2023 Please follow the directions carefully Examination of current literature using the 5 articles presented here

2023 Nursing Assignment FOR KIM …..

Please follow the directions carefully Examination of current literature using the 5 articles presented here 2023

Please follow the directions carefully.

Examination of current literature – using the 5 articles presented here:

 

 

 

1. Bilir, Y., Hancı V., Okyay R., Erdoğan K., Ayoğlu H., Özkoçak T. (2016). Effects of Peroperative Intravenous Paracetamol and Lornoxicam for Lumbar Disc Surgery on Postoperative Pain and Opioid Consumption: A randomized, prospective, placebo-controlled study. Ağrı-The Journal of The Turkish Society of Algology, 2016 April;28(2):98-105. doi: 10.5505/agri.2015.45220.

 

In this study Bilir, Y., Hancı V., Okyay R., Erdoğan K., Ayoğlu H., and Özkoçak T., perform a study to compare the effects either Lornosicam (NSAID) , IV acetaminophen or placebo, prior to surgery will decrease post-op pain, and analgesic control.

I find this research very interesting because even though there was no direct answer to my PICOT question the above information does place me in  a position to incorporate my thoughts because this study utilizes Demerol PCA for breakthrough pain. 

In this study there was no significant change in the demand dosing of the PCA when paired with either drug. This however is not including the placebo where there was an obvious increase there. This means that pain is decreased with oral medication and there is a decreased need in patient controlled analgesia and adverse events related to it.

 

 

Garcia, R., Cassinelli, E., Messerschmitt, P., Furey, C., Bohlman, H., (2013). A multimodal approach for postoperative pain management after lumbar decompression surgery: a prospective, randomized study.

Journal of Spinal Disorders and Techniques. 2013 Aug;26(6):291-7. DOI: 10.1097/BSD.0b013e318246b0a6

 This study was to determine if multimodal medication management would decrease the consumption of  morphine use post lumbar laminectomy. 

Evaluation of patient pain was using the visual analog scale and  were recorded every four hours up until the thirty-six  hour mark.

This study concluded that there too was a reduction in PCA usage and goals were met for earlier mobility.

 

Kim, S., Ha, K., Oh, I., (2016). Preemptive Multimodal Analgesia for Postoperative Pain Management After Lumbar Fusion Surgery: a randomized controlled trial.

European Spine Journal. 2016 May;25(5):1614-9. doi: 10.1007/s00586-015-4216-3

 

In this study there are 80 participants that were divided into two groups. Both groups were thoroughly investigated to be sure that they met the inclusion criteria. Both groups had surgery for symptomatic lumbar stenosis of L4-5. They were then placed in subgroups where group 1 had multimodal pain medication including schedules celecoxib, extended release oxycontin, and pregabalin.  Group 2 only had IV morphine. Both groups had morphine PCA’s.

In this study they used scheduled pain medication for these patients. The results concluded that treating the patients pain preemptively was successful when compared to patient controlled analgesia for lumbar surgery.

 

 

Kumar, K., Kulkarni, D., Gurajala,I., and Gopinath, R., (2013). Pregabalin Versus Tramadol for Postoperative Pain Management in Patients Undergoing Lumbar Laminectomy: a randomized, double-blinded, placebo-controlled study, Journal of Pain Research 6: 471–478. doi:  10.2147/JPR.S43613

In this study there was a group of 75 patients. Each group of 25 had been given one of 2 pain medications and then the placebo. Drug one Tramadol caused the patient to use less “rescue pain” medication than group 2 the pregabalin group, and of course the placebo group required the most rescue doses of medication.

This is significant because finding the best combination of drugs will decrease the need for PCA and opiate use.

