Category: Solved Questions

Read the following articles found in the Learning Materials section of this course and watch the video noted below:

• An Analysis of US School Shootings (1840–2015) (Paradice, 2017)
• Development of the SaFETy Score: A Clinical Screening Tool for Predicting Future Firearm Violence Risk (Goldstick et al., 2017).

My Son was a Columbine Shooter. This is My Story.

My Son was a Columbine Shooter. This is My Story. Video Transcript

Consider the information in the learning module for Week 15 and the course. Answer three of the following questions in your initial post. (Please include at least three scholarly sources within your initial post.)

1. Has your community been directly affected by gun violence/mass shootings? Discuss the affects you have noted.
2. Discuss what you believe to be the greatest risk factor(s) in your community that could be associated with a potential for violence.
3. What are your thoughts about the Predictive Firearm Violence Risk Scale?
4. Will you use this scale in your practice? Why or why not?
5. What type of changes has your community made to help improve safety?
6. What are your thoughts about the Columbine shooter’s mother’s TED Talk?

Reply Posts

Consider the community risk factors your peers listed. Are they similar to your community? Did any of their risks surprise you? Why or why not? Reply to at least two of your classmates on two separate days (minimum) utilizing at least two scholarly references per peer post.

Please refer to the Grading Rubric for details on how this activity will be graded.

Instructions

Overview: After you have read Chapters 28, 32, and 33 in your De Chesnay text, consider the healthcare policies within your state. What health-related stories are in the news? Are there any “upstream” concerns in your community? How do you believe that a doctorally prepared APRN could positively affect the overall health of the citizens in your state?

Write a one-to two-page journal submission about your thoughts to the questions that have been posed. Provide references to validate the healthcare policy and your concerns.

You may journal in first person, and this assignment does not require references as it is your thoughts; however, if you choose to use quotes or citable material, you are expected to follow APA formatting.

Please refer to the Grading Rubric for details on how this activity will be graded.

Introduction

Throughout this course, we have looked at health promotion and disease prevention and focused on various vulnerable populations. This week’s discussion will focus on applying one guideline to two patients. Please select ONE of the following scenarios and then answer the questions in your initial post. Please include at least three scholarly sources within your initial post.

Scenario A: Focus on Preventative Guidelines for Childhood Immunizations

You are working as an APRN in your local primary care office. The rural town of Maynard has 300 people, a post office, doctor’s office, and a gas station. The primary source of income is farming or driving 45 minutes to a somewhat larger town. With the blizzard coming, all your patients except two have cancelled for the morning. Jose is scheduled at 0900; he is a nine-year-old Hispanic male born in Mexico. He and his family (Mom, Dad, and six siblings, ages six months to 14 years) moved into the area just a few months ago. Jose’s mother reported that he had nearly died at two months after contracting pertussis.

Your final patient of the morning is Irena, a 15-year-old teenage female who lives with her aunt in Maynard. Irena is Romanian and barely speaks any English. Her aunt has been your patient for the past few years, and she told you that Irena had been abducted in Romania at the age of 10. Irena’s parents found her quite by accident when a sex trafficking ring dumped all their “product” in a refugee camp in Serbia just a few months ago. Irena’s parents are still in Romania, but they sent Irena here to live with her aunt.

Scenario B: Focus on Preventative Guidelines for Colorectal Cancer Screening

On a busy Thursday morning, you note on your schedule a couple of patients who routinely “take a long time” no matter what their complaint. Jimmy is a 62-year-old male who is mentally challenged and lives in a local group home. Both his parents passed away last year, and his sister has never really been in the picture. She lives at least eight hours away. Jimmy has a “genetic disorder” but actually his symptoms are more like autism that we are familiar with today. Jimmy’s caregiver states he has been having some problems with constipation but otherwise he seems okay. Jimmy is nonverbal and hates to be touched. Approaching Jimmy can be difficult, and he has taken a swing at staff a couple of times because he doesn’t understand what is going on – especially if they try to touch him to check his pulse or blood pressure.

