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Requirements: Your initial discussion post should include the following: Identify and discuss 2-3 definitions of polypharmacy (there are multiple

Requirements: Your initial discussion post should include the following: Identify and discuss 2-3 definitions of polypharmacy (there are multiple definitions). Your textbook can count as 1 reference. You must also include an additional reference from an evidence-based practice journal article or national guideline. Identify three risk factors that can lead to polypharmacy. Explain the rationale for why each listed item is a risk factor. Risk factors are different than adverse drug reactions. ADRs can be a result of poly-pharmacy, and is important, but ADRs are not a risk factor. Explore three action steps that a provider can take to prevent poly-pharmacy. Provide an example of how your clinical preceptors have addressed poly-pharmacy.
Annotated Bibliography: Ending Controversy Budd, Louis J. “Afterword: Mark Twain and the Sense of Racism.” Prospects: An Annual of American Cultural Studies 25 (2000): 151-58. Print. In the article, Budd is discussing the time in which Twain grew up in, one of racism and inequality. The main point emphasized in this piece of writing is that Twain’s racial point of view is not entirely his fault. The surroundings in which he was raised in resulted in his outlook on slavery; “Anybody tempted to belittle twain for swaying back toward racism should ponder how difficult it was to think otherwise in the 1800’s and early 20th century.” (page 155) Rather, his family kept Blacks as slaves during his childhood, and maintained the standpoint that they were inferior to Twain and his family. As the times changed, Twain became more insightful about the issues that Black people faced, although he continued to hold the same attitude. This shows his conflicting viewpoints causing people to question is authenticity, like Budd claims, “I question Twain’s credentials as, overall, a consistent antiracist. I Williams 2 emphasize “overall” because discussing only Huckleberry Finn ignores both the rest of his career – he would write and socialize for another twenty-five years – and also the changing political, economic, and sociocultural context during those twenty-five years.” (p. 152) The author suggests that Twain was a man of his time, yet he was a progressive, maintaining a paternal attitude towards Blacks. Budd believes Twain is a paternal figure to the slaves; he is kind and generous but is also authoritative and condescending. Chwast, Seymour. “Selling ‘Huck Finn’ Down the River.” New York Times. New York Times, 10 Mar. 1996. Web. In the article, Chwast writes about how people like Jane Smiley admire The Adventures of Huckleberry Finn novel. Chwast writes how Smiley compares Harriet Beecher’s Stowes novel, Uncle Tom’s Cabin, to Mark Twain’s novel, The Adventure of Huckleberry Finn. Jane Smiley concludes that, in contrast to Uncle Tom’s Cabin, The Adventures of Huckleberry Finn creates the idea that racism will not go away just by pure actions, like Uncle Tom’s Cabin promotes, but by altering Americans feelings toward African Americans and seeing them as full human, just like Huck did to Jim throughout the novel. Smiley backs up her argument that actions toward racism will not work and cites historical figures, like John Brown and Nat Turner, who were killed for taking action against racism. Jane Smiley also compares the books’ two endings. She concludes that Uncle Tom’s Cabin ending represents hopelessness, where Stowe’s vision represents the tragety of slavery as a instituion and blacks always being a inferior race to whites. The Adventures of Huckleberry Finn ending however, is a little more optimistic, as Jane Smiley concludes that Jim’s future as a free man, who is able to be reunited with his family, remains an open question at the end of the book. Chawst ends the article by citing people like John Wallace, who believe The Adventures of Huckleberry Finn is racist and should not be given to children to read. The conflicting points of view of the book between Jane Smiley and John Wallce connect to the ending of The Adventures of Huckleberry Finn. This isbecause the book ends on a note of uncertainty, just like how Americans are still uncertain on how to feel about the book today, as Huck realizes that he’ll have to leave again toward the American west and will have to seek out a new place in which to feel at home. This makes us have hope for Huck, and people in American society today like John Wallace, that their time on the “river” becomes part of a much larger journey toward acceptance, understanding, and compassion. Nilon, Charles H. “The Ending of Huckleberry Finn “Freeing the Free Negro.”” Satire or Evasion?: Black Perspectives on Huckleberry Finn. Durham: Duke UP, 1992. 62-76. Print. In this article, Nilon starts off by connecting the ending of Huckleberry Finn to real world events that were going on in the 1870s when Twain was writing The Adventures of Huckleberry Finn. Nilon gives a historical background of Mark Twain’s life and the historical background gives the reader insight on how Twain’s views on antislavery and racism came to be subjects inside his books. Although Twain’s irony can confuse readers, Nilon feels as though the book is an ironic triumph. The ending signifies the failure of Reconstruction and its “changes.” Nilon explains that during the Reconstruction era in the 1880s, there was an increase in black officeholders, but blacks were still denied political recognition and sometimes had to sharecrop and get lynched in order to survive. Despite the effort for social equality, his depiction of the South shows whites continuing to be cruel to blacks. This reference was written to show how even though there were black officeholders, violent discrimination was still in place. This also connects to The Adventures of Huckleberry Finn because, on the Phelps farm at the end of the book, the story falls back into stereotyping common African American caricatures, and, to return to the boys adventure mood at the beginning, is kinda like admitting defeat and giving up on what Huck and Jim strived for, which was equality between races. Nilon ends the article by analyzing Jim’s character. Jim trusts whites and helps Huck and Tom, but he is always regarded as a “nigger.” Twain’s interpretation of his characters ultimately relates to the race relations of the present period that Twain was writing in.
