Sample Questions

Pathophysiology. Module 1

Hematopoietic:
J.D. is a 37 years old white woman who presents to her gynecologist complaining of a 2-month history of intermenstrual bleeding, menorrhagia, increased urinary frequency, mild incontinence, extreme fatigue, and weakness. Her menstrual period occurs every 28 days and lately there have been 6 days of heavy flow and cramping. She denies abdominal distension, back-ache, and constipation. She has not had her usual energy levels since before her last pregnancy.

Past Medical History (PMH):
Upon reviewing her past medical history, the gynecologist notes that her patient is a G5P5with four pregnancies within four years, the last infant having been delivered vaginally four months ago. All five pregnancies were unremarkable and without delivery complications. All infants were born healthy. Patient history also reveals a 3-year history of osteoarthritis in the left knee, probably the result of sustaining significant trauma to her knee in an MVA when she was 9 years old. When asked what OTC medications she is currently taking for her pain and for how long she has been taking them, she reveals that she started taking ibuprofen, three tablets each day, about 2.5 years ago for her left knee. Due to a slowly progressive increase in pain and a loss of adequate relief with three tablets, she doubled the daily dose of ibuprofen. Upon the recommendation from her nurse practitioner and because long-term ibuprofen use can cause peptic ulcers, she began taking OTC omeprazole on a regular basis to prevent gastrointestinal bleeding. Patient history also reveals a 3-year history of HTN for which she is now being treated with a diuretic and a centrally acting antihypertensive drug. She has had no previous surgeries.

Case Study Questions

  1. Name the contributing factors on J.D that might put her at risk to develop iron deficiency anemia.
  2. Within the case study, describe the reasons why J.D. might be presenting constipation and or dehydration.
  3. Why Vitamin B12 and folic acid are important on the erythropoiesis? What abnormalities their deficiency might cause on the red blood cells?
  4. The gynecologist is suspecting that J.D. might be experiencing iron deficiency anemia.
    In order to support the diagnosis, list and describe the clinical symptoms that J.D. might have positive for Iron deficiency anemia.
  5. If the patient is diagnosed with iron deficiency anemia, what do you expect to find as signs of this type of anemia? List and describe.
  6. Labs results came back for the patient. Hb 10.2 g/dL; Hct 30.8%; Ferritin 9 ng/dL; red blood cells are smaller and paler in color than normal. Research list and describe for appropriate recommendations and treatments for J.D

1. Identify Nursing Case Management Roles and explain 5 Roles of the Case Manager. 2. Describe the Essential Skills for Case Managers.

 

1. Identify Nursing Case Management Roles and explain 5 Roles of the Case Manager.

2. Describe the Essential Skills for Case Managers.

Chapter 25

Case Management

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1

Define continuity of care, care management, case management, care coordination, population health management, transitional care, integrated care, social determinants of health, and advocacy.

Describe the scope of practice, roles, and functions of a case manager.

Compare and contrast the nursing process with processes of case management and advocacy.

Objectives (1 of 2)

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2

 

2

Identify methods to manage conflict, as well as the process of achieving collaboration.

Define and explain the legal and ethical issues confronting case managers.

Objectives (2 of 2)

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3

 

3

Population management

Social mandate

Care management

Utilization management

Critical pathways

Disease management

Demand management

Definitions

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4

 

4

Case management and the nursing process

Characteristics and roles

Knowledge and skill requisites

Tools of case managers

Historical evidence

Contemporary evidence

Concepts of Case Management

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5

 

5

Assessment

Diagnosis

Planning for outcomes

Implementation

Evaluation

Case Management and the Nursing Process

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6

See Table 25.1, The Nursing Process and Case Management.

6

Case Management Roles

Broker

Consultant

Coordinator

Educator

Facilitator

Liaison

Mentor

Monitor/reporter

Negotiator

Client advocate

Researcher

Standardization monitor

Systems allocator

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7

See Box 25.1, Case Manager Roles, for descriptions of these roles.

7

Factors That Demand Case Management Attention

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8

Fig. 25.4: Factors that require the attention of the nurse and client in the case management process

8

Knowledge and Skill Requisites

Standards of practice for case management

Evidence-based practice guidelines

Knowledge of the health care financial environment

Clinical knowledge, skill, and maturity

Care resources

Transition planning

Management skills

Teaching, counseling, and education skills

Program evaluation and research

Performance improvement techniques

Peer consultation and evaluation

Requirements of eligibility and benefit parameters by third-party payers

Legal and ethical issues

Information management systems

Health care legislation/policy

Technical information skills

Outcomes management and applied research

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9

See Box 25.2 for an expanded list of knowledge and skill requisites.

