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To Prepare:

• Develop a PICO(T) question to address the clinical issue of interest you identified for the “search database Assignment” This PICOT question will remain the same for the entire course.
• Use the key words from the PICO(T) question you developed and search at least four different databases in the Walden University Library. Identify at least four relevant systematic reviews or other filtered high-level evidence, which includes meta-analyses, critically-appraised topics (evidence syntheses), critically-appraised individual articles (article synopses). The evidence will not necessarily address all the elements of your PICO(T) question, so select the most important concepts to search and find the best evidence available.
• Reflect on the process of creating a PICO(T) question and searching for peer-reviewed research.

The Assignment (Evidence-Based Project)

Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews

Create a decorative 6- to 7-slide PowerPoint presentation in which you do the following:

• Identify and briefly describe your chosen clinical issue of interest.
• Describe how you developed a PICO(T) question focused on your chosen clinical issue of interest.
• Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected.
• Provide APA citations of the four relevant peer-reviewed articles at the systematic-reviews level related to your research question. If there are no systematic review level articles or meta-analysis on your topic, then use the highest level of evidence peer reviewed article.
• Describe the levels of evidence in each of the four peer-reviewed articles you selected, including an explanation of the strengths of using systematic reviews for clinical research. Be specific and provide examples.

Case Study #1 – Cardiac

 This case study is meant to be completed individually.  Please place questions and answers into a Word document and upload into the drop box when complete.  APA formatting is not necessary, but you must cite your work and avoid copy/pasting from any source…paraphrase!

Mr. Jones is a 52-year-old obese man with a medical history of gastric reflux and degenerative arthritis.  He arrives at the emergency department with his wife. They had been to dinner and a movie. During the movie Mr. Jones began experiencing excruciating chest pain that radiated to his jaw and left arm.  He appears short of breath and diaphoretic. He reaches the registration window when he suddenly collapses. The nurses place him on a stretcher. He has no pulse, and the monitor reveals ventricular tachycardia.  He was successfully converted to sinus rhythm after one minute of CPR and one defib/shock at 300 joules.

Mr. Jones regains consciousness after his rhythm converts.  He has a blood pressure of 130/92, a heart rate of 112, and a respiratory rate of 24.  O2 is immediately started at 3 liters/minute. Three 18 g IV’s are started, lab work is drawn (CPK-MB, Troponin, CBC, PT, PTT, type and screen & Chem 21) and a 12-lead EKG is preformed. He still complains of chest pain (8/10) and nausea. Sublingual NTG 1/150 gr is given.  The 12-lead EKG reveals sinus tachycardia, a PR interval of 0.24, and 3 mm ST-segment elevation in leads V2, V3, & V4. 

After being admitted to the CCU Mr. Jones complains of chest pain continuing at 8/10. Mr. Jones is given IV morphine 4mg and a nitroglycerin gtt.  This drip was started 10 mcg/min and titrated up every 3-5 minutes until the pain was relieved at 50 mcg/min.  His blood pressure drops to 84/40.  He is pale and diaphoretic.  He is prepared for a percutaneous coronary intervention (PCI) and taken to the cardiac cath lab.

Questions

1. What classic signs and symptoms did Mr. Jones experience which would indicate myocardial infarction (MI)? What are the specific pathophysiological reasons for each of these signs and symptoms?
2. What ECG changes indicate myocardial injury? According to the ECG, which coronary arteries were experiencing occlusion and subsequently what area of the heart was being affected? (List the type of change and the coronary artery most often associated with changes in V2, V3, and V4.
3. What are three things the nurse can do to speed up the time between admission and intervention? 
4. How is a heparin drip calculated and what is the nurses’ role in maintaining this medication?
5. If the blood pressure drops while the patient is receiving nitroglycerin, should the nitro be shut off completely?
6. Why is morphine the drug of choice for cardiac pain?
7. With this type of MI, an intra-aortic balloon pump may be inserted.  What are the two main functions of the IABP?
8. What are three differences between CKMB’s and Troponin blood tests?
9. After the angioplasty and stent placement, Mr. Jones is admitted to the CCU for monitoring.  What are the nursing considerations and assessment priorities for a patient with an arterial sheathe in place?
10. Once admitted to the CCU, what nursing diagnosis would be the top priority? (The diagnosis must include the “related to” and “as evidenced by”). 
11. After angioplasty, the patient begins experiencing frequent PVC’s.  What does this indicate and what should be done about it?
12. If the patient begins to experience chest pain post angioplasty, what is the first thing the nurse should do?
13. Patient teaching should consist of education about risk factors and lifestyle modifications.  What are three things the nurse could teach Mr. Jones about prior to discharge?
14. Mr. Jones is going to be discharged on Plavix, Lopressor, Zocor, and Aspirin.  List one teaching point for each of these medications.
15. Discuss the American Association of Critical Care Nurses (AACN) Synergy Model and how this concept would be important in this patient’s care.

