detrimental health effect related to smoking

Another potentially detrimental health effect related to smoking. That has implications for care of older adults is the potential for altering the effects of medications. Interactions can occur in people who smoke or use nicotine products (including smokeless tobacco) and in people who have recently quit smoking. Interactions can be due directly to the physiologic effects of nicotine or they may be caused by the hydrocarbons in tobacco smoke, which can affect hepatic metabolism of some medications. Additional information and examples of drug–nicotine interactions are discussed in Chapter 8.

Identify 2 medications affected by nicotine. What changes can it cause? How would you address this with your patients?

please do at least 300 words with in text citation and reference

Advocacy and public health nursing

Advocacy and public health nursing

The president and the governor are referred to as the chief administrative. Or executive officers of the country and state, respectively. Analyze the differences and similarities in the roles and responsibilities of the respective heads of these executive branches.

2. Advocacy and public health nursing intersect in many ways. What are some specific examples that demonstrate how public health benefited from the advocacy provided by nurses?

3. Describe how you will utilize and implement the IOM Nursing Reports from 2010 and 2016 in your role as an Advanced Practice Nurse.

the U.S. healthcare system


As the U.S. healthcare system moves toward an emphasis on value. And accountability, a key underlying mechanism that facilitates this shift is healthcare quality measurement. Healthcare organizations are increasingly put in the position to demonstrate the quality of care they provide. And with the shift from manual to electronic charting, organizations are now using electronic clinical quality measures (eCQMs). Baird et al. (2020) defined quality measurement as the process of collecting data related to prescribed quality measures and reporting this data to requesting agencies and payers and used the U.S. Centers for Medicare and Medicaid Services (CMS) as an example which now requires or incentivizes hospitals or healthcare institutions to collect and report data related to prescribed quality measures.

Integumentary Function – Psoriasis

Instructions: Response must be at least 310 words written in current APA format with at least two academic references cited. References must be within the last five years. Response must extend, correct/refute, or add additional nuance.

Integumentary Function – Psoriasis

Psoriasis is a chronic skin disease that is characte by deficiencies in the normal cycle of the epidermal development that lead to epidermal hyperproliferation, altered growth of the skin, inflammation, and vascular

dysfunction (Peters, Weissman, & Gill, 2000).

There are several types of psoriasis lesion that individuals can experience, and each may differ in the way they respond to treatment (Peters, Weissman, & Gill, 2000). The different types of psoriasis includes: plaque psoriasis

which is the most common type, and is characterized by dry scalling patches, guttate psoriasis is characterized by drop-like dots that develops in individuals recovering from a streptococcal or viral infection, erythrodermic psoriasis

characterized by exfoliation of fine scales that covers large areas accompanied by severe itiching, and pain (Peters, Weissman, & Gill, 2000). Other types of psoriasis are pustular psoriasis characterized as pus-like blisters that are not

infectious with fluids that contains white blood cells. Nail psoriasis that is seen on toe and finger nails; inverse psoriasis that is characterized by smooth, inflamed lesions mostly in flexural areas of the body, such as the armpits. Psoriatic

arthritis is characterized by an inflammation, swelling, and joint destruction, and scalp psoriasis that is a plaque type lesion (Peters, Weissman, & Gill, 2000).

The onset of psoriasis can be sudden or steady, and many patient such as K.B. will experience remissions, and exacerbations. The most common triggers for psoriasis are bacterial or viral infections on any part of the skin, dry air

or skin, use of certain medications such as beta blockers, and lithium. Other triggers are skin injuries, such as cuts, and insect bites, too little or too much sunlight, and excessive alchohol intake (Dlugasch & Story, 2021).

           cure for psoriasis

Although there is no cure for psoriasis, there are treatment available that will improve the symptoms. There three main approaches to treatment including topical treatments, phototherapy, and systemtic medications. Topical

treatments includes corticosteriods is the topical agent that is mostly used in treating psoriasis, and is used to reduce inflammation, itching, and scaling of lesions (Peters, Weissman, & Gill, 2000). Other topical treatments include

vitamin D, anthralin, retinoids, calcinerin inhibitors, salicylic acid, coal tar, mositurizers, and dandruff shampoo (Dlugasch & Story, 2021). Phototherapy is used in the treatment of moderate forms of psoriais, these therapies are