9

Six “rights” of case management

Right care

Right time

Right provider

Right setting

Right price/value

Right outcomes

 

Tools of Case Managers (1 of 2)

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10

 

10

Three tools

Case management plans

Standards of client care and nursing practice

Clinical guidelines

Evidence-based practices

Critical path development gave way to care maps

Disease management

Focus: the natural progression of a disease in high-risk populations

Life care planning

Needs of a client for catastrophic or chronic disease over a life span

Technology driven

 

Tools of Case Managers (2 of 2)

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11

Technology supports the delivery of processes used by the case manager. The technology sector is refining software in the areas of documentation, decision support, dashboard tools, predictive modeling, workflow automation, reporting capabilities, electronic health records, patient engagement strategies and social media, and remote monitoring.

11

Historical evidence

Taylor’s three models

Client focused

System focused

Social service

Contemporary evidence

Model of intensive case management (ICM)

Kolbasovshy (2009)

Reduced readmissions

CARE ONE program: reduced emergency room (ER) visits

2012 Study: decreased acute outpatient and inpatient admissions

Evidence-Based Examples of Case Management

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12

Client-focused models are concerned with the relationship between case manager and client to support continuity of care and to access providers of care.

System-focused models, in contrast, address the structure and processes of using the population-based tools of disease management and case management plans to offer care for client populations.

The social service models provide services to clients to assist them in living independently in the community and in maintaining their health by eliminating or reducing the need for hospital admissions or long-term care.

 

These models offer a solution to unnecessary health care expenses by reducing costs and accessing appropriate health care services.

12

Which model demonstrated a consistent reduction in ER visits, readmissions, and acute outpatient and inpatient admissions in multiple studies?

Social service

Client-focused

System-focused

Intensive case management

 

Quick Recall (1 of 2)

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13

 

13

Answer is D.

Intensive case management

 

Quick Recall (2 of 2)

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14

Model of intensive case management (ICM)

Reduced readmissions

Reduced ER visits

Reduced acute outpatient and inpatient admissions

 

How’d You Do?

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15

Advocacy

Conflict management

Collaboration

Essential Skills for Case Managers

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16

 

16

The advocacy role aims to achieve patient engagement.

By helping patients become invested in their health and care through programs that provide information and tools to empower them to take control and evaluate their care

Advocacy (1 of 2)

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17

The definition of nursing includes advocacy: “Nursing is the protection, promotion and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities and populations” (ANA, 2010).

 

17

Process of advocacy

Promoting self-determination in clients

Informing:

Amplifying

Clarifying

Verifying

Supporting

Affirming

Illuminating values

Advocacy (2 of 2)

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18

Amplifying occurs between the nurse and the client to assess the needs and demands that will eventually frame the client’s decision. Information is exchanged from both viewpoints.

Clarifying is a process in which the nurse and client strive to understand meanings in a common way.

Verifying is the process used by the nurse advocate to establish accuracy and reality.

The second major process, supporting, involves upholding a client’s right to make a choice and to act on it.

The third process in the advocacy role is affirming. It is based on an advocate’s belief that a client’s decision is consistent with the client’s values and goals.

 

18

Allocation roles in nursing

Triage

Gatekeeping

Rationing

Systems-level demands

Budget decisions

Staffing assignments

Clinical level demands

Implementing treatment protocols

Advocacy can conflict with allocation.

Limited resources contribute to this conflict.

Allocation and Advocacy

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19

 

19

Negotiation outcomes

Distributive outcomes

One party gains

Integrative outcomes

Mutual advantages override individual gains

Negotiation stages

Prenegotiating

Negotiating

Aftermath

Conflict Management

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20

Negotiating is a strategic process used to move conflicting parties toward an outcome. The outcome can vary from one in which one party gains benefit at the other’s expense (distributive outcomes) or in which mutual advantages override individual gains (integrative outcomes).

20

Establish issues and agenda.

Advance demands and uncover interests.

Bargain and discover new options.

Work out an agreement.

