ATTN ***Essaywriter***ENG 315 -Assignment 2.2: Justification Report – Part 2

Assignment 2.2: Justification Report – Part 2
Due Week 5 and worth 150 points

In Part 1 of your Justification Report assignment, you built up the following sections: Problem Statement, Overview of Alternatives, Criteria, and Methods. In Part 2, you will revise Part 1 based on your instructor’s suggestions and add to it the following sections: Evaluation of Alternatives, Findings and Analysis, and References.

Use the basic outline below to draft your paper. Organize your responses to each question under the following section headings:

  • Evaluation of Alternatives (for Questions 1-3)
  • Findings and Analysis (for Questions 4-5)
  • References (for Question 6)

Write a two (2) page, single-spaced report in which you:

  1. Research the two (2) alternatives (i.e. possible solutions) that you’ve identified in your Part 1 Evaluation of Alternatives section. Record bibliographic information during research.
    1. Example: You might research other organizations that have attempted similar solutions to the problem you have identified and explore the results of those experiments. 
  2. Use what you discover in your research to evaluate each alternative by each of your five (5) criteria.
    1. Example: If your research revealed that four companies similar to yours increased productivity after allowing their workers to telework from home three days per week, you might conclude that one of your suggested alternatives – in this case, the option to telework from home three days per week – satisfies one of your criterion of “Productivity” as a high-potential solution to a problem you’ve identified (of decreased worker morale and productivity at Doe’s Electronics). However, additional research might frustrate a recommendation of this alternative if it is found to fall short of other criteria while a second alternative fares better. For instance, a telework alternative might be found to be too costly to implement; too frustrating for consumers who prefer daily, in-person customer service; or too divergent from the company’s brand, “Always there for you!”
  3. Organize the assignment by your criteria. Explain in narrative form how each of your two (2) alternatives stacks up against your first criterion. Next, explain how each alternative stacks up against your second criterion, etc.
    1. Example: An abbreviated outline of what this longer section might look like based on the above example is below (Note: Only the first two [2] of five [5] required criteria are included to give you a feel for the structure). Your researched findings, represented as circled bullets below, should be explained in two to five (2-5) sentences. Include in-text citations and follow up with References in APA style):

      Evaluation of Alternatives

      • Productivity
        • Alternative A: Telework from home 3 days per week
          • {narrate findings based on research article 1 here}
        • Alternative B: Offer two extra Floating Holidays to each employee per year
          • {narrate findings based on research article 2 here}
      • Cost
        • Alternative A: Telework from home 3 days per week
          • {narrate findings based on research article 1 here}
        • Alternative B: Offer two extra Floating Holidays to each employee per year
          • {narrate findings based on research article 2 here}
  4. Briefly summarize in narrative form the major discoveries that emerged from the Evaluation of Alternatives section.
  5. Include a chart like the ones below to illustrate at a glance:

    Figure 1: Alternatives Analyzed by Criteria

    Criteria

    Telework Option

    Floating Holiday Option

    Productivity

    Very high

    Negligible increase

    Cost

    Very high

    Moderate

    Company Image

    Increased

    Negligible increase

    Worker Morale

    Increased

    Negligible increase

    Practicality

    Moderate

    Low

    TOTAL Feasibility* of Alternatives based on Criteria?

    Moderate to High

    Low to Moderate

    *Feasability = Capability of an alternative being carried out with success

  6. Include an APA style (6th edition) References page that documents the two (2) sources (minimum) that you used and cited in-text in your Evaluation of Alternatives section.  Note that both resources may be secondary resources, or you may include one primary source and one secondary source. Remember that both in-text citations and References must be included (to avoid plagiarism) whenever you are directly quoting, summarizing, or paraphrasing researched material.

Your assignment must:

  • Be typed, single spaced, using Times New Roman font (size 12), with one-inch margins on all sides; citations and references must follow APA or school-specific format. Check with your professor for any additional instructions.
  • Include a cover page containing the title of the assignment, your name, the professor’s name, the course title, and the date. The cover page and the reference page are not included in the required assignment page length.

The specific course learning outcomes associated with this assignment are:

  • Support ideas or claims in body paragraphs with clear details, examples, and explanations.
  • Organize ideas logically by using transitional words, phrases, and sentences.
  • Use sentence variety and effective word choice in written communication.
  • Apply writing process strategies to develop formal business reports and / or proposals.
  • Use technology and information resources to research issues related to selected topics.
  • Write clearly and concisely using proper writing mechanics.

Consider the feedback from your professor and / or online tutor when making your revisions.

Click here to view the grading rubric.