 

Maund, E., McDaid, C., Rice, S.,Wright, K., Jenkins, B.,  Woolacott,N., (2011). Paracetamol and selective and non-selective non-steroidal anti-inflammatory drugs for the reduction in morphine-related side-effects after major surgery: a systematic review. British Journal of Anaesthesia 2011; 106 (3): 292-297. doi: 10.1093/bja/aeq406 

 

Maund, E., McDaid, C., Rice, S.,Wright, K., Jenkins, B.,  Woolacott,N., (2011), performed a study to compare the effectiveness of NSAIDS, acetaminophen, and COX-2 inhibitors to control post operative pain. This study showed that the three non-opioids were effective in decreasing the use of the morphine PCA in the first 24 hours post surgery. Also in the study it showed that NSAIDS also decreased morphine related adverse effects. However none of the three drugs were proven to be better than the other.

This study gives me the impression that with these medications that there can be complete control of pain without PCA or opiates for relief.

 

 

Ultimately with these surgeries there is consistency of PCA use with that being said, non-opioids are paramount and NSAIDS have a bonus for their anti-inflammatory effects although they carry an increase risk for bleeding so the risks and benefits must be weighted.

 

Answer the following question usinf the resources provided.

Intervention or therapy- To determine which treatment leads to the best outcome

In adult patients post lumbar laminectomy (P)

how effective is PCA pain medication management (I)

compared to scheduled oral pain medication (C)

 

 

in controlling post op pain (O) during the recovery phase.

 

  1. Identify the implications to nursing practice and patient outcomes –

  2. Include with the poster a section describing the implications to nursing practice and patient outcomes.

    Evidence Based Research Poster Rubric 45 points

    Criteria

    Mastery (A = 45)

    Developing (B = 36)

    Limited (C = 33.75)

    Critical Thinking

    Poster shows evidence of application of skills of analysis, synthesis, and evaluation. Logic is nearly flawless.

    Poster shows inconsistent application of skills of analysis, synthesis, and evaluation. Logic may be flawed.

    Poster shows minimal application of skills of analysis, synthesis, and evaluation. Logic may be flawed.

    Focus

    Poster remains focused with every reference appropriate to topic of paper

    Poster remains focused with most references appropriate to topic of paper

    Poster without clear focus with some references appropriate to topic of paper.

    Quality of support

    Well-chosen textual support adequately examined and relevant.

    Acceptably chosen support with inconsistent relevance.

    Questionable support with few valid points, lacking relevance.

    Organization

    And Presentation

    Information is very organized with clear titles.

    Information is organized but the titles are missing or do not help the reader understand.

    Information is without organization.

    Mechanics and Style

    Poster is well written in scholarly style and follows all APA formatting

    Poster is acceptably written in scholarly style and follows most APA formatting

    Poster is poorly written with little scholarly style and/or is inconsistent in following of APA formatting.

     Peer Evaluation Template Preview the documentView in a new window

We give our students 100% satisfaction with their assignments, which is one of the most important reasons students prefer us to other helpers. Our professional group and planners have more than ten years of rich experience. The only reason is that we successfully helped over 100000 students with their assignments on our inception days. Our expert group has more than 2200 professionals in different topics, and that is not all; we get more than 300 jobs every day more than 90% of the assignment get the conversion for payment.

Place Order Now

2023 APA format MSN degree 2 pages long with 3 references 2 from walden university library Due Saturday March

2023 Nursing Need response to below discussion

APA format MSN degree 2 pages long with 3 references 2 from walden university library Due Saturday March 2023

APA format MSN degree 2 pages long with 3 references 2 from walden university library  Due Saturday March 23, 2018 6pm EST 

 

Neurological Disorders

            Neurological disorders affect people of all ages, every day, and everywhere in the world. Our senses stem from the neurological system, the ability to taste, smell, hear, see, and touch are the main five senses. When one of these senses is affected our body reacts to it, however there are other senses affected such as the vestibular system that tells our body where we are spatially in the universe and proprioception that helps us gage strength, and ability to do the things we do firmly, or gently. This paper will discuss migraine headaches, share how behaviors can influence the headache and affect medications for headaches, share drug treatments, measures that can decrease symptoms, and organizations available that can help give information to patients affected by the disorder.