 

Negotiation Phases

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21

 

21

Communication is essential but not sufficient.

Joint decision making valued

However, one member should be accountable.

Handling competing expectations

 

Collaboration (1 of 2)

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22

 

22

Collaboration (2 of 2)

Goal: to amplify, clarify, and verify all team members’ points of view

 

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23

 

23

Legal issues

Ethical issues

Issues in Case Management

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24

 

24

Liability for managing care

Negligent referrals

Experimental treatment and technology

Confidentiality/security

Fraud and abuse

Legal Issues

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25

 

25

Autonomy

Beneficence

Fidelity

Justice

Nonmaleficence

Veracity

Ethical Issues

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26

 

26

Please Reply To The Following 2 Discussion Posts DISCUSSION POST # 1 Julie

Please Reply to the following 2 Discussion posts:

 

Requirement

 

APA format with intext citation

Word count minimum of 150 words per post not including references.

References at least one high-level scholarly reference per post within the last 5 years in APA format.

Plagiarism free.

Turnitin receipt.

 

DISCUSSION POST # 1 Julie

Many professional organizations have used media to promote health policy agendas. Every state is different in regards to the nurse practitioner’s ability to practice their Full scope of practice. A lot of things have changed after Covid and the issues the patients have had been able to have primary care. Nurse Practitioners hold a specific role they can fill in the gaps for our patients. Nurse practitioners (NPs) are on the front lines of health care, using a patient-centered approach to provide quality care to people of all ages.

The American Association of Nurse Practitioners (AANP) is educating the public and policymakers about the important roles NPs hold and the positive contributions NPs make to the health of our nation. Media campaigns are just a few examples of AANP’s outreach. In 2020, AANP launched a national multimedia campaign highlighting the work NPs are doing to ensure patients have access to quality care amid the COVID-19 pandemic. The “NPs Combat COVID” campaign includes a television commercial featuring photos and videos of real NPs working on the COVID-19 front lines. Also in this campaign is a website they can educate the patient about coronavirus and the NPs role. The website is NPsCombatCOVID.org (Media campaigns. American Association of Nurse Practitioners (n.d.). AANP has used social media and commercials to reach patients and educate them on the NP’s role. The more each state uses their nurse practitioners to fill in these gaps for our patients. The more that NPS can help patients.

DISCUSSION POST # 2 Minu

Social media is a useful instrument for communication that enables connections and information sharing. Social media information influences about 75% of Americans who use the internet. Many people now use social media sites regularly, including healthcare professionals (Chen and Wang, 2021). Social networking is becoming more popular as a resource in healthcare. Healthcare practitioners are utilizing social media as an instructional tool. Social media may be a powerful instructional tool. While there is a belief that social media has a detrimental influence on productivity and efficiency, many organizations use it for program marketing, research dissemination, and teaching and training. Twitter® and other social media platforms have been employed in the instructional curriculum of medical training programs, boosting access to critical resources and topic expertise. Many renowned healthcare organizations and medical expert groups use a Twitter hashtag (#) chat to educate and discuss current and contentious issues with conference attendees, members, and others (Stellefson et al., 2020). Several organizations have established guidelines on how healthcare practitioners and institutions may utilize social media as a beneficial medium for marketing and sharing academic deliverables due to the influx of professional users and benefits to the target audience. Professional networking, professional education, organizational promotion, patient care, patient education, and public health campaigns are all examples of how social media is used in healthcare. As new clinical evidence becomes available, healthcare knowledge is always evolving. Cancer is one area of healthcare where social media has been used to raise public awareness, drive campaigns, and influence governmental decision-making. Social media is viewed as a helpful instrument by policymakers in the healthcare setting for increasing public involvement in developing and implementing policies to provide public services that satisfy society’s requirements (Charalambous, 2019). Social media can be an effective tool for healthcare education if used effectively and efficiently by healthcare organizations.

 

Cultural, Spiritual, Nutritional, & Mental Health Disorders

Cultural, Spiritual, Nutritional, & Mental Health Disorders

 

For this Discussion, you will take on the role of a clinician who is building a health history for one of the following cases.