Share this: Facebook Twitter Reddit LinkedIn WhatsApp Diabetic Ketoacidosis: Diabetic ketoacidosis (DKA) results from absolute or relative deficiency of circulating insulin (Kitabchi AE, Umpierrez GE, Murphy MB, Kreisberg RA, 2006). DKA is characterized by severe depletion of water and electrolytes from both the intra and extracellular fluid compartments. Despite their dehydration, patients continue to maintain normal blood pressure and have considerable urine output until extreme volume depletion and shock occurs leading to a critical decrease in renal blood flow and glomerular filtration. Assessment: Perform a clinical evaluation to confirm the diagnosis and determine its cause. Carefully look for evidence of infection. Also weigh the patient. Assess clinical severity of dehydration. Assess level of consciousness using Glasgow coma scale [GCS]. Management: Laboratory blood glucose should be measured at diagnosis. An ECG monitor should be applied until the patient is stable. Consulate the Diabetes Team as soon as possible for a decision on continuing management. Transfer to subcutaneous (SC) insulin one the patient is able to eat and drink properly. Do not stop the IV insulin until SC insulin has been given. Patient with known diabetes should go back to their previous insulin regimen. If possible identify the precipitating cause of DKA. Always inform the Diabetes Team so that education can be given to reduce the risk of future episodes of DKA. Hyperosmolar non – ketotic coma (HONK): Type 2 diabetes, usually in patients over 60 years. This condition is characterized by hyperglycemia and high plasma osmolality without significant keton-uria or acidosis (Pinies JA, Cairo G, Gaztambide S, et al.1994). Assessment: Same as Diabetic ketoacidosis (DKA) but look for precipitating medical condition, e.g. sepsis, myocardial infarction etc Management: Management of Hyperosmolar non – ketotic coma is same as DKA . Also the insulin infusion rate should be halved as paradoxically these patients can be quite insulin sensitive. Elderly patients are more likely to need a CVP line to optimize fluid replacement. Risk of thromboembolic disease is high – anticoagulant fully if no contraindications. Most patient can be managed with oral hypoglycemic agents or diet, but recovery of insulin may take time and insulin may be required for few weeks. Hypoglycemia: Hypoglycemia is the result of a mismatch between insulin dose, food consumed, and recent exercise and is rarely, if ever, a spontaneous event (Kovatchev BP, Cox DJ, Farhy LS, Straume M, Gonder-Frederick L, Clarke WL,2003).Because it can be accompanied by unpleasant, embarrassing, and potentially dangerous symptoms and because it causes significant anxiety and fear in the patient and their caregivers, it’s occurrence is a major limiting factor in attempts to achieve near normal BG levels (Clarke WL, Gonder-Frederick A, Snyder AL, Cox DJ 1998,Cryer PE 2002). Assessment: Each hypoglycaemic episode should be assessed carefully to determine its cause evaluating the insulin action profile (time of insulin administration, peak insulin action and intensity of insulin action). Check the recent food intake (timing and amount of carbohydrates eaten and peak BG effect on recent food. Also check recent physical activity (timing, duration and intensity). Also check and missed signs and symptoms of early hypoglycaemia. Management: Management of hypoglycemia involves immediately raising the blood sugar to normal, determining the cause, and taking measures to hopefully prevent future episodes. Initially Glucose 10-20 g is given by mouth either in liquid form or as granulated sugar (2 teaspoons) or sugar lumps (Smeeks FC, 2006). If hypoglycemia causes unconsciousness, or patient is unco-operative, 50 mL of glucose intravenous (IV) infusion 20% can be given. Alternatively, 25 mL of glucose intravenous infusion 50% may be given, but this higher concentration is viscous, making administration difficult; it is also more irritant. Once the patient regains consciousness oral glucose should be administered as above. References : Kitabchi AE, Umpierrez GE, Murphy MB, Kreisberg RA. Hyperglycemic crises in adult patients with diabetes: a consensus statement from the American Diabetes Association. Diabetes Care 2006 Dec: 29(12): 2739-48. Hanas R, Lindgren F, Lindblad B. A 2-yr national population study of pediatric ketoacidosis in Sweden: predisposing conditions and insulin pump use. Pediatr Diabetes 2009 Feb: 10(1): 33-7. McDonnell CM, Pedreira CC, Vadamalayan B, Cameron FJ, Werther GA. Diabetic ketoacidosis, hyperosmolarity and hypernatremia: are high-carbohydrate drinks worsening initial presentation? Pediatr Diabetes 2005 Jun: 6(2): 90-4. Rewers A, Klingensmith G, Davis C, Petitti DB, Pihoker C, Rodriguez B, et al. Presence of diabetic ketoacidosis at diagnosis of diabetes mellitus in youth: the Search for Diabetes in Youth Study. Pediatrics 2008 May: 121(5): e1258-66. Pinies JA, Cairo G, Gaztambide S, et al. Course and prognosis of 132 patients with diabetic non ketotic hyperosmolar state. Diabete Metab 1994; 20: 43-48. Kovatchev BP, Cox DJ, Kumar A, Gonder-Frederick L, Clarke WL. Algorithmic evaluation of metabolic control and risk of severe hypoglycemia in type 1 and type 2 diabetes using self-monitoring blood glucose data. Diabetes Technol Ther 2003: 5: 817-828. Kovatchev BP, Cox DJ, Farhy LS, Straume M, Gonder-Frederick L, Clarke WL. Episodes of severe hypoglycemia in type 1 diabetes are preceded and followed within 48 hours by measurable disturbances in blood glucose. J Clin Endocrinol Metab 2000: 85: 4287-4292. Clarke WL, Gonder-Frederick A, Snyder AL, Cox DJ. Maternal fear of hypoglycemia in their children with insulin dependent diabetes mellitus. J Pediatr Endocrinol Metab 1998: 11(Suppl. 