Pathophysiology of Migraine Headaches

            Headaches are common disorders of the neurological system, but they can also signal underlying disease such as tumors, meningitis, or even brain bleeds per Huether and McCance (2017). They further share migraines can last four to 72 hours and a patient must have two documented episodes of criteria such as unilateral head pain, pain that worsens with activity, and the pain must be moderate to severe in nature. Patients must also have one of these criteria such as nausea, vomiting, photophobia, or phonophobia. Migraines can be with or without perceived auras that affect the visual, sensory, or motor pathways. (Huether and McCance, 2017) They further share the trigeminal vascular system is related to migraine pain, through the release of calcitonin gene-related peptide (CGRP), and that migraines have clinical phases such as a premonitory phase where the patient may be tired, irritable, or have a stiff neck. Migraine auras can accompany just before the migraine and can be visual,sensory, or motor. Headache phase such as throbbing pain, on one side but can spread to the whole head, cause fatigue, nausea, vomiting, dizziness and the recovery phase where the patient can experience continued fatigue, irritability or depression. Migraines are wose than general headaches or tension headaches in that the symptoms are worse, last longer, and prevent the patient from doing anything besides heading to a darkened, quiet, room. When migraines become chronic, they are quite debilitating and can require medications to treat them, next we will look at treatments for migraines.

Migraine Treatments

First line treatment in migraines is the salicylates and nonsteroidal anti-inflammatory (NSAIDs) for mild to moderate migraines, with triptan type medications as first line for moderate to severe migraines. (Arcangelo, Peterson, Wilbur, and Reinhold, 2017) They further share second line treatment as over the counter caffeine compounds such as Excedrin when the salicylates and NSAIDS have not worked. If the migraine is severe the recommendation is to add Ergot derivative medications along with an antiemetic if triptan medications are not effective. Finally, is the third line medication treatments when all the above fail Butalbital or other opioids are recommended. Selecting treatment and trying medications can take months to find a combination that works and it is important to let the patient know this and assess if the patient is trying alternative or complimentary medicine practices along with medical science in the treatment of migraines as their can be drug interactions. Most of the medications used in migraine treatment require assessment of the cardiac status prior to use, and are not recommended during pregnancy. Several are affected by CYP3A4 pathways and therefore should not be used with inhibitors in that drug pathway. If a patient fails one triptan type drug another is tried as different medications can work better for some patients than others, the Butalbital and opioids are only used when all else fails due to addictability and the need to taper dosing prior to stopping these types of medications.

Behaviors Affecting Migraines and Migraine Medications

Patient behaviors can have an effect on migraines, too much sleep, too little sleep, alcohol, foods such as chocolate, and tyramine agents like red wine, stress, medications like vasodilators, hormones. Pretty much it seems life in general can be a trigger for some such as lower socioeconomical status, caffeine, smoking, and even loud noises, strong odors, weather, skipping meals, obesity. (Arcangelo, Peterson, Wilbur, and Reinhold, 2017) Often times we get busy with life and forget to slow down and take care of ourselves properly, it seems life is focused on getting ahead, or trying to fit into society rather than the health components that make life more enjoyable, and overall less costly. If one takes care of ones self, there is less expense for medical care and medication in general. Having patients keep a journal of their headaches can lead to triggers that are specific to that patient and this can help head off migraines but also help with finding medications to use specific to that patients condition. Educating on smoking and alcohol cessation, or adjusting diet if known triggers are found can help decrease symptoms and episodes of migraines.

Organizations are available to offer advice and support for patients that suffer with migraines such as the United States Headache Consortium, the Migraines.org which discusses facts and myths of migraines. Coalition for headache and migraine patients or CHAMP is a foundation to discuss migraines, find a cure and support patients and families dealing with chronic migraines.

Summary

          While migraines are a disorder, and are neurologically related they can take time to diagnose, treat, and find triggers or behaviors that can affect the onset, duration, and occurrence of migraines. Working with patients to fully assess the type of headache, when it occurs, where it occurs, how long it lasts, how often it occurs, what worsens or alleviates it if anything, what kind of pain it brings such as stabbing, or throbbing, what medications or treaments they have already tried, and how it affects the patients life in that are they able to do anything when the migraine occurs. These are all questions as advanced practice nurses that will help guide diagnosis and treatment for migraine sufferers.