 

Chief Complaint (CC) “I came for my annual physical exam, but do not want to be a burden to my daughter.”
History of Present Illness (HPI) At-risk 86-year-old Asian male – who is physically and financially dependent on his daughter, a single mother who has little time or money for her father’s health needs.
PMH Hypertension (HTN), gastroesophageal reflux disease (GERD), b12 deficiency and chronic prostatitis
PSH S/P cholecystectomy
Drug Hx Current Meds: Lisinopril 10mg daily, Prilosec 20mg daily, B12 injections monthly, and Cipro 100mg daily.

 

 

Review of Systems (ROS)

 

General + weight loss of 25 lbs over the past year; no recent fatigue, fever, or chills.
Head, Eyes, Ears, Nose & Throat (HEENT) No changes in vision or hearing, no difficulty chewing or swallowing.
Neck No pain or injury
GU no urinary hesitancy or change in urine stream
Integument multiple bruises on his upper arms and back.
MS/Neuro + falls x 2 within the last 6 months; no syncopal episodes or dizziness

 

 

 

Objective Data

 

PE B/P 188/96; Pulse 89; RR 16; Temp 99.0; Ht 5,6; wt 110; BMI 17.8
HEENT Atraumatic, normocephalic, PERRLA, EOMI, arcus senilus bilaterally, conjunctiva and sclera clear, nares patent, nasopharynx clear, edentulous.
Lungs CTA AP&L
Card S1S2 without rub or gallop
Abd benign, normoactive bowel sounds x 4
Ext no cyanosis, clubbing or edema
Integument multiple bruises in different stages of healing – on his upper arms and back.
Neuro No obvious deformities, CN grossly intact II-XII

 

 

Once you received your case number, answer the following questions:

1. Discuss the specific socioeconomic, spiritual, lifestyle, and other cultural factors related to the health of the patient you selected.

2. Describe the Subjective, Objective, Assessment, Planning (S.O.A.P.) approach for documenting patient data and explain what they are.

3. Discuss the functional anatomy and physiology of a psychiatric mental health patient. Which key concepts must a nurse know in order to assess specific functions?

 

Your initial post should be at least 550 words, formatted and cited in current APA style with support from at least 3 academic sources.

Realistic Clinical Case Study

Realistic Clinical Case Study

 

For this assignment, you will develop a presentation on a realistic clinical case on a topic that is of interest to you.

 

Content Requirements You will create a PowerPoint presentation with a realistic case study and include appropriate and pertinent clinical information that will be covering the following:

1. Subjective data: Chief Complaint; History of the Present Illness (HPI)/ Demographics; History of the Present Illness (HPI) that includes the presenting problem and the 8 dimensions of the problem; Review of Systems (ROS)

2. Objective data: Medications; Allergies; Past medical history; Family history; Past surgical history; Social history; Labs; Vital signs; Physical exam.

3. Assessment: Primary Diagnosis; Differential diagnosis

4. Plan: Diagnostic testing; Pharmacologic treatment plan; Non-pharmacologic treatment plan; Anticipatory guidance (primary prevention strategies); Follow up plan.

5. Other: Incorporation of current clinical guidelines; Integration of research articles; Role of the Nurse practitioner

 

Submission Instructions:

· The presentation is original work and logically organized, formatted, and cited in the current APA style, including citation of references.

· The presentation should consist of 10-15 slides

 

Incorporate a minimum of 4 current (published within the last five years) scholarly journal articles or primary legal sources (statutes, court opinions) within your work. Journal articles and books should be referenced according to APA style (the library has a copy of the APA Manual).

Case Study Rubric

Criteria

 

Chief Complaint (Reason for seeking health care) – S: Includes a direct quote from patient about presenting problem

 

Demographics: Begins with patient initials, age, race, ethnicity and gender (5 demographics)

History of the Present Illness (HPI) – S: Includes the presenting problem and the 8 dimensions of the problem (OLD CARTS – Onset, Location, Duration, Character, Aggravating factors, Relieving factors, Timing and Severity)

Allergies – S: Includes NKA (including = Drug, Environemental, Food, Herbal, and/or Latex or if allergies are present (reports for each severity of allergy AND description of allergy)

 

Review of Systems (ROS) – S: Includes a minimum of 3 assessments for each body system and assesses at least 9 body systems directed to chief complaint AND uses the words “admits” and “denies”

 

Vital Signs – O: Includes all 8 vital signs, (BP (with patient position), HR, RR, temperature (with Fahrenheit or Celsius and route of temperature collection), weight, height, BMI (or percentiles for pediatric population) and pain.)