administered in the form of sunlight, natural or artificial, broadband ultraviolent B phototherapy, photochemotherapy, and excimer laser (Dlugasch & Story, 2021). Oral or injectible forms of treatment are usually prescribed for

individuals with serve symptoms or those who are resisitant to other forms of treatment (Dlugasch & Story, 2021). These systemic theraputic agents are retinoids, methotrexate, cyclosporine, hydroxyurea, phosphodiesterease 4 inhibitor,

immunomodular drugs, and janus kinase inhibitors. These medications are used for a short time due the potential for individuals to experience serious side effects (Dlugasch & Story, 2021). In addition to the treatment modalitied

mentioned, stress management, and referral to a therapist to address the patients’ psychological needs is important. Recommendation for treatment in this case would include phototherapy, systemic therapy, and psychotherapy to address

K.B. emotional needs.

The medications used to treat psoriasis has severe adverse effects such as phototoxicity, nephrotoxicity bone marrow depression, and others, as a result. In addition, there is a high probability of these drugs to interact with other

medications that could result in a negative outcome; therefore it important to reconcile the medications that patient is taking (Peters, Weissman, & Gill, 2000).

Other clinical manifestations as mentioned above may include psoriatic arthritis that is characterized by joint pain, nail changes to include yellow-brown spots, dents on the nails, and separation from the base. An individual may

also experience symptoms of cardiovascular disease, inflammatory bowel disease, hypertension, and other autoimmune disorders as there is an increased risk associated with psoriasis that may be manifested as skin lesions (Dlugasch &

Story, 2021)

methods of developing theories

Instructions: Response must be at least 310 words written in current APA format with at least two academic references cited. References must be within the last five years. Response must extend, correct/refute, or add additional nuance.

As humans, we tend to respond to certain events within our environment by finding a way to explain how these events occurred. Our interpretations are based on how we formulate our ideas by establishing possible theories. Therefore, a theory can be explained as a set of ideas arranged in an orderly way to enable one to explain certain events and phenomena as observed. For instance, medical theories help medics to try to understand the causes and nature of health and diseases. So, theories enable us to understand, explain and make predictions about a certain event we have seen or encountered or concerning a given topic or subject matter.

There are various ways and methods of developing theories since the human mind is constantly seeking answers. They can be constructed using sentences that are based on the subject matter. Through our minds, we can come up with personal theories from events we have observed and by critically evaluating the event (Berente et al., 2019). Scientists on the other hand use scientific data and a variety of tests to develop and build their theories. These are new theories and they have to be well researched. Another way to develop a theory would involve relying upon previous established/published theories and using them as a guide of foundation for the new theory. By so doing, the theorist can add discoveries, integrate new concepts using different approaches, or modify the existing theory. From a simple hypothesis followed by appropriate research and a valid deduction, we can easily come up with a good theory.

Established theories

A good theory should depend on facts, values, and other theories. It is upon these 3 dependencies that theories are evaluated upon. Facts help support the theory and make it evidence-based. Many theorists rely on facts presented in research reports. Values include the data that is used to support the theory. It could be measurements or another figure that support the testability of the theory. Established theories provide support to new theories as evidence and support and if the old theories were true then chances are that the new theory will also be true. An example of a theory would be a business strategy created by a businessman to increase his sale and number of customers. Through research and information from others, his theory will be tested depending on the sales trajectory. Poor results from few customers would imply a poor theory.

The primary criteria to evaluate a theory is to falsify or test it. The result of the testing can either be the refutation or the collaboration of the theory. However, there is no specifically defined way to evaluate theories (Woodcock et al., 2021).   Due to the infinite number of repetitive tests required, theories are hard to prove. The Severity, the validity of tests, measures, and identification of all variables are other factors that prohibit proving theories. Values that are hard to disapproved and present testable predictions collaborated by the research are highly valued. Another method of evaluation would involve considering the accuracy and precision of the prediction of a theory. Prediction accuracy of around 80% would imply that the theorist has done a good job and has accounted for all variables and factors.

In conclusion, theories are important tools that help us analyze and interpret the events surrounding our lives.

Centers For Medicare & Medicaid Services (CMS)


According to the Centers for Medicare & Medicaid Services (CMS), quality measures rare represented in structured Health Quality Measure Format (HQMF) is a way that they can be interpreted by information systems like electronic health records (EHR). Electronic clinical quality measures (eCQMs) are tools used to measure and track quality of health care services. Eligible professionals, hospitals, and critical access hospitals generate information populated through the EHR. Measuring eCQMs help to ensure the safe effective, efficient, equitable, timely, and patient-centered care (Centers for Medicare & Medicaid Services [CMS], n.d.).