 

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This week, complete the Aquifer case titled “Case #3: 65-year-old female with insomnia – Mrs. Gomez

Apply information from the Aquifer Case Study to answer the following discussion questions:

·  Discuss the Mrs. Gomez’s history that would be pertinent to her difficulty sleeping. Include chief complaint, HPI, Social, Family and Past medical history that would be important to know.

·  Describe the physical exam and diagnostic tools to be used for Mrs. Gomez. Are there any additional you would have liked to be included that were not?

·  Please list 3 differential diagnoses for Mrs. Gomez and explain why you chose them.  What was your final diagnosis and how did you make the determination?

·  What plan of care will Mrs. Gomez be given at this visit, include drug therapy and treatments; what is the patient education and follow-up?

You are doing an eight-week clerkship in a family medicine practice. Christina, the medical assistant, hands you the progress note for the next patient, which identifies the patient as Mrs. Gomez, “a 65-year-old woman who is here today reporting that she can’t sleep.”

Dr. Lee, your preceptor, fills you in: “Mrs. Gomez has been a patient here for several years. Difficulty sleeping is a new issue for her. Her past medical history is significant for hypertension and diabetes. Generally, she has been doing well, although I notice that her last hemoglobin A1c has climbed to 8.7%.”

Question

What are common causes of insomnia in the elderly?

SUBMIT

References

Yaremchuk K. Sleep disorders in the elderly. Clin Geriatr Med. 2018 34(2):205-216. doi: 10.1016/j.cger.2018.01.008.

CONTINUE

DIAGNOSES

FINDINGS

NOTES

BOOKMARKS

Common causes of insomnia in the elderly:

1.  Environmental problems

2.  Drugs/alcohol/caffeine

3.  Sleep apnea

4.  Parasomnias: restless leg syndrome/periodic leg movements/REM sleep behavior disorder

5.  Disturbances in the sleep-wake cycle

6.  Psychiatric disorders, primarily depression and anxiety

7.  Symptomatic cardiorespiratory disease (asthma/chronic obstructive pulmonary disease/congestive heart failure)

8.  Pain or pruritus

9.  Gastroesophageal reflux disease (GERD)

10. Hyperthyroidism

11. Advanced sleep phase syndrome (ASPS)

TEACHING POINT

Common Causes of Insomnia in the Elderly

Issues that may lead to an environment that is not conducive to sleep.

·  Specific examples include: noise or uncomfortable bedding.

·  You can teach the patient sleep hygiene techniques that will increase the likelihood of a restful night’s sleep.

Question the use of prescription, over-the-counter, alternative, and recreational drugs that might be affecting sleep.

  • Patients should be counseled to avoid caffeine and alcohol for four to six hours before bedtime.

Sleep apnea is common in the elderly, occurring in 20% to 70% of elderly patients.

  • Obstruction of breathing results in frequent arousal that the patient is typically not aware of; however, a bed partner or family member may report loud snoring or cessation of breathing during sleep.

In restless leg syndrome, the patient experiences an irresistible urge to move the legs, often accompanied by uncomfortable sensations.

In periodic leg movement and REM sleep behavior disorder, the patient experiences involuntary leg movements while falling asleep and during sleep respectively.

  • As in sleep apnea, the sleeper is often unaware of these behaviors and a bed partner or family member may need to be asked about these movements.

Disturbances in the sleep-wake cycle include jet lag and shift work.

Patients with depression and anxiety commonly present with insomnia.

  • Any patient presenting with insomnia should be screened for these disorders.

Patients with shortness of breath due to cardiorespiratory disorders often report that these symptoms keep them awake.

Pain or pruritus may keep patients awake at night.

Those with GERD may report heartburn, throat pain, or breathing problems.

  • These patients may also have trouble identifying what awakens them.
  • Detailed questioning may be needed to elicit the symptoms of this disorder.

Elderly patients with hyperthyroidism frequently do not present with typical symptoms such as tachycardia or weight loss, and laboratory studies may be required to detect this problem.

Circadian rhythms change, with older adults tending to get sleepy earlier in the night. In advanced sleep phase syndrome (ASPS), this has progressed to the point where the patient becomes drowsy at 6 to 7 p.m. If they go to sleep at this hour, they sleep a normal seven to eight hours, waking at 3 or 4 a.m. However, if they try to stay up later, their advanced sleep/wake rhythm still causes them to awaken at 3 or 4 a.m. This can be difficult to distiguish from insomnia.

SLEEP HYGIENE

TEACHING

Dr. Lee tells you, “Poor sleeping habits can also cause insomnia. Here is a handout on sleep hygiene. For some patients, simply correcting their sleep habits by following these tips will correct their quality of sleep.”

You review the handout.