 

OutcomeLabs – O: Includes a list of the labs reviewed at the visit, values of lab results and highlights abnormal values OR acknowledges no labs/diagnostic tests were reviewed.

 

Medications – O: Includes a list of all of the patient reported medications and the medical diagnosis for the medication (including name, dose, route, frequency)

 

Screenings – O: Includes an assessment of at least 5 screening tests

 

Past Medical History – O: Includes, for each medical diagnosis, year of diagnosis and whether the diagnosis is active or current AND there is a medical diagnosis for each medication listed under medications

 

Past Surgical History – O: Includes, for each surgical procedure, the year of procedure and the indication for the procedure

 

Family History – O: Includes an assessment of at least 4 family members regarding, at a minimum, genetic disorders, diabetes, heart disease and cancer.

 

Social History – O: Includes all 11 of the following: tobacco use, drug use, alcohol use, marital status, employment status, current and previous occupation, sexual orientation, sexually active, contraceptive use, and living situation.

 

Physical Examination – O: Includes a minimum of 4 assessments for each body system and assesses at least 5 body systems directed to chief complaint

 

Diagnosis – A: Includes a clear outline of the accurate principal diagnosis AND lists the remaining diagnoses addressed at the visit (in descending priority)

 

Differential Diagnosis – A: Includes at least 3 differential diagnoses for the principal diagnosis

 

Pharmacologic treatment plan – P: Includes a detailed pharmacologic treatment plan for each of the diagnoses listed under “assessment”. The plan includes ALL of the following: drug name, dose, route, frequency, duration and cost as well as education related to pharmacologic agent. If the diagnosis is a chronic problem, student includes instructions on currently prescribed medications as above.

 

Diagnostic/Lab Testing – P: Includes appropriate diagnostic/lab testing 100% of the time OR acknowledges “no diagnostic testing clinically required at this time”

 

Education – P: Includes at least 3 strategies to promote and develop skills for managing their illness and at least 3 self-management methods on how to incorporate healthy behaviors into their lives.

 

Anticipatory Guidance – P: Includes at least 3 primary prevention strategies (related to age/condition (i.e. immunizations, pediatric and pre-natal milestone anticipatory guidance)) and at least 2 secondary prevention strategies (related to age/condition (i.e. screening))

 

Follow up plan – P: Includes recommendation for follow up, including time frame (i.e. x # of days/weeks/months)

 

References: High level of APA precision

 

Grammar: Free of grammar and spelling errors

 

Incorporation of Current Practice Guidelines: Includes recommendations from at least 1 professional set of practice guidelines (although not the current version)

 

Role of the Nurse Practitioner: Includes a discussion of the role of NP pertaining to the assessment, work up, collaboration and management of the case presented AND gives at least 1 example pertaining to each of the 4 areas (assessment, work up, collaboration and management).

Assignment 5, nutrition and diet

PLEASE USE THE UPLOADED PRIOR ASSIGNMENT AS A GUIDE….

 

Assignment 5, nutrition and diet

Diet/Nutrition/Obesity/Food insecurityIn the unit on Nutrition and Obesity, the various assigned materials approach the content from different angles. The following questions will be the basis of a short reflection assisgnment

  1. Collect a 24 hours diet on a client.
  2. Analyze the diet according to current recommendations, evidence based recommendations. According to BMI, sex, activity level, any health issues etc, anything missing in the diet? Anything too much or too little? Are you suggesting any change?
  3. Address the diet, giving advise vs a motivational interviewing approach vs a combo vs other? Your thoughts….
  4. What are socio-economic factors influencing access to healthy foods resulting in health disparities?

In a short assignment (minimum of 3 paragraphs, but doesn’t need to be much longer than 3 paragraphs), comment on the above questions with something that struck you from the assigned materials. You can also relate it to your experience with patients or your experience as a patient. However, use the assigned materials as a basis for your discussion. Did something surprise you or was new information for you? Is there something you agree or disagree with?Be sure to appropriately site any sources using APA. I do not expect you to do research or include anything outside of the assigned readings.(1-2 pages, double spaced, using APA format)

Grading Criteria

1. 24 hour diet 0.5 pt

2. Analysis of the 24 hour diet by age, sex, BMI, activity etc. 1.5 pt

3. Reflect on communication strategies with patients re diet 1 pts

(MI vs advise)

4. Identify socio-economic factors & health disparities related to diet and food access 1.5 pts

5. Utilize at least 2 sources* & correct APA format 0.5 pts

Diet/Nutrition/Obesity/Food Insecurity

Health professionals are bestowed with the sole responsibility of ensuring that their assigned patients receive the best quality of care. Obesity is one of the most popular health issues affecting individuals across the globe. Diet and nutrition therapy has been fundamental in aiding the obese to adopt healthier eating habits and lifestyles.