 

Global Health infographic Assignment Guidelines and Rubric

 Purpose

• This assignment aims to enhance your understanding of key global health issues and competencies by creating an informative and visually appealing infographic.

Topic Selection

• Choose a Global Health Issue: Select a specific global health issue that aligns with the global health determinants. Ensure the issue is complex and multifaceted.

Research and Data Gathering

• In-Depth Research: Conduct comprehensive research on your chosen global health issue. Gather data, evidence-based information, and epidemiological trends from reputable sources.

Infographic Creation

• Organize your infographic into the following sections, aligning with the competencies:
  • Analyzing and Prioritizing Global Health Issues
    • Issue Highlight: Provide a concise title or introduction for your chosen global health issue.
    • Data and Trends: Present data, statistics, and trends related to the issue from diverse and credible sources.
    • Rationale: Explain why this issue is a significant health challenge in various populations and regions, considering social, economic, and environmental factors.
  • Evaluating Socioeconomic Impact
    • Visual Representation: Use graphics, charts, or diagrams to illustrate how socioeconomic factors influence health outcomes.
    • Relationship Visualization: Create visual elements that show the interplay between poverty, education, access to healthcare, and disease prevalence.
    • Brief Strategies: Offer brief insights or strategies to address health disparities related to socioeconomic factors.
  • Examining Ethical Implications
    • Ethical Context: Include a dedicated section highlighting the ethical dimensions of your chosen global health issue.
    • Specific Issues: Identify and visually represent specific ethical dilemmas or human rights violations associated with the issue.
    • Ethical Solutions: Suggest interventions or ethical approaches to protect vulnerable populations and ensure ethical healthcare practices.
  • Culturally Sensitive Health Promotion
    • Cultural Sensitivity: Emphasize the importance of cultural sensitivity in health promotion.
    • Cultural Impact: Provide examples or visuals depicting how cultural diversity impacts health outcomes.
    • Age-Appropriate Interventions: Suggest culturally sensitive interventions for different age groups, with a focus on preventive care.
  • Interprofessional Collaboration
    • Visualize Collaboration: Create visuals that represent the concept of interprofessional collaboration in the context of global health.
    • Communication and Coordination: Include elements that emphasize effective communication, coordination, and teamwork among diverse healthcare professionals and stakeholders.
    • Benefits of Diversity: Highlight the benefits of integrating diverse perspectives and expertise in addressing global health challenges.

APA Guidelines

• Title of the Infographic Assignment
• Your Name
• Institutional Affiliation
• Date
• In-Text Citations
  • If you use information or data from sources within your infographic, provide in-text citations. Use author-date format. For example: (Smith, 2022) or (World Health Organization, 2020).
• References List
  • If you refer to sources within your infographic, include a separate reference list. Format it according to APA style. Each source cited in your infographic should have a corresponding full citation in the reference list.
  • Use minimally 3 peer reviewed sources, written within the last 5 years.
• Fonts and Formatting
  • Ensure your infographic is legible by using a clear and consistent font style and size.
• Figures and Images
  • If your infographic includes figures, charts, or images from external sources, cite them in the figure caption, and include the full citation in your reference list.
• Submission Format
  • PowerPoint, PDF, PNG or JPEG

 

1. Week 5: Roll-Out (250 words)
   • Describe the process of rolling out this new company-wide quality initiative. Pay specific attention to the logistics and supply chain management functions. Include the following:
     • A communication plan
     • Recommended sequence of steps to get personnel trained
     • Stakeholders on board (e.g., the vendor base, trucking companies, warehouse personnel)