What is polypharmacy?

Polypharmacy In The Elderly

APA format
4-5 pages, including references
no plagiarism
Must answer the following questions (not necessarily in that order)
– What is polypharmacy?
– What risks does polypharmacy bring to older adults
– What concerns do medical professionals (nurses in particular) have with polypharmacy in elderly patients?
– Problems caused by polypharmacy
– Possible solutions for problems caused by polypharmacy
– As a nurse, what tips can be given to elderly patient to monitor polypharmacy.
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effect of rapid population growth in the suburbs on local environments

Ecological Footprint Assignment

Our ecological footprint is a way to measure the impact humans have on the natural environment. Every day, millions of Canadians drive their vehicles to work, school, or entertainment venues, which creates greenhouse gases and consumes non-renewable resources. These behaviours, and many other consumption habits, all contribute to our ecological footprint. Many experts believe that we are consuming more resources each year than the Earth can produce.
The topic of the paper is about the effect of rapid population growth in the suburbs on local environments. Your task is to explore the relationships that exist between population growth, personal consumption, technological development, and our ecological footprint and write an opinion paper based on your findings.
Below are a couple of links to sites that may help you in organizing your opinion paper. If you have any questions, please contact me. The paper should be about 3-4 pages excluding the title page and references page. All citations should be embedded and in APA format.
All information and relevant data are to be included in a logically sequenced manner.  In your writing, it is important to use appropriate writing style, tone, and scientific terminology.  Conduct your research using reliable, peer-reviewed and industry sources and ensure that sources listed in your reference list are directly related to information presented in your paper.  Use the appropriate referencing style for science to cite your sources.

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asthma and air pollution in California

Environmental Health

Topic research, asthma and air pollution in California
my part is only about methodology (like causes and more) of asthma and air pollution, 2 pages long and must be in APA format, including in-text citations and reference list, excluding title page and abstract (general orientation on APA format.
 
PAGE ONE: Title page will have title, name, and NU affiliation. (2 points)

  • PAGE      TWO: Abstract and Key Words will      provide an overview of what you determined within your paper within      200-250 words, and have 5-7 keywords at the end of the abstract (10      points)
  • PAGE      THREE TO SIX: 
    • Introduction to the topic of choice (one to two       paragraphs). (12 points)
    • Methods and Discussion section including the       methods you used for your literature view and all applicable research       information. (30 points)
    • Conclusion- summary of ove
    • rall research, quality, and potential recommendations you       would (or would not) make regarding your environmental health topic. (10       points)
  • PAGE      SEVEN: Reference page (include at least 10 references primarily      from peer-reviewed journals). (15 points)
  • Quality of work: APA formatting, grammar,      structure, effort, overall professionalism of paper. (15 points)

· Submission of Journal References in PDFs: All pdf journal references must be uploaded in electronic version and contain the following name format to receive
 
base on the PowerPoints that is attached, Grading Rubric:
 
full points:
Group_#_Topic_LastNameAuthor_Year
Grading Rubric:

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Epigenetics Reaction Paper

Epigenetics Reaction Paper

You will be writing a 1,000 word Reaction Paper in this course using the instructions and links found below. You will be completing the following tasks and gathering the following information for your paper:

  1. Watch the epigenetics video from PBS. Begin your paper by defining epigenetics in your own words and discussing your reaction to the video. (Here’s an additional link if the first link is not working – https://www.dailymotion.com/video/x1luqdj)
  2. Interview your family members and complete the Family History-Dr. Oz.pdf.  Find out which disease(s) you are most at risk for.
  3. Research and locate one article on epigenetics and whatever disease you are most at risk for (select a study on research conducted on humans) from a reputable academic source:

Reputable Sources:

  • journal articles
  • government publications based on research

Do not use:

  • magazines of any sort, whether they are on paper or online
  • Websites of any type, including epigenetics websites
  • Wikipedia

How to Perform Your Research

  • Use the College Library in person or online (log in with your new MDC ID number (the one that is all numbers). Your password is the last four digits of that same MDC ID unless you have changed it.

Read the epigenetics article you find. Continue your paper with a discussion of the epigenetics article. Be sure to paraphrase (put things in your own words) and be sure to cite the author(s) of the article you find using APA style (see the section below on using APA style). Aim for about a page for this part of your paper.