The patient claims that she ate a high-fat breakfast consisting of a cup of yogurt, bacon, and four whole eggs. Before she took her lunch, she consumed over five bars of chocolate candy and had an 8 oz glass of milk. During lunch time, she ordered ultra-processed foods; 2 slices of pizza and a burger. At dinner, she took wine and enjoyed eating steak and potatoes. Over the previous 24 hours, she took five glasses of mineral water to remain hydrated a day.

The patient was a 46-year-old non-Hispanic black female with a body mass index (BMI) of 30. According to the assessment, it was discovered that she had hypertension and was diabetic. She maintains that she leads a sedentary lifestyle and does not engage in vigorous physical activities. It is important to note that a lot is missing in the patient’s diet. Following research, starch and protein are pivotal in the morning (Lesser et al., 2015). The patient should regulate her intake of high-fat proteins like yogurt and replace them with a piece of fruit like banana, apple, or orange, depending on her preferences. At lunch and dinner time, she mostly consumes ultra-processed foods that are less filling as well as raise a person’s blood sugar tremendously. In my opinion, the patient required a workable nutritional program to help manage her weight.

The patient’s diet primarily lacks vitamins and starch. Noteworthy, the over-consumption of processed food could have caused the development of her diabetes. For the client to achieve weight loss, she must shift to dried or fresh unsweetened whole fruits like those mentioned above. She also needed to embrace cooking whole foods rich in essential nutrients (Lesser et al., 2015). I would first encourage the patient to engage in physical activities like walking or jogging multiple times a week regarding her overall lifestyle. Following National Heart, Lung, and Blood Institute Editors (n.d), physical activity helps improve body composition boosting the patient’s overall health and well-being. Moreover, I would support the patient by aiding her in coming up with a workable weight management program that would guide her appropriately in the future.

Several socio-economic factors affect access to healthy foods, fostering health disparities in different populations. The first factor is poverty. In my experience working with overweight patients, the majority came from low-income households. The majority of these individuals develop the propensity to consume ultra-processed or junk foods as they are cheap and accessible. Another critical factor is a lack of awareness or knowledge about the importance of taking healthy meals. To my knowledge, only a tiny percentage of black women are knowledgeable about the effects of their eating habits on their weight and overall health. This population is noted to be at higher risk of developing weight-related health problems such as type 2 diabetes, hypertension, stroke, and heart disease, to mention but a few.

Noteworthy, obesity is a crucial health problem impacting many people across different continents. Dietitians and nutritionists are responsible for helping vulnerable individuals adopt healthy eating habits and take the appropriate steps to change their overall lifestyles. It is worth noting that weight management is a complex process that requires care providers to be available to their patients.

 

References

Lesser, L., Carol, M., & Lucan, S. (2015). Nutrition myths and healthy dietary advice in clinical practice. American Family Physician. https://www.aafp.org/pubs/afp/issues/2015/0501/p634.html#healthy-dietary-advice

National Heart, Lung, and Blood Institute Editors. (n.d). Aim for a healthy weight. National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health/educational/lose_wt/recommen.htm

Student Answer 1 StrengthsFinder Assessment Results

StrengthsFinder Assessment Results

The top five themes revealed from the StrengthsFinder assessments are as follows: command, achiever, strategic, relator and belief. The first theme presented is command. The command theme talks about having a strong presence, being bold, assertive, and self-reliant. The second theme is achiever. The achiever theme discusses my drive, need to achieve, and stamina to power through projects. The third theme is strategic which explains my appreciation for straightforward, candid, concise conversations, and the ability to find multiple solutions or angles to a problem. The fourth theme is relator which describes my attitudes toward relationships. The relator theme speaks about appreciating small, intimate, genuine relationships with lots of depth. Lastly, the fifth theme is belief reveals that I operate off my core values; family oriented, altruistic, spiritual, and ethical.