Several eCQM measures are monitored. Patient and family engagement, patient safety, care coordination, population/public health, efficient use of healthcare resources, and clinical process/effectiveness. There are many barriers to full meaningful use, however, many benefits have been identified. Baillieu et al., states when an organization is implementing eMeansures. And eCQM programs, the nurse informaticist may need to convince naysayers of the benefits that can be derived. Meaningful use of eMeasures. And eCQMs used by primary care providers facilitates quality improvement (QI), presents unnecessary acute care visits, improves patient outcomes. And promises to promote better continuity of care, especially for the underserved patient populations.

Another convincing argument is the fact there has been a positive association between practice size and meaningful use in both adult. And pediatric preventative care, suggesting successful implementation of clinical care and workflow that is supported by health IT contributes to reducing preventable chronic diseases. Understanding that advancements in health IT can improve patient outcomes by improving capacity for disease prevention, improve health promoting and chronic care management are compelling reasons to implement eMeasures and eCQMs (Baillieu et al., 2020).

history of hypertension

Mr. White is a 72-year-old man, with a history of hypertension, COPD and moderate dementia, who presents with 4 days of increased confusion, nighttime restlessness, visual hallucinations, and urinary incontinence. His physical exam is unremarkable except for tachypnea, a mildly enlarged prostate, inattentiveness, and a worsening of his MMSE score from a baseline of 18 to 12 today.


Mr. White’s presentation is most consistent with an acute delirium (acute change in cognition, perceptual derangement, waxing and waning consciousness, and inattention).

1. What is the most likely diagnosis to frequently cause acute delirium in patients with dementia?

2. What additional testing should you consider if any?

3. What are treatment options to consider with this patient?

What does evidence- based practice (EBP) mean?


What does evidence- based practice (EBP) mean? Why is it important to nursing? How does your own work environment use EPB and what strategies you can use to implement EBP into nursing practice? This week you will need to think about and analyze a specific situation that has occurred in your work setting and the impact critical thinking had on that specific situation.

Learning Outcomes

After completing this module, you will be able to:

  • Compare and contrast creative strategies to implement research evidence into nursing practice.
  • Analyze a critical incident in the workplace using a critical thinking tool or model of your choice.

Reading & Resources 

Read Chapters 5 & 8 In Rubenfeld, M. G., & Scheffer, B.K. (2015). Critical thinking TACTICS for nurses: Achieving the IOM competencies (3rd ed.). Sudbury, MA: Jones and Bartlet

Discussion 4

Discuss strategies that you can use to encourage and support implementing evidence- based practice and use of nursing outcome indicators in your current work environment to improve nursing practice and ultimately high quality, safe patient care?

Please support your initial discussion and opinions with at least two citations from the assigned readings, or peer-reviewed professional nursing literature.

See the Nursing Syllabus Standards & Policies Document for Discussion Participation Guidelines & Grading Criteria.

influence patient education has in health care using the experiences of a patient

on the influence patient education has in health care using the experiences of a patient. Interview a friend or family member about that person’s experiences with the health care system. You may develop your own list of questions.

Suggested interview questions:

  1. Did a patient education representative give you instructions on how to care for yourself after your illness or operation?
  2. Did a health care professional, pharmacist, nurse, doctor, or elder counselor advise you on your medication, diet, or exercise?
  3. Who assisted you at home after your illness or operation?
  4. Do you know of any assistance services, i.e., food, transportation, medication, that would help you stay in your home as you get older?

epic poetry about your life

1. Two Summaries

Read “Penelope’s Agnoia” and “Herakles, Odysseus, and the Bow,” then write a summary of that article, no more than ½ page in length, which explains the article’s main claim and the arguments it uses to support that claim. You can earn up to ten points of credit for the first article you summarize, and up to five additional points if you submit a summary for the other article as well.

2. One poem

Write 20-40 lines of epic poetry about your life.  How you make it poetry is up to you; you may want to use rhyme, meter or other formal devices.  How you make it “epic” is also up to you, but you can apply some of the things you’ve learned in lecture and section to make what you write more like the Odyssey.  Like Odysseus, you should not feel bound by a strict respect for the truth.