  1. Discuss the concept of epigenesis in light of your family history and the article you read. Aim for one page for this section of your paper.
  2. Complete the Living to 100 Questionnaires. Integrate your findings on the questionnaire into your discussion. Aim for another page.
  3. Discuss how you can improve your health and longevity in light of your findings in this questionnaire, your understanding of epigenetics, and your knowledge of your family history. This should be your final page.

You can go over or under a page for any of the sections of the paper as long as your total paper is 1,000 words not counting the references.
General Rules for an “A” Paper (check your paper against this list)
◻    1,000 words
◻    Original work; plagiarism free!!
◻    Double-spaced, 12-point font, 1-inch margins
◻    Covers all 6 tasks
◻    Spellchecked
◻    College-level grammar
◻    Cite your article APA style (author & year within body of paper; full reference at end)
◻    No abstract, no cover
◻    Place your name and reference number on the first page. Use page numbers.

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Conducting an Environmental Analysis

THE PURPOSE OF THIS DETERMINE YOUR ORGANIZATIONS ABILITY TO CONTINUE TO PROVIDE QUALITY CARE AND REMAIN FINANCIALLY SOLVENT IN THE FACE OF THESE CHALLENGES.

 NO COMMENTS
Assignment 1: Conducting an Environmental
Analysis
Due Week 4 and worth 300 points
For all assignments assume that you are the administrator of a
fictitious organization of your choice. The organization can be any type
of health care organization such as a hospital, nursing home, rehabilitation
center, clinic, etc. As the administrator, you are faced with the challenges of
declining reimbursements from insurance providers and increasing demands for
patient services due to dramatic changes in the external environment. Such
changes include those imposed by the Patient Protection and Affordable Care
Act.
Your first step in evaluating the position of your organization
will be conducting an environmental analysis. The purpose of this is to
determine your organizations ability to continue to provide quality care and
remain financially solvent in the face of these challenges.
Write a six to eight (6-8) page paper in which you:
1.
Determine two (2) specific
forces in the external environment that will have the most impact on your
organization. Provide a rationale for your decision.
2.
Determine two (2) specific
internal factors that the organizations leaders need to consider in preparing
for the future of health care and the future of the organization. Provide a
rationale for your decision.
3.
Discuss the impact of both the
identified internal and external forces on the organizations ability to
develop a competitive strategy.
4.
Recommend one (1) strategy that
involves the organizations managers in implementing and maintaining the
momentum of the strategic plan.
5.
Use at least three (3) quality
academic resources in this assignment.Note: Wikipedia and other
Websites to not qualify as academic resources.
Your assignment must follow these formatting requirements:
Be typed, double 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, the students name, the professors 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:
Differentiate between strategic
management, strategic thinking, strategic planning, and managing strategic
momentum.
Analyze the significance of the
external environments impact on health care organizations.
Examine the purpose and
importance of service area competitor analysis.
Examine the role of internal
environmental analysis in identifying the basis for sustained competitive
advantage.
Use technology and information resources
to research issues in the strategic management of health care organizations.
Write clearly and concisely
about strategic management of health care organizations using proper writing
mechanics.
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Article Critique-Public Health Disparities/Questions

Article Critique-Public Health Disparities/Questions
Details
Points: 100
Complete the “Article Critique.”
use this article found in The New York Times: https://drc.bmj.com/content/6/1/e000496
APA format is not required, but solid academic writing is expected.
You are not required to submit this assignment to Turnitin.
4HLT515.v1ArticleCritique.doc
                                             Article Critique
Directions: For this assignment, you will select and critique one article from a popular media source (e.g., newspaper, magazine, news journal, etc.) that provides information regarding a health disparity within a population group and complete the questions below. Please make sure to use complete sentences when answering each question. Make sure the health disparity is different from your research assignment. In addition, the article must have been published within the last 2 years.
1) Provide the article reference and link. (1point)
2) What health disparity is the article highlighting? (1point)
3) Why is this information newsworthy? How would it benefit the public health community? (3 points)
4) What causes and factors contributed to the health disparity? (2 points)
5) How does the health disparity affect health outcomes? (3 points)
6) Does the article make any recommendations or suggest resources that could benefit the public? If not, what suggestions or recommendations would you suggest? (2 points)
7) Was the article well-written? Justify your rationale? (3 points)
8) Did it include all pertinent information? Justify your rationale? (2 points)
9) Was there information or a perspective that the article should have included? If so, what? What else would you have like to have seen? (3 points)
Score calculation: Total earned  / 20 x 10 =

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what are the three most important power sources for a nurse leader?