Core Values

Two core beliefs that I operate and live by is God/family first and honesty second. God and family is my center and foundation My spiritual beliefs and family keep me grounded and remind me that my life is not just mine, humankind is all part of one big picture, and in some way all the decisions we make as individuals affect one another. Secondly, having integrity is important. According to (2020) integrity is the foundation of leadership, a crucial characteristic of a nurse leader, and needed to sustain lasting organizational value extending beyond bottom-line success. Being honest with myself and others is my catalyst for change, provides opportunities for growth for myself and others, and allows me to be transparent about my needs and the needs of others. The theme belief is fully accurate and representative of who I am and how I function in life, and I work to strengthen those values daily.

Strengths

The strengths I possess, authenticity and solution oriented, I believe derive from my relator, achiever, and believer theme. I am genuinely me every day. I do not pretend to be anyone else but myself. I love who I am and what I offer to the world. I genuinely try to get to know people and understand what is important to them and support their dreams. Secondly, I am solution oriented. Every obstacle, problem or issue has a solution, you just need to find it, and I am dedicated to finding that solution. It is a pet peeve of mine that people complain but do not try to think of solutions. According to Broome and Marshall (2022) transformational leaders look at old problems in new ways by being fearless and taking risks to find solutions (p. 17). I would like to strengthen these two strengths because when you have authentic relationships with people, you care about them, and it is easier to create solutions with people when you understand who they are and their intentions.

Characteristics

Being assertive and caring are characteristics that I possess that are a double edge sword. I am assertive with needed especially when setting boundaries and resolving conflicts. However, people admire my assertiveness when it is beneficial to them. On the other hand, people can perceive my assertiveness as being mean or bossy. In research from Hu et al. (2019) reveals that extraversion, a broad trait encompassing dominance, assertiveness, warmth, and outspokenness, has been identified as the strongest and most consistent antecedent of leadership emergence among leadership development and team effectiveness in the absence of formal leadership. So, strengthening my command theme is finding a way to continue to be assertive in a way that is not perceived as being confrontational or dismissive. Caring for people is also a double-edged sword. I naturally care about most people and want to be of assistance to help them reach their dreams. However, people can take my kindness as a weakness and get used by people that are not genuine. I would like to better discern when to intervene and when to be a cheerleader on the side lines.

References

Broome, M., & Marshall, E. S. (2020). Transformational Leadership in Nursing: From Expert Clinician to Influential Leader (3rd ed.). New York, NY: Springer Publishing Company.

Hu, J., Zhang, Z., Jiang, K., & Chen, W. (2019). Getting ahead, getting along, and getting prosocial: Examining extraversion facets, peer reactions, and leadership emergence. Journal of Applied Psychology, 104(11), 1369–1386. https://doi.org/10.1037/apl0000413

Hughes, V. (2018). Authentic Leadership. Journal of Christian Nursing, 35(2), E28–E31. https://doi.org/10.1097/cnj.0000000000000491

Student Response 2 Discussion: Leadership Profile

Discussion: Leadership Profile

The StrengthsFinder assessment is a personal development tool developed by Gallup Education, which provides an individual with their top 5 strengths. Focusing on your strengths on a daily basis has been shown to have profound positive effects on an individual’s personal and professional well-being (Comer et al., 2019). My strengths, according to the StrengthsFinder assessment, are focus, consistency, strategy, achiever, and responsibility. Being focused means that I regularly set goals that act as my compass, regularly evaluate actions to determine whether they help move in the right direction, and tends to be impatient with tangents, obstacles, and delays. Being consistent means that I value balance, I am keenly aware of the need to treat people the same, and believe that people function in an environment where rules are clear. Being strategic means that I am able to sort through the clutter and find the best route, being an achiever means that I have a constant need for achievement, and responsibility means that I take ownership of anything I am committed to and become emotionally bound to follow it through to completion.

The two core values that I would like to strengthen, based on the results of the StrengthsFinder assessment, are honesty and loyalty. The results indicate that I am a dependable person because of my consistency, taking ownership of others, desire to achieve, and establishing the right direction. Because others rely on me for all these, it means that I need to be trusted hence; the value of honesty. Honesty is important in gaining stronger support from employees and allows the right solutions to be applied (Karthikeyan, 2018). I can effectively lead others if I am loyal to my job and role as a leader. Loyalty sets leadership apart from management and enables leaders to continuously remind their team of organizational goals and vision (Steinmann et al., 2018).