TEACHING POINT

Good Sleep Hygiene

Your Personal Habits

·  Fix a bedtime and an awakening time. The body “gets used to” falling asleep at a certain time, but only if this is relatively fixed. Even if you are retired or not working, this is an essential component of good sleeping habits.

·  Avoid napping during the day. If you nap throughout the day, it is no wonder that you will not be able to sleep at night. The late afternoon for most people is a “sleepy time.” Many people will take a nap at that time. This is generally not a bad thing to do, provided you limit the nap to 30 to 45 minutes and can sleep well at night.

·  Avoid alcohol four to six hours before bedtime. Many people believe that alcohol helps them sleep. While alcohol has an immediate sleep-inducing effect, a few hours later as the alcohol levels in the blood start to fall, there is a stimulant or wake-up effect.

·  Avoid caffeine four to six hours before bedtime. This includes caffeinated beverages such as coffee, tea and many sodas, as well as chocolate, so be careful.

·  Avoid heavy, spicy, or sugary foods four to six hours before bedtime. These can affect your ability to stay asleep.

·  Exercise regularly, but not right before bed. Regular exercise, particularly in the afternoon, can help deepen sleep. Strenuous exercise within the two hours before bedtime, however, can decrease your ability to fall asleep.

Your Sleeping Environment

·  Use comfortable bedding. Uncomfortable bedding can prevent good sleep. Evaluate whether or not this is a source of your problem, and make appropriate changes.

·  Find a comfortable temperature setting for sleeping and keep the room well ventilated. If your bedroom is too cold or too hot, it can keep you awake. A cool (not cold) bedroom is often the most conducive to sleep.

·  Block out all distracting noise, and eliminate as much light as possible.

·  Reserve the bed for sleep and sex. Don’t use the bed as an office, workroom or recreation room. Let your body “know” that the bed is associated with sleeping.

Getting Ready For Bed

·  Try a light snack before bed. Warm milk and foods high in the amino acid tryptophan, such as bananas, may help you to sleep.

·  Practice relaxation techniques before bed. Relaxation techniques such as yoga, deep breathing and others may help relieve anxiety and reduce muscle tension.

·  Don’t take your worries to bed. Leave your worries about job, school, daily life, etc., behind when you go to bed. Some people find it useful to assign a “worry period” during the evening or late afternoon to deal with these issues.

·  Establish a pre-sleep ritual. Pre-sleep rituals, such as a warm bath or a few minutes of reading, can help you sleep.

·  Get into your favorite sleeping position. If you don’t fall asleep within 15 to 30 minutes, get up, go into another room, and read until sleepy.

Getting Up in the Middle of the Night

Most people wake up one or two times per night for various reasons. If you find that you get up in the middle of night and cannot get back to sleep within 15 to 20 minutes, then do not remain in the bed “trying hard” to sleep. Get out of bed. Leave the bedroom. Read, have a light snack, do some quiet activity, or take a bath. You will generally find that you can get back to sleep 20 minutes or so later. Do not perform challenging or engaging activity such as office work, housework, etc. Do not watch television.

A Word About Television

Many people fall asleep with the television on in their room. This is often a bad idea. Television is a very engaging medium that tends to keep people up. We generally recommend that the television not be in the bedroom. At the appropriate bedtime, the TV should be turned off and the patient should go to bed. This also applies to computers, tablets and smart phones. Some people find that the radio helps them go to sleep. Since radio is a less engaging medium than TV, this is probably a good

EACHING POINT

Treatments for Primary Insomnia in the Elderly

Of the behavioral treatments, many of which may be of some assistance in the elderly, only sleep restriction/sleep compression therapy and multi-component cognitive-behavioral therapy have met evidence-based criteria for efficacy.

Cognitive Behavioral Therapy for Insomnia (CBT-I)

CBT-I is recommended as the first choice for most patients with insomnia. CBT-I combines different behavioral treatments, resulting in improvements lasting up to two years. Recent guidelines recommend CBT-I as the first-line therapy for insomnia in adults. Examples include:

·  Sleep restriction therapy: The patient is told to reduce his or her sleep/in-bed time to the average number of hours the patient has actually been able to sleep over the last two weeks (as opposed to the number of hours spent in bed (awake plus asleep)). As sleep efficiency increases, time allowed in bed is increased gradually by…

MyPlate Diet Analysis

MyPlate

Profile Info

Personal: Sujin Park Female 22 yrs 5 ft 1 in 105 lb

Day(s): 2019 Sep 16, Sep 17, Sep 18 (All)

Activity Level: Low Active

BMI: 19.8

Weight Change: None

(Strive for an Active activity level.)

Normal is 18.5 to 25.

Best not to exceed 2 lbs per week.

The MyPlate Food Guide report displays graphically how close the foodlist compares to the lastest USDA Dietary Guidelines (see ChooseMyPlate.gov for more info).