Nursing Leadership
Part 1
In your opinion, what are the three most important power sources for a nurse leader? Why?
The three most important power sources for nurses in my personal opinion are the following:
Expert power refers to such power that can influence others by using knowledge and skills. Experience knowledge and skills together make an expert power that is possessed by nurse leader and transferred to other nurses during practice of nursing. (The Sentinel Watch, 2010).  For a nurse leader to have the respect of those around him or her, I believe that first and foremost they must have the confidence that their leader knows what they are doing.  If the leader isn’t capable of doing the job, how can they be capable of supervising or evaluating my performance?
Coercive power refers to authority of a nurse leader i.e. nurse leader can impose penalties or punish other nurses by taking their privileges if they are not doing a good job. If nurses are not doing satisfactory job, nurse leader ensures that every nurse is doing a good job and ensuring patient’s satisfaction. The truth is that the underlying fear of retribution for poor performance comes into play at some point for most employees.
Reward power depends on the ability of the person who holds power to confer valued material rewards.The reward source of power depends on the ability of one person to grant another some type of reward for specific behaviors or changes in behavior. Nurses, in their daily provision of care, can use this source of power to influence client behavior as well as others employees.
So I think that these power sources are most important in nurse leader as these powers influence directly to nurses and help them to get educated punctual and skillful at the same time.
How are they best used in a leadership role? Describe
Power sources are best used in leadership role as these powers are true essence of the leadership. Nurse leader empowered by skills and expertise will be a good mentor and a working role-model for the junior staff nurses. Her/his authorities to keep a strict check on them give them a sense of responsibility. On one hand, reward for doing great job gives them a challenging, encouraging and motivating working environment; meanwhile, a threat to punish can bring best out of them.  A nurse leader makes best use of her power sources by supervising and managing the duties of nurses to satisfy patient’s demands. (Yapton, 1998)
What sources of power do you see most often displayed in your work environment? Why?
Part 2
You brought up a good point about coercive power. In health care coercive power is used to maintain standards. Many nurses think that this type of power is negative, but this is not always the case. Several times we must protect other staff and our patients from dangerous situations or incompetent care. The human resource roles are used to uphold many standards for employees, and coercive power is used to sustain them (Stapleton, 2017). The leader must be careful how they use this power, but using it is not a negative situation unless it is done in a ruthless and unfair way. It is a leadership skill to know how to use all the types of power they possess. Have you had a situation where another employee was suspended or fired after an incident? Do you think the use of coercive power was fair in this situation?

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Nutrition

Nutrition
1. Have you ever encountered a situation in which you experienced (or had another person experience) a drug (OTC or prescription), herbal, or supplement-nutrient interaction? If so, explain what it was. If you have not, research a common interaction and explain it. Your explanation should include what drugs, herbs, or supplements and nutrient(s) are involved as well as the possible result of the interaction. Note that you are not to report on the side effects of a drug, herb or supplement, but rather how these might interact with a nutrient (in foods or in supplemental form) and result in a negative effect.
2. When you looked for information on the interaction where did you look? How were your questions or concerns addressed?
3. Where, in your experience, does the public turn to for information on drugs, herbs, or supplements? Are these sources usually reputable? How would you determine if a source, whether a person or an article or other, is reputable?
4. Do you think healthcare professionals have met the challenge of helping people find suitable nutritional supplements? Why or why not? How might socioeconomic status come into play when choosing between or within prescription medications or OTC medications/supplements/herbs? If someone needed to determine if nutrient status was being compromised because of an interaction, what tests could be done?
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Change project: patients with type 2 diabetes, lifestyle modification essay