The strengths that I intend to strengthen further, based on the StrengthsFinder assessment results, are accountability and persistence. The health care setting represents an important setting where results play an important role. A focus on higher and positive results is the goal of healthcare providers. Working on my strengths as an accountable and persistent leader can help me to remain accountable in all my tasks and initiatives, and be successful in promoting positive outcomes, respectively. In addition to this, leader effectiveness ensures that organizational objectives are carried out in accordance with organizational vision and mission, implying the need to remain accountable and an achiever.

The characteristics that I would like to strengthen based on the StrengthsFinder assessment results are effective negotiation skills and self-awareness. The results indicate that I have dependability values, implying that I am likely to undertake positions where I am supposed to lead others in navigating various situations. Having good negotiation skills helps in creating good relationships and understanding the interests of those that are being led with the aim of finding ways of satisfying those interests. This strategy can help in influencing others towards the achievement of success or common goals. According to the results, I am aware that my subconscious mind continuously absorbs information and creates possible options. Being self-aware will help me to identify my strengths and weaknesses, and ways of addressing them so that I can continually improve on my skills as a leader.

References

Comer, R., Schweiger, T., & Shelton, P. (2019). Impact of students’ strengths, critical thinking skills and disposition on academic success in the first year of a PharmD program. American Journal of Pharmaceutical Education, 83(1), 6499. https://doi.org/10.5688/ajpe6499

Karthikeyan, C. (2018). A meta-analytical study on leadership integrity: a leadership ethics perspective. Journal Homepage: http://www. ijmra. us, 7(4). IJMRA-11476.pdf

Steinmann, B., Klug, H., & Maier, G. (2018). The path is the goal: How transformational leaders enhance followers’ job attitudes and proactive behavior. Frontiers in Psychology, 9. https://doi.org/10.3389/fpsyg.2018.02338

Nursing Case Altered Oxygenation

L.S. is a 59-year-old female who goes to see her primary care physician because of increasing fatigue and shortness of breath with activity. She has a history of hypertension, hypothyroidism, rheumatoid arthritis, and rheumatic fever as a child. She is taking the following medications:

  • Triamterene/hydrochlorothiazide (Dyazide) 37.5/25 mg PO daily
  • Levothyroxine (Synthroid) 150 mcg PO daily
  • Methotrexate (Rheumatrex) 15 mg PO every Sunday

Subjective Data

  • Does not exercise, but was always able to do daily activities such as go up and down the stairs of her home and go grocery shopping
  • The last few weeks has noticed that she gets short of breath with her normal daily activities
  • Has been waking up at night short of breath
  • Denies any pain in her chest
  • Does not have any pain in her joints as long as she takes her “arthritis medicine”

Objective Data

Physical Examination

  • Temperature 98.5° F, pulse 88 and irregular, respirations 24, blood pressure 134/82, O2 saturation 92%
  • Irregular heart rate with a grade III diastolic murmur
  • Crackles in bilateral bases of lungs
  • No peripheral edema noted

Diagnostic Studies

  • ECG shows atrial fibrillation with heart rate of 90
  • Echocardiogram reveals mitral valve stenosis with mild left-sided heart failure
  • Laboratory Studies:
    • Hemoglobin 12 g/dL
    • Hematocrit 37%
    • T4 (total) 5.1 mcg/dL

Discussion Questions

1. What is mitral stenosis? What could be the possible cause of L.S.’s mitral stenosis?

2. What clinical manifestations of mitral valve stenosis does L.S. have?

3. How did the mitral valve stenosis contribute to the development of left-sided heart failure?

4. What clinical manifestations of left-sided heart failure does L.S. have?

5. What are the treatment options for L.S.?

6. What would be some pertinent nursing diagnoses and goals for L.S.?

7. What are the priority nursing interventions for these nursing diagnoses?

Diversity Discussion 4

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.

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

Submission Instructions:

APA 7 edition is a must.

NO WEBSITES ALLOWED FOR REFERENCE OR CITATION. 500 words at least. References and citation must be only from journal articles or books published from 2017 up to now. Must employ at least 3 references entries which will be cited at the end of the paragraph. INCLUDE DOI, PAGE NUMBERS. etc PLAGIARISM NEED TO BE LESS THAN 10%.