Group Percent Amount

Dairy Intake 44 % 1.3

Dairy Recommendation 3.0

cup equivalent

cup equivalent

Protein Foods Intake 132 % 7.3

Protein Foods Recommendation 5.5

oz equivalent

oz equivalent

Vegetables Intake 69 % 1.7

Vegetables Recommendation 2.5

cup equivalent

cup equivalent

Fruits Intake 100 % 2.0

Fruits Recommendation 2.0

cup equivalent

cup equivalent

Grains Intake 50 % 3.0

Grains Recommendation 6.0

oz equivalent

oz equivalent

Comparison

2000 Calorie Pattern

Make Half Your Grains Whole Vary Your Vegetables

Oils & Empty Calories

Dark Green Vegetables

Orange Vegetables

Dry Beans & Peas

Starchy Vegetables

Other Vegetables

cups weekly3.0

cups weekly2.0

cups weekly3.0

cups weekly3.0

cups weekly6.5

Aim for at least 3.0 oz equivalents whole grains a day

Aim for 6.0 teaspoons of oils a day

Limit your extra fats & sugars to 267 Calories a

Intake vs. Recommendation

oz equivalent is a 1 ounce estimate, rounded to consumer friendly units. For example, an oz equivalent of Grains is 1 slice of bread, or 1/2 cup of rice. An oz equivalent of Protein Foods 1 oz of meat, 1 egg, or 1/4 cup cooked beans.

*

*

9/19/19 4:55 PM Page 2 of 2
Bar Graph Report The Bar Graph Report displays graphically the amount of the nutrient consumed and compares that to the dietary intake recommendations. Profile Info

Personal: Sujin Park Female 22 yrs 5 ft 1 in 105 lb

Day(s): 2019 Sep 16, Sep 17, Sep 18 (All)

Activity Level: Low Active

BMI: 19.8

Weight Change: None

(Strive for an Active activity level.)

Normal is 18.5 to 25.

Best not to exceed 2 lbs per week.

DRI GoalValueNutrient Percent 0 50 100 150

Basic Components Calories 1,541.78 1,961.11 79 %

Calories from Fat 587.99 549.11 107 %

Calories from SatFat 142.78 176.50 81 %

Protein (g) 63.51 38.10 * 167 %

Protein (% Calories) 16.48 7.77 * 212 %

Carbohydrates (g) 186.92 269.65 69 %

Carbohydrates (% Calories) 48.49 55.00 88 %

Total Sugars (g) 93.29 ^

Dietary Fiber (g) 13.72 27.46 50 %

Soluble Fiber (g) 0.94

InSoluble Fiber (g) 2.30

Fat (g) 65.33 61.01 107 %

Fat (% Calories) 38.14 28.00 136 %

Saturated Fat (g) 15.86 19.61 ~81 %

Trans Fat (g) 0.26

Mono Fat (g) 19.32 21.79 89 %

Poly Fat (g) 15.30 19.61 78 %

Cholesterol (mg) 180.39 300.00 ~60 %

Water (g) 683.38 2,700.00 25 %

Vitamins Vitamin A – RAE (mcg) 512.38 700.00 73 %

Vitamin B1 – Thiamin (mg) 1.32 1.10 120 %

Vitamin B2 – Riboflavin (mg) 1.39 1.10 126 %

Vitamin B3 – Niacin (mg) 17.44 14.00 125 %

Vitamin B6 (mg) 2.11 1.30 162 %

Vitamin B12 (mcg) 4.95 2.40 206 %

Vitamin C (mg) 162.41 75.00 217 %

Vitamin D – mcg (mcg) 4.96 15.00 33 %

Vitamin E – a-Toco (mg) 3.74 15.00 25 %

Folate (mcg) 252.10 400.00 63 %

Minerals

Calcium (mg) 527.47 1,000.00 53 %

Iron (mg) 14.25 18.00 79 %

Magnesium (mg) 134.35 310.00 43 %

Phosphorus (mg) 668.61 700.00 96 %

Potassium (mg) 1,774.01 4,700.00 38 %

Sodium (mg) 2,172.55 2,300.00 ~94 %

Zinc (mg) 3.74 8.00 47 %

Other Omega-3 (g) 1.07 +

Omega-6 (g) 14.17 +

Alcohol (g) 0.00

Caffeine (mg) 0.00

* Protein is not adjusted for endurance/strength athletes at an Active or Very Active activity level.

^ Total Sugars includes those naturally occuring in food and added sugars.

~ This value is a recommended consumption limit, not a goal.

+ There is no established recommendation for Omega-3 and Omega-6.

9/19/19 4:55 PM Page 2 of 2

 

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