Having finished up with Jimmy, you move on to Marvin. Marvin is a 67-year-old male here for his annual physical. Marvin is pretty healthy despite a scare with colon cancer when he was 50. He is obsessed with his bowels and even brings charts to each of his appointments as he is always concerned that the cancer will return.

Scenario C: Focus on Preventative Guidelines for Breast Cancer Screening

Volunteering once a month for a mobile clinic, you head out this Saturday morning with two other providers and staff. The mobile RV is a large motorhome retrofitted as a primary care clinic. Headed downtown where there is a large homeless encampment, everyone is excited to see what the day brings.

Miss Eleanor is a 72-year-old African American female who you have seen many times. Today she is complaining of some breast tenderness due to a fall she took with her grocery cart a couple of weeks ago. While examining Eleanor’s breast, you took the opportunity to do a manual breast exam. Eleanor said it had been at least 30 years since she’d had a breast exam and that she had never had a mammogram.

Finishing up your day on the mobile clinic, Sally, a 48-year-old female, is concerned that she has an STI. During Sally’s pelvic exam, you learn that she has been living in a tent under a bridge downtown for about a year. Sally is eager to talk to someone and tells you that she used to work in a medical office as a receptionist but that was a long time ago, before she was diagnosed with bipolar disorder. You are concerned that Sally does have an STI and you ask about her medical history. After quite a story, Sally tells you she had a mammogram about two years ago before she left Texas and there was a place the doctor wanted to evaluate further but she never went back for the ultrasound.

Scenario D: Focus on Cervical Cancer Guidelines

Working near a naval base, you see a lot of patients who are somehow connected with the military. Today, Shelesha, a 21-year-old African American female, is requesting to be seen for her annual exam before she leaves for deployment. Shelesha seems really anxious today. She is usually so excited about being on board her ship, but today she is different. You complete her annual exam, but she refuses her cervical and breast exam. After leaving the room so she can get dressed, you return to find Shelesha crying. She finally tells you that she was attacked – sexually assaulted on board her ship six months ago – and she has these “bumps” that keep getting bigger around her vagina and she is worried.

Virginia arrives for her annual well-woman exam. Virginia is a 67-year-old female who has been married for 42 years. Virginia and Harrold are still sexually active with the use of medications, and like clockwork, Virginia comes every year for her pelvic exam requesting a Pap smear. Virginia had breast cancer with a mastectomy when she was 52, but otherwise she is healthy, only taking medication for her cholesterol.

Scenario E: Focus on Prostate Cancer Guidelines

Ivan is a 59-year-old Caucasian male in your office today for his annual exam. He has been reading about prostate cancer and the need to have some lab work done. His wife really wants him to get his PSA drawn, but he’s not so sure. Your physical exam of Ivan is “all normal.” When reviewing Ivan’s health assessment form, you see he smokes two packs of cigarettes a day and his only complaint is a chronic cough.

Chen is 76-year-old gentleman of Chinese descent. He is here today for an annual exam and a recheck of his blood pressure. Chen tells you he just heard from his brother that his PSA (Prostate Specific Antigen) is really high, and they are concerned he may have prostate cancer. Chen’s brother is from his father’s second marriage and he is only 59 years old. Chen is asking to have his PSA drawn to make sure he doesn’t have prostate cancer.

Initial Post

Having discussed many guidelines throughout this term, consider the content you have explored. Using this knowledge, answer the following questions related to your chosen scenario. Note: please try to choose a topic for your initial post that you did not choose previously during the semester or aren’t as familiar with so you can gain additional knowledge as we finish up this course

1. Discuss the guidelines assigned with your scenario.
2. Will both patients be treated in the same manner? Why or why not?
3. What would your treatment plan be for each of the individuals in your scenario?

Please include at least three scholarly sources within your initial post.

Reply Posts

Reply to at least two of your classmates who chose two different scenarios. For each of your peer’s posts, discuss other applicable preventative guidelines for one of the patients from the initial scenario. Provide a link to patient education relating to this additional guideline that your peer would find interesting and helpful. Reply on two separate days (minimum) utilizing at least two scholarly references per peer post.