1) : 189-194. Cryer PE. Hypoglycaemia: the limiting factor in the glycaemic management of type I and type II diabetes. Diabetologia 2002: 45: 937-948. Strategies for Dealing with the Psychological Issues such as Fear and Anxiety Associated with Diagnosis of Cancer, and How These Can Improve Coping’ A diagnosis of breast cancer is a great shock. Women report that they fear breast cancer more than heart disease, even though they have a better chance of surviving breast cancer, and dying of stroke or heart failure. Breast cancer has been with us since the early Egyptians, and fear of this disease as well as the treatments for it, seems to be inherent in women all across the world. Normal Emotions and Breast Cancer Here are some normal emotions that you may experience at diagnosis and during treatment. Fear, shock Denial Anger Depression Sadness Anxiety Stress Guilt Loneliness, alienation Hope Physical Responses to Strong Emotions As you begin to deal with diagnosis and treatment, your body will be reacting to emotions as well as surgery and drugs. Your physical responses to the overall stress may be: Fear – trouble sleeping, headaches, body aches Anger – change in blood pressure Depression – fatigue, crying, feeling moody Stress – pain, irritability, tension Unresolved or Unexpressed Emotions May Lead to Other Problems You are not alone with your diagnosis – or your emotions. Expressing your feelings can give you quite a bit of relief, helping you move forward in your journey. Not all of us are freely expressive, but there are safe and creative outlets for your feelings. Letting out your emotions will help you get support and heal more quickly. Your bottled-up emotions may lead to: Loneliness, withdrawal from others Frustration Hopelessness Feeling out of control Emotional Concerns and Breast Cancer When you’ve accepted your diagnosis, you may be facing other emotional concerns. The loss of a breast, or part of a breast, has an impact that goes beyond the physical fact. If aggressive treatment is required, it might have long-term impact on your health. It is normal to be concerned about: Fear of recurrence Loss of attractiveness Difficulty with sexual function Loss of fertility Coping With and Surviving Breast Cancer You can improve your emotional health and reduce your physical symptoms with good coping strategies. A study published in the Journal of Psychosocial Oncology reports that women who get help with pain and emotional distress have lower levels of anxiety, fatigue and depression. Here are some ways to cope with your emotions: Communicate with family and friends Maintain intimacy (if you have a partner) Visit with a counselor or spiritual director Join a support group Express your needs and ask for help Report your symptoms to your healthcare team Keep a log of medical visits, save test results, keep receipts Educate yourself about your cancer and treatments Exercise Make plans for a crisis Getting Help for Emotions Is Not a Sign of Weakness You may feel under pressure to “be strong” or “act brave” when you least feel that way. Perhaps you don’t easily share your feelings with others. You may be in a position of responsibility and trust, and feel like you must contain your fears and hide your disease or the effects of treatment. Sharing these feelings and struggles may make you feel vulnerable. A study published in the Journal of Personality shows that women with breast cancer who do express their anger, fear, sadness, and affection in a group setting live longer than women who suppress these emotions. Here are some ways to express your emotions and boost your emotional and physical health: Make time to talk to family members Communicate with friends and coworkers Attend a support group, or join an online support list Find a good therapist and commit to regular visits Take-Home Message Your feelings about breast cancer and its affect on your body, family, relationships, finances, and mortality are valid and normal. Expressing your emotions and needs will help boost your mental and physical health. Letting it out lets you live longer! Sources: Journal of the American Geriatric Society. Effect of depression on diagnosis, treatment, and survival of older women with breast cancer. Published January 2004. Journal of Psychosocial Oncology. Examining the influence of coping with pain on depression, anxiety, and fatigue among women with breast cancer. Published 2005. National Institute of Health. Women’s Fear of Heart Disease Has Almost Doubled in Three Years, But Breast Cancer Remains Most Feared Disease. Published 2008. National Cancer Institute. Support for People with Cancer – Taking Time. Published 2005. California Breast Cancer Research Program. Does Change in Emotional Expression Mediate Cancer Survival? Final Report Published 1999. Breast cancer is an uninvited and life-altering event frequently associated with a rapid entry into a challenging treatment regimen and a long process of learning to cope with significant physical, practical, and emotional challenges (Boehmke
NUR 400 Denver School of Nursing Decisions in Evidence Based Practice Discussion.