Change project: patients with type 2 diabetes, lifestyle modification essay
Change project: In South Florida patients with type 2 diabetes, does lifestyle modification such as diet and physical activity help lower HBA1C compared to
those who do not make life style changes.
Write a literature review of your change project topic using peer-reviewed articles, books, and evidence-based guidelines. Identify and cite all sources of data according to APA guidelines. The goal is to review and critique the most current research to support your change project; this research will help drive the focus of your research.Summarize the key findings and provide a transition to the methods, intervention, or clinical protocol section of your final paper. Describe any gaps in knowledge that you found and the effects this may have on nursing practice as it relates to your change project topic. The literature review should be a synthesis of how each article relates to your change project. Also, when writing your literature review, remember to include subtopics to your main topic and gather data on these areas as well. For example, if you are doing a project on cancer, then subtopics for cancer treatments should be included.
A minimum of 10 Peer-reviewed articles
Literature is supported by scientific evidence that is credible and timely. Subtopics
are used to support the main topic.
Presents a thorough and insightful analysis of significant findings related to the change project topic. Ideas are synthesized and professionally sound and creative. Insightful and comprehensive conclusions and solutions are present
Your integrative literature review should be at least 6 pages. Change project: patients with type 2 diabetes, lifestyle modification essay

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List and describe the physiological effects, complications and weaning procedure of PEEP