Please refer to the Grading Rubric for details on how this activity will be graded.

Consider what you learned from the video, along with other content that has been discussed in this course. For your initial post, choose one of the three scenarios presented below and answer the following questions. (Please include at least three scholarly sources within your initial post):

Questions:

• As an APRN, how could you positively affect the health of the woman in the scenario you chose?
• What would be the pros and cons of utilizing the technique of Motivational Interviewing with the woman in the scenario.
• Trial the techniques you have read about over the previous few weeks related to Motivational Interviewing with a coworker, family or friend. What was this experience like? Do you see benefits to becoming more comfortable with this technique? Why or why not?

Note: As you are choosing a topic, please try to make sure that all topics are chosen at least by one person. You can see this by noting if anyone has posted to the topic within the corresponding threads

Scenarios:

1. A 34-year-old female who is 36 weeks pregnant – G2P1AB0 – presents to your office complaining of shortness of breath and ankle swelling. She states she has had “the flu” for several days and is insistent that this is why she can’t stop coughing. She is obviously short of breath when talking. In reviewing her chart, you can see she has a history of hypertension. She states she “”officially” stopped her blood pressure medications when she found out she was pregnant but admits that she rarely took her pills anyway, so “no big deal.”
2. Sumar has just found out she is pregnant and presents to the local free clinic. She is a 26-year-old G2P0AB1, and her first OB appointment is in two weeks. Sumar thinks she is about 12 to 14 weeks pregnant. She has come to the clinic complaining of indigestion. You notice the strong smell of cigarette smoke, and she admits she smokes one pack of cigarettes a day but states she is smoking less now since she started vaping.
3. You are seeing a 19-year-old female for STI screening. When reviewing her health and sexual history to determine her risk, she indicates she has had several new partners over the past six months and that she has not been using condoms but does have an IUD. She has started smoking marijuana and has dabbled with some other prescription medications over the previous two months. She is worried about having contracted an STI because she has noticed some “cauliflower” type bumps “down there” and would like to be tested.

Reply Posts

Reply to at least two of your classmates on two separate days (minimum) who chose the two other topics utilizing at least two scholarly references per peer post. What did you learn from your experience with Motivational Interviewing this week that could help your peer better address the preventive guidelines for the women in the scenario?

Please refer to the Grading Rubric for details on how this activity will be graded.

Overview

In reading your assigned textbook chapters and select articles, and reviewing the CDC website link on IPV found within the Learning Material section of this module, you will have looked at both ends of the spectrum—from disparity to privilege—and at triggers, which are not bound by any social class, leading to intimate partner violence. Consider the following:

1. Does trauma-informed care apply to IPV? Why or why not?
2. Review the maternal and infant mortality statistics within our country and your state. Do you note any disparity?
3. How can “privilege” become a beacon for change?
4. Intimate partner violence expresses a need for power and control by many methods. Would you recognize them all?
5. Is there a path that most violent individuals follow?

Reflect on the content presented and submit a one- to two-page journal (this does not include the title or reference pages) providing an example of how you have been witness to IPV, disparity, and or privilege and outline how you, as an APRN, can recognize and reduce violence and health disparity in women.

You may journal in first person, and this assignment does not require references as it is your thoughts; however, be sure to review the rubric, as a minimum of one reference is required to be considered exemplary work. If you choose to use quotes or citable material, you are expected to follow APA formatting.

Please refer to the Grading Rubric for details on how this activity will be graded.

Initial Post

This discussion will allow you to examine several different preventive guidelines related to women’s health. Please read the following three scenarios and choose ONE  for your initial post; be sure to address all the questions posed and include at least three scholarly sources within your initial post.

Note: As you are choosing a topic, please try to make sure that all topics are chosen at least by one person. You can see this by noting if anyone has posted to the topic within the corresponding threads.