References

Arcangelo, V. P., Peterson, A. M., Wilbur, V. & Reinhold, J. A.  (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.

Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.

We give our students 100% satisfaction with their assignments, which is one of the most important reasons students prefer us to other helpers. Our professional group and planners have more than ten years of rich experience. The only reason is that we successfully helped over 100000 students with their assignments on our inception days. Our expert group has more than 2200 professionals in different topics, and that is not all; we get more than 300 jobs every day more than 90% of the assignment get the conversion for payment.

Place Order Now

2023 The influence of consequential ethics as an ethical framework the greatest good

2023 Nursing NUR-502 Topic 7 DQ 1

The influence of consequential ethics as an ethical framework the greatest good 2023

The influence of consequential ethics as an ethical framework (the greatest good for the greatest number) opposes the ethical principle of deontology (i.e., the rightness of an act itself determines what is right). Both of these affect the nursing profession. Modern social exchange theories are based on the principle of utility. Read the assumptions of social exchange theory and consider how these would affect the nurse-patient relationship, compared to how these impact the nurse within the health care environment. To what extent are all theories ethical? Is social exchange theory compatible with the values of the nursing profession?

We give our students 100% satisfaction with their assignments, which is one of the most important reasons students prefer us to other helpers. Our professional group and planners have more than ten years of rich experience. The only reason is that we successfully helped over 100000 students with their assignments on our inception days. Our expert group has more than 2200 professionals in different topics, and that is not all; we get more than 300 jobs every day more than 90% of the assignment get the conversion for payment.

Place Order Now

2023 Barriers to Healthcare for Women and Minorities Poverty and lack of education are two big barriers to healthcare for

2023 Nursing homework help w4A1

Barriers to Healthcare for Women and Minorities Poverty and lack of education are two big barriers to healthcare for 2023

 

Barriers to Healthcare for Women and Minorities

Poverty and lack of education are two big barriers to healthcare for  women and minorities. Low levels of education are associated with low  life expectancies and high mortality rates. People living in poverty  often lack education about when, why, and where to access healthcare.  There have been various legislative activities in the US to improve  public health.

On the basis of your understanding of the access to healthcare  facilities and impacts of barriers to healthcare access, answer the  following questions:

  • Explain at least three public health campaigns targeting access to  healthcare for women and/or minorities. Describe at least two aspects of  their advertising strategies that have addressed income and education.
  • Abortion has been the subject of numerous legislative activities in  the United States. How have various legislations affected low-income and  minority women?
  • Describe the legal battle over birth control devices in the United  States. Include how access to healthcare has been affected by the legal  decisions.
  • Describe the legal barriers to healthcare access for low-income immigrant minorities.
  • Review the articles, “Ethnic and gender disparities in needed  adolescent mental health care”, and “Overlooked and underserved:  Improving the health of men of color”. Explain what it means to be  “overlooked” by the healthcare system.
  • Discuss at least two examples that illustrate why minorities are  often overlooked in the healthcare system. Do you agree or disagree with  these reasons, why or why not?
  • Despite the fact that school-based psychological counseling is  available to all students, Thomas et al., report that ethnic disparities  in mental healthcare access and utilization still persist. Explain why  this disparity exists. What can be done to decrease mental health access  and utilization barriers for low-income and minority students?

What strategies does former U.S. Surgeon General, David Satcher,  M.D., discuss that will decrease the potential for minorities to be  overlooked by the healthcare system?

We give our students 100% satisfaction with their assignments, which is one of the most important reasons students prefer us to other helpers. Our professional group and planners have more than ten years of rich experience. The only reason is that we successfully helped over 100000 students with their assignments on our inception days. Our expert group has more than 2200 professionals in different topics, and that is not all; we get more than 300 jobs every day more than 90% of the assignment get the conversion for payment.

Place Order Now