In this assignment, you will write a paper that analyzes a scenario and considers the relationships between theory, research, and practice in evidence-based research.Step 1: Read the following scenario.During the course of your practice as a staff nurse on a medical-surgical unit, the nurse manager and unit-based council state that discharge teaching for postoperative patients will now include information pertaining to wound assessments, care, and dressing changes (as needed). The basis for this change stemmed from the unit consensus about postoperative readmissions with wound infections. The unit-based council performed a review of the literature and has decided to implement a discharge teaching plan that will include specific information addressing wound care.Step 2: Identify one research article pertaining to this problem.The article must be from nursing research from the United States and be published within the last five years in a peer-reviewed journal. Suggestions for finding an article include use of the library and journal articles posted to the Internet.Step 3: Review aspects of theories and conceptual models.Consider the various aspects of a theory and nursing conceptual models.Consider the purpose of research and how theory and research work together to support evidence-based practice.Think of how theory and nursing conceptual models could be used to reflect on the problem in nursing practice described in Step 1.Step 4: Write a two-four page paper.Write a paper that analyzes the importance of theory, research findings, and practice as it relates to evidence-based research. Then, using the scenario from Step 1 and the article you identified in Step 2, summarize how the aspects of a theory would help support evidence-based research into the problem described in the scenario. Also, describe which nursing conceptual model would be appropriate for research into this problem and why.Construct your paper and cite any sources in APA 7th edition format.
NUR 400 Denver School of Nursing Decisions in Evidence Based Practice Discussion