Breast Cancer Screening

A 39-year-old female presents to your office for her annual well-woman exam. She reports that she has a maternal aunt and a cousin who have had breast cancer, so she does her self-breast exams every month. She would like to start getting mammograms, but her friends all say she doesn’t need to worry about a mammogram until she’s at least close to 50.

1. What are the mammogram recommendations from American College of Obstetrics and Gynecology (ACOG), American Cancer Society (ACS), and United States Preventive Services Task Force (USPSTF)?
2. What is meant by shared decision-making regarding screening for breast cancer?
3. What are the screening recommendations regarding self-breast exams and clinical breast exams?
4. Based on the scenario provided, what recommendations would you give this patient?
5. What factored into your decision-making?

Cervical Cancer Prevention/Screening

An 18-year-old is accompanied by her mother for her first visit to the gynecologist. She has never been sexually active. She has no concerns with her menses. Her mom reports that she brought her in “because she is 18 and when I turned 18, I had to get my first Pap smear.” Her mother requests the patient have a Pap smear and be tested for HPV “just in case.” The patient is up to date on all vaccines “mandatory for school” but has never had the HPV vaccine.

1. What are the recommendations on the HPV vaccine?
2. How would you counsel this patient about the HPV vaccine?
3. What are the current ASCCP guidelines for Pap smears and HPV testing?
4. How will you explain the rationale to the patient and the mother?

STI Prevention and Screening

A 52-year-old female presents to your clinic concerned that she may have contracted a sexually transmitted infection (STI). She states she is recently divorced and admits she never had to practice “safe sex” before and that she has been with several people over the last few months. She has been drinking “way too much” and feels she should just be tested for everything as she has been experimenting.

1. What type of questions would you want to ask to begin to focus your plan? How will her risk factors affect your screening?
2. There are several preventive guidelines related to STI risk and screening. What do the current guidelines indicate she should be screened for?
3. What recommendations should you make regarding “safe sex” practices?
4. Are there any other preventive guidelines you should address with this patient?

Reply Posts

Review the presentations of two other peers who chose two different topics. Discuss how health disparities in women could affect their care (for example, geographic location, race, finances, literacy, etc.). Use the UpToDate database  as one of your required references and a second scholarly reference of your choice; remember you should have at least two references for each peer post.

Please refer to the Grading Rubric for details on how this activity will be graded.

Grading Category: Assignments

For this week, you are responsible for completing the following immunization modules from the CDC*.

• WB4265: Immunization:  You Call the Shots-Module Sixteen-Vaccines for Children Program—2020
• WB2660: Immunization:  You Call the Shots-Module Two-DTaP/DT; 2016
• WB4202: Immunization:  You Call the Shots-Module Four-Hemophilus influenza type b (Hib) 2019
• WB4096: Immunization:  You Call the Shots-Module Seven-MMR-2019
• WB2147: Immunization:  You Call the Shots-Module Fourteen-Rotavirus
• WB2709: Immunization:  You Call the Shots-Module Thirteen-Varicella

*As the CDC updates its links frequently, if you are having trouble accessing any of the modules’ direct links, please utilize the CDC You Call The Shots website as an option to locate the appropriate modules.

Upon your completion of these modules, please upload your completion certificates to receive credit for the assignment in the assignment section in Week 11.

All five modules must be completed. Each module represents 20 percent of your score to equal 100 percent.

To receive your certificates of completion, you will need to register for a FREE account. See the instructions below to complete this step

1. Go to Training and Continuing Education Online (TCEO) and register for an account.
2. Then, follow the steps listed  on the 9 Simple Steps to Get Your Continuing Education (CE) page.

To Submit Your Assignment:

1. Select the Add Submissions button.
2. Drag or upload your file to the File Picker.
3. Select Save Changes .

Instructions

This week you are to submit your certificates of completion of the following immunization modules from the CDC. These modules were introduced during Week 9 and are due by the end of Week 11 Day 7.