Learning Objectives Covered
1. List and describe the physiological effects, complications and weaning procedure of PEEP
2. Describe techniques such as: weaning approaches, oxygenation titration, closed-loop control, and evidence-based weaning
3. Explain assessment techniques used to determine successful ventilator discontinuance
Background
In week one we discussed extrapulmonary effects of mechanical ventilation. Equally important however is understanding the pulmonary effects, the actual impacts of positive pressure ventilation on the lungs and other respiratory structures.
Competent respiratory therapists know how to ventilate patients in a way that achieves appropriate oxygenation levels and appropriate carbon dioxide levels, but in a way that also minimizes adverse effects on the pulmonary system. The concepts of barotrauma and volutrauma are especially important. The NBRC is very interested in assessing your knowledge in this area. The national board wants to credential therapists who know how to protect patient’s lungs while effectively ventilating them. Another key topic this week involves weaning your patient from the mechanical ventilator. No patient wants to stay on a ventilator for life. We want to “liberate” the patient from the ventilator as soon as feasible, but it is so important to do that safely. We need to make sure that the problem that put the patient on the ventilator has been corrected, and we need to make certain that key parameters have reached safe levels before we give the patient a “spontaneous breathing trial” away from the ventilator. You will learn this week about essential monitoring to make sure that the patient is succeeding with that spontaneous breathing trial. Let us now take a closer look at weaning.
Weaning from Mechanical Ventilation
Ventilator management should be aimed at getting the patient off ventilator support as quickly and safely as possible after stabilization. Weaning (also known today as liberation) should be considered as soon as the underlying disease process that led to mechanical ventilation is under control. For example, if the patient was intubated and ventilated due to pulmonary edema, then weaning can commence as soon as the excess pulmonary fluid has been removed and the patient’s gas exchange improves. This will also be evident on chest x-ray as the disappearance of the butterfly fluid pattern. If the patient was ventilated due to pneumonia, clearing of the chest x-ray infiltrates and improvement of sputum clearance would indicate that we could begin the weaning process.
Definitions Relating to Weaning from Mechanical Ventilation
First, sharing a few definitions to help us classify weaning:
·  Simple weaning: the ventilator is discontinued after the first weaning assessment
·  Difficult weaning: the ventilator is discontinued within one week after the first weaning assessment
·  Prolonged weaning: the ventilator is discontinued more than one week after the first weaning assessment
·  Weaning failure: this is failure to pass a spontaneous breathing trial (SBT) or the need for reintubation within 48 hours following extubation
Avoiding Reintubation 
Obviously, we do not want to extubate our patient and then have to reintubate them. So predicting weaning success is very important for reducing the rate of reintubation. Careful attention to the criteria for weaning, and optimal patient management to increase weaning success can both help to avoid reintubation. Reintubation is a very bad prognosticator for the patient, but smart RRT’s can keep reintubation rates very low. Consider the following:
· Reintubation is associated with a 7-10 fold increase in hospital mortality
· Reintubation rates of 10 to 15% are typical for most well run Respiratory Therapy weaning programs
· A reintubation rate of 0% is not realistic, and it would mean that we are not being aggressive enough with our weaning efforts
Criteria to Begin Weaning
· Lung disease is stable and resolving
· Oxygen titration to FiO2 less than 0.5 and PEEP less than 5-8cmH2O
· Hemodynamic stability, little or no pressure (blood pressure) agents
· Neuromuscular ability to initiate spontaneous breathing
 Approaches to Weaning from Mechanical Ventilation  
Weaning is typically a Two-step process leading up to ventilator liberation:
· First, essential weaning parameters are assessed, sometimes called the “wean screen,” and the wean screen should be performed daily once the decision is made to begin weaning. Parameters to be measured here include Maximal Inspiratory Pressure, Spontaneous Tidal Volume, Spontaneous Vital Capacity, Spontaneous Minute Volume, and Spontaneous Respiratory Rate. The Rapid Shallow Breathing Index should also be calculated daily.
· Next, we perform the first weaning trial
Patient Management to Avoid Weaning Delays:
Optimize Respiratory Muscle Power through:
· Good nutrition
· Discontinuing neuromuscular blocking drugs
· Decreasing steroid use
· Encourage spontaneous breathing but avoiding patient exhaustion
· Stabilizing electrolytes
· Physical Therapy for strength and range of motion
Decrease Respiratory Work:
· Patient should be sitting up
Decreasing Respiratory Demand:
· Treat any pyrexia
· Treat agitation
· Minimize respiratory dead space
· Decrease airway resistance
· Decrease abdominal distension
Optimize Ventilatory Drive
· Discontinue patient sedation
· Consider any causes prior to the neuromuscular junction
· Correct any metabolic acidosis
Increase Oxygen Carrying Capacity
· Eliminate atelectasis
· Correct anemia
· Correct any shifts in oxyhemoglobin dissociation curve
Optimize Cardiac Function
· Evaluate left ventricular function
· Treat congestive heart failure
· Treat ischemia
Optimize Sputum Clearance
· Treat infection
· Chest physiotherapy
· Suction before trials
· Therapeutic bronchoscopy if appropriate
Techniques of Weaning
· Gradual reduction in mandatory rate during synchronized intermittent mandatory ventilation
· Gradual reduction in pressure support ventilation
· Spontaneous breathing through a T-piece
· Spontaneous breathing via the ventilator on flow by with no pressure support and no PEEP
It is important to note that there is no evidence that gradual reduction of ventilation support speeds up the weaning process, so when patients meet Wean Screen criteria, the most rapid approach to weaning is to initiate spontaneous breathing trials, either by T-piece or by flow by.
Evidence-Based Protocols
Weaning protocols simply work, and this has been well demonstrated clinically over recent years. Protocol driven ventilator liberation procedures have clearly demonstrated that traditional care is often associated with significant delays in ventilator withdrawal. Respiratory Therapist (RT) run protocols consistently produce faster ventilator discontinuation times when compared to physician run usual care in the ICU. Perhaps this is because physicians who are leading the weaning process do not adhere to evidence-based guidelines. Also, they simply not be available often enough to move the weaning process forward quickly. There are approved Respiratory Therapy weaning protocols in each facility that allow RT’s to be in charge of the weaning process.
Automated feedback systems
Several recent innovations are improving the weaning process, and automation of weaning is certainly a hot topic in critical care today. For example, Adaptive Support Ventilation (ASV) is the most studied closed loop system in place today. It is an improvement over physician led weaning. Automated systems use a closed-loop control to enable ventilators to perform basic and advanced functions while supporting respiration. These systems provide a unique automated weaning system which measures selected respiratory variables, adapts ventilator output to individual patient needs by operationalizing predetermined algorithms and automatically conducts spontaneous breathing trials (SBTs) when predetermined thresholds are met. As a result, there is no delay in weaning when the patient is, in fact, ready. These systems are very new, and research is underway at this time to determine just how effective they really are.
For this assignment, discuss the following relating mechanical ventilation:
The title for this paper should be reflective of what you are to describe.  I might suggest something like this; Adverse Effects of Invasive Positive Pressure Ventilation.
List and describe 4 adverse effects of invasive positive pressure ventilation on the pulmonary system with strategies for minimizing or avoiding the negative effects entirely. Be specific about your recommended strategies.
Requirements
Unless specifically stated otherwise, all written assignments are expected to follow the writing style guidelines outlined in the APA Publication Manual, 6th Edition (see link below). Assignments will include a title page, double spacing with indented paragraphs (first line of each paragraph), in-text source citations and a references page.
APA Publication Manual, 6th EditionLinks to an external site.
Assignment Grading Rubric.pdf 
Submit your 500 word assignment (excluding references) in a Word document.  You must have 3 in-text citations with 3 corresponding references shown in proper APA format to defend and support your position.  This assignment is due before midnight, MST, this Saturday.

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