inspection
• PALPATION: Left breast no abnormalities noted. Right breast: denies tenderness, pain, no abnormalities noted.
Inguinal Lymph nodes: tenderness bilaterally, numerous, 1 cm in size
tender during palpation; the left lower quadrant was very tender during palpation; patient denies nausea or vomiting
labia major and minor: numerous ulcerations, too many to count; some ulcerations enter the vaginal introitus; no ulcerations in the vagina mucosa; cervix is clear, some greenish discharge; bimanual exam reveals tenderness in left lower quadrant; able to palpate the left ovary; unable to palpate the right ovary; no tenderness; uterus is normal in size, slight tenderness with cervical mobility

Muscles are smooth, firm, symmetrical. Full ROM. No pain or tenderness on palpation.
No obvious deficits and CN grossly intact II-XII

Submission Instructions:

Your instructor will assign you your case number and you will post on the case number you have been assigned.
You will reply to the other two case studies (One of each).
Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.
You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.) 
All replies must be constructive and use literature where possible