Big Five Factors Job Performance Management Essay

Nowadays, making good use of personality traits to select employees is very popular in organizations. A lot of research showed there is a strong linkage between personality and job performance. Personality is a useful tool to predict job performance and professional careers and it was proven by many scholars (Costa and McCrae, 1988; Carl Gustav Jung, 1923). The Big Five personality dimensions are authoritative about predicting job performance. The Myers-Briggs Type Indicator (MBTI) is broadly used to explain to individuals’ personality characteristics to professionals. Big Five personality dimensions will be used to examine how personality predicts overall employee performance first and then these models are used to explore how personality traits translate into individual’s professional careers. Literature Review

PHIL 347N Chamberlain College of Nursing Critical Thinking and Metacognition Paper

research paper help PHIL 347N Chamberlain College of Nursing Critical Thinking and Metacognition Paper.

I’m working on a other report and need a sample draft to help me learn.

Required ResourcesRead/review the following resources for this activity:Textbook: Chapter 1, 2, 3LessonIntroductionThe journal is an essential assignment that is meant to sum up the conclusions you come to after having reflected on the readings in the text, the online lecture, discussion posts, including your own and those of your peers, and any outside material you consult. You will probably find that you do as much or more thinking than you do writing in responding to the journal prompts – and that is perfectly okay. In general, the weekly journal should meet the noted length requirement – not including the space needed for the prompts.You may feel the need to write out longer reflections – and that is also okay. If you do feel the need for longer reflections, then, once you have written them out, try to edit them, reducing them to their essence.Part of this course is process – training ourselves to think critically. Part of it is learning to understand how we think and why we think or believe what we think or believe. While the journal prompts will occasionally address the process, it will more often ask you to reflect on the hows and whys of what you know and believe – or what you think you know and believe.InstructionsFor this journal assignment, briefly answer each of the following prompts:Critical ThinkingAfter reading the required resources for this week and participating in the discussion, how do you define critical thinking? You will want to carry this definition with you, so keep it brief – perhaps 4 to 6 lines. You will find many definitions online – don’t be tempted to just quickly copy one; try to form your own so that it is meaningful to you.Heart of the MatterConsidering just what is in this weeks’ readings, why do you think the authors (looking forward in the text) see Chapters 12, 13, and 14 as the “heart of the matter”?What do you think they mean by that?What two concepts do the authors say these chapters emphasize?How do you define these concepts?Why do you think the authors find these concepts important to critical thinking?Challenges & InsightsWhat do you see as your greatest challenge for this session in general? For this class in particular?How do you think you can use the concepts in these first three chapters to help you meet these challenges as well as challenges in your personal life as a member of your family and your community?If you include references to outside sources (beyond the textbook), make sure you cite them properly.Writing Requirements (APA format)Length: 2-3 pages (not including title page or references page)1-inch marginsDouble spaced12-point Times New Roman fontTitle pageReferences page (as needed)THe Lessons: Bloom, B. S., Engelhart, M. D., Furst, E. J., Hill, W. H., and Krathwohl, D. R. (1956). Taxonomy of educational objectives: The classification of educational goals. Handbook I: Cognitive domain. David McKay Company.Lovett, M. C. (2008). Teaching metacognition.…Vanderbilt University Center for Teaching. (n.d.). Bloom’s taxonomy pyramid [Image file]. The content of the metacognition section was based largely on the following sources:Lai, E. R. (2011). Metacognition, a literature review.…Papaleontiou-Louca, E. (2003). The concept and instruction of metacognition. Teacher Development, 7(1).…TEXTBOOK: Facione, P. A., & Gittens, C. A. (2016). Think critically (3rd ed.). Boston: Pearson.This textbook is available as an e-book and can be accessed from the module view.
PHIL 347N Chamberlain College of Nursing Critical Thinking and Metacognition Paper

HCA 320 Aspen University Healthcare Policy and Economics Discussion

HCA 320 Aspen University Healthcare Policy and Economics Discussion.