• You Call the Shots: General Best Practice Guidelines for Immunization
• Human Papillomavirus
• Pneumococcal
• Zoster
• Hepatitis B

*As the CDC updates their links frequently, if you are having trouble accessing any of the module direct links, please utilize the CDC You Call The Shots website as an option to locate the appropriate modules.

Upon your completion of these modules, please upload your completion certificates to receive credit for the assignment in the assignment section in Week 11.

All five modules must be completed. Each module represents 20 percent of your score to equal 100 percent%.

To receive your certificates of completion, you will need to register for a FREE account. See the instructions below to complete this step

1. Go to Training and Continuing Education Online (TCEO): Create Account and register for an account.
2. Then, follow the steps listed here: Training and Continuing Education Online (TCEO): 9 Simple Steps to Get Your Continuing Education (CE).

To Submit Your Assignment:

1. Select the Add Submissions button.
2. Drag or upload your file to the File Picker.
3. Select Save Changes .

Initial Post

This discussion will allow you to examine several different preventive guidelines related to vaccinations. Please read the following four scenarios and choose ONE for your initial post; be sure to address all the questions posed by the scenario and include at least three scholarly sources within your initial post.

Note: As you are choosing a topic, please try to make sure that all topics are chosen at least by one person. You can see this by noting if anyone has posted to the topic within the corresponding threads

Immunizations

1. Patient #1: Two five-year-old girls are on your schedule for a kindergarten physical. The foster parent of one of the children indicates she received all her immunization from birth to one year of age, but after that the child has not had any further vaccines. The second child appears to have been vaccinated per the CDC schedule.
   • Is there a difference in the immunization plan you will initiate today for these two patients? Why or why not?
   • What immunizations will you be ordering for each of these two patients today?
2. Patient #2: Today you have two patients on your schedule for the HPV vaccine. One is a 27-year-old female. In taking her health history, you find that she is sexually active and that she had a splenectomy when she was 17. The second patient is an eleven-year-old female whose mother is concerned and wants to discuss the vaccine further before consenting. She feels that by giving the child the vaccine she is giving her permission to be sexually active.
   • What type of immunizations will you recommend and why for each of these patients?
   • What type of counseling will you provide in each of these scenarios related to their immunization needs?
3. Patient #3: The following two patients present for their yearly physicals before going to spend the holidays with their grandchildren, who are two months, 18 months, and seven years of age. The 72-year-old male states he “doesn’t want a flu shot” because he’s afraid he will just get sick like his neighbor who got her shot last week; however, his 67-year-old wife (who you are also seeing for a follow-up related to shingles she had a month ago) states, “I want the flu vaccine, but I don’t need the shingles vaccine now since I’ve already had it.”
   • How will you counsel these individuals? Are there risks related to the children from either party?
   • What adult immunization should be recommended for these patients?
   • Should you discuss COVID vaccines? Why or why not?
4. Patient #4: Your final patient of the day is a three-month-old baby. The nurse states that the mom is refusing vaccinations today even though the baby’s records show she is up to date on her immunizations. Mom explains that she feels like her baby is getting “too many” shots and since everyone else is being vaccinated, they can skip a few of the vaccines and her baby will be just fine.
   • What is herd immunity and how can this help protect individuals who are not vaccinated? What are the rates for your state related to immunizations, and how could this affect herd immunity?
   • What immunizations should this patient receive today, and is there any leeway in the schedule to help alleviate some of the mom’s concerns?

Reply Post

Reply to two of your peers who chose two different topics. Provide your own examples of situations in which you have had to discuss immunizations/vaccines. What suggestions might you provide your peers in terms of dealing with misinformation related to this topic? Replies to your peers must be on two separate days (minimum) and must utilize at least two scholarly references per peer post.

Please refer to the Grading Rubric for details on how this activity will be graded.

Overview

During this assignment, you will be asked to discuss the concepts of health promotion and disease prevention, relating this information to the role of the APRN and applying it to the vulnerable population you selected during Week 1. In Week 6, you submitted a rough draft of your paper and received feedback from faculty, so please make sure you incorporate those comments along with direction you received from SmartThinking, Pearson Writing Center, and the Library.

Health Promotion and Disease Prevention Population-Specific Paper

This paper was to be developed throughout the first six to nine weeks of the course, with an opportunity to submit a rough draft for feedback during Week 6 and your final submission due this week, in Week 10. The goal of this assignment is twofold: 1) for you to demonstrate an understanding of the key concepts of health promotion and disease prevention as related to the role of the APRN while applying this information to a specific vulnerable population; and 2) for you to have an opportunity to develop your writing and APA formatting skills through faculty feedback and the utilization of various tools here at Regis (that is, Regis Library and staff, SmartThinking, Pearson Writing Center, etc.).

The faculty at Regis want you to be successful. Being able to present not only your thoughts but evidence-based practice information in a concise, systematic, and clear manner will be a talent that serves you well.

Note:  You must submit a SmartThinking report from Week 9 or 10 with your paper.  The suggested APA / grammatical corrections must be made along with the faculty-suggested corrections from Week 6.  If this is not done, you will automatically receive a zero.  Do not wait to submit your work to SmartThinking, as they will be backed up, so submit early (that is, the end of Week 8/first part of Week 9).

This entire paper is about your vulnerable population, so each topic listed in the paper needs to be related to your chosen population; from the introduction to the conclusion, it is about your chosen group.

The paper is to be five to eight pages in length, not including the title page, attachments, and reference pages. Note: Points will be deducted for going over the max of 8 pages (5 points for each page).

The paper will be divided into four sections.

1. Section 1 (Content can be found in Week 1)
   1. Introduction
      1. WHO’s definition of health
      2. Applying the WHO’s definition of health to your vulnerable population.
      3. The concept of vulnerable individuals and populations, in general and then related to your specific group.
   2. Historical Perspectives of Health
   3. Levels of Prevention – overview, brief
      1. Primordial
      2. Primary
      3. Secondary
      4. Tertiary
      5. Quaternary
   4. The role of nursing, specifically APRNs, in health promotion and disease prevention, and advocacy
2. Section 2 (Content can be found in Week 2 and 3)
   1. Health disparities related to your vulnerable group
   2. Cultural competency as a provider
   3. Defining resilience and applying to the vulnerable, specifically to your group
3. Section 3 (Content can be found in Week 2 through 4. Don’t forget to use the media/website/video links, as they will provide a lot of great information). Focus on your specific vulnerable population group
   1.  Using Mechanic and Tanner’s 2005 article, is your vulnerable population a sinner or a victim and why?
   2. Social justice related to your population
   3. Low literacy within your population and how this affects their health
   4. Evaluate your vulnerable population related to current Healthy People Initiative guidelines – what specifically relates to your group (Connect D and E)
   5. Discuss one primary health concern for your population and include the preventive guideline related to this concern and how you might motivate this group to make behavioral changes.
   6. Discuss use of Community Based Participatory Research (CBPR) with your vulnerable population – pros and cons. How can community-level plans/interventions influence individual and family health?
   7. Discuss what resources are available within your community for your specific population.
4. Section 4
   1. The conclusion of your paper should bring all your information together.
   2. Discuss an approach for improving health literacy within your population
   3. Discuss how, as an APRN, you can impact vulnerable individuals in your community.
   4. Conclude with a summary of how we as a nation are doing with health promotion and disease prevention.

Note: This assignment is to be submitted in an APA paper format (that is, title page, title, introduction and purpose statement, body of the paper with a conclusion, appropriate citations, and reference page(s) along with attachments) as was your SmartThinking Report. Please make sure that ALL paragraphs are well developed, and have five to six sentences each, with citations for validity.

Please refer to the Grading Rubric for details on how the final submission of paper will be graded.

Please submit your Final Paper and a NEW SmartThinking Report.

Note: Failing to submit a NEW SmartThinking Report will result in a ZERO for this assignment.

To Submit Your Assignment:

1. Select the Add Submissions button.
2. Drag or upload your file to the File Picker.
3. Select Save Changes .