Assignment:Signature Assignment: Medicare and MedicaidConsider how people qualify to receive Medicare and/or Medicaid and write a paper that addresses the bullets below. There should be four (4) sections in your paper; one for each bullet below. Separate each section in your paper with a clear brief heading that allows your professor to know which bullet you are addressing in that section of your paper. Start your paper with an introduction and include a “Conclusion” section that summarizes all topics. This paper should consist of at least 1750 words and no more than 2000.This week reflect upon the Medicare and Medicaid programs to address the following:Describe the Quality Improvement Organization (QIO) and explain how the QIO improves policies and healthcare for Medicare beneficiaries. Briefly define the qualifications for Medicare and Medicaid benefits. How can qualifications be modified to serve more people who are considered a vulnerable population?Discuss the impact (including at least two positive and two negative aspects) that the ACA has had on benefits and coverage for Medicare and Medicaid recipients. Describe your role(s) as a healthcare leader as it applies to the practice of advocating for cost effective care for vulnerable populations.Assignment ExpectationsLength: 1750-2000 words in lengthStructure: Include a title page and reference page in APA format. These do not count towards the minimal word amount for this assignment. Your essay must include an introduction and a conclusion.References: Use the appropriate APA style in-text citations and references for all resources utilized to answer the questions. A minimum of two (2) scholarly sources are required for this assignment.
HCA 320 Aspen University Healthcare Policy and Economics Discussion

CTUO Apix Printing Financial Performance Analysis and Comparison

CTUO Apix Printing Financial Performance Analysis and Comparison.

This week you will learn to interpret and analyze hurdle rates, return on equity, and project selection. This knowledge will be applied to the following scenario:When you arrive at Apix Printing, Inc. the following day, you see the following e-mail from Mary requesting the Week 2 assignment described below. For comparative analysis, it will be useful at this time to do some research. You know that you can obtain the financials of companies within the same sector or Standard Industry Code as Apix Printing (e.g., commercial printing), and that the North American Industry Classification System (NAICS) Standard Industry 2012 code for Apix Printing is presently 323111. Use Hoover’s Pro to search for two other companies in the same industry as Apix Printing.Week 2 Individual Project assignment:In anticipation of Mary’s request for comparative analysis, it will be useful at this time to do some research. You know that you can obtain the financials of companies within the same sector or Standard Industry Code as Apix Printing (e.g., commercial printing), and that the North American Industry Classification System (NAICS) Standard Industry 2012 code for Apix Printing is presently 323111. Use the FINC615 Library Guide to search for two other companies in the same industry as Apix Printing.When you get to work the next day, you see the following e-mail from Mary:Here is the list of financial ratios you asked for. I need you to explain the computation of each and compute these for Apix’s results for the financial statements you are using for the PowerPoint presentation. Also, compare Apix’s 2-year trend results to that of two other firms in the sector. Indicate how each of Apix’s ratios differ, and indicate whether the two other companies’ ratios or Apix’s ratios are indicative of better performance.Explain the computation for each of the following, and compute each for Apix and two other companies in the same industry as Apix Printing:Current ratio(Long-term) debt to equity ratioGross margin percentageNet profit margin percentageReturn on equity percentagePresent your findings of the above data in a table. Add a paragraph that summarizes your results, indicating whether investors would find the financial analysis results of Apix competitive as compared to rivals in the sector. Be sure to include both positive and negative trends in your analysis.Mary’s email says: “Here is the list of financial ratios you asked for. I need you to explain the computation of each and compute these for Apix’s results for the financial statements you are using for the PowerPoint presentation. Also, compare Apix’s 2-year trend results to that of two other firms in the sector. Explain the computation for the Current ratio, (Long-term) debt to equity ratio, Gross margin percentage, Net profit margin percentage, Return on equity percentage. Indicate how each of Apix’s ratios differ, and indicate whether the two other companies’ ratios or Apix’s ratios are indicative of better performance.”Individual Project assignment due WednesdaySubmit a Table with the ratio calculations for 2 years of Apix and 2 competitorsand a 400 word minimum analysis of how each of Apix’s ratios differ, and indicate whether the two other companies’ ratios or Apix’s ratios are indicative of better performance.ATTACHMENTS
CTUO Apix Printing Financial Performance Analysis and Comparison