Assignment: The Nurse Leader As Knowledge Worker

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The term “knowledge worker” was first coined by management consultant and author Peter Drucker in his book, The Landmarks of Tomorrow (1959). Drucker defined knowledge workers as high-level workers who apply theoretical and analytical knowledge, acquired through formal training, to develop products and services. Does this sound familiar?

Nurses are very much knowledge workers. What has changed since Drucker’s time are the ways that knowledge can be acquired. The volume of data that can now be generated and the tools used to access this data have evolved significantly in recent years and helped healthcare professionals (among many others) to assume the role of knowledge worker in new and powerful ways.

In this Assignment, you will consider the evolving role of the nurse leader and how this evolution has led nurse leaders to assume the role of knowledge worker. You will prepare a PowerPoint presentation with an infographic (graphic that visually represents information, data, or knowledge. Infographics are intended to present information quickly and clearly.) to educate others on the role of nurse as knowledge worker.

Reference: Drucker, P. (1959). The landmarks of tomorrow. New York, NY: HarperCollins Publishers.

To Prepare:

  • Review the concepts of informatics as presented in the Resources.
  • Reflect on the role of a nurse leader as a knowledge worker.
  • Consider how knowledge may be informed by data that is collected/accessed.

The Assignment:

  • Explain the concept of a knowledge worker.
  • Define and explain nursing informatics and highlight the role of a nurse leader as a knowledge worker.
  • Develop a simple infographic to help explain these concepts.

    NOTE: For guidance on infographics, including how to create one in PowerPoint, see “How to Make an Infographic in PowerPoint” presented in the Resources.

  • Your PowerPoint should Include the hypothetical scenario you originally shared in the Discussion Forum. Include your examination of the data that you could use, how the data might be accessed/collected, and what knowledge might be derived from that data. Be sure to incorporate feedback received from your colleagues’ responses.

hypothetical scenario originally shared in the discussion forum is:

Nursing, as with all other professional fields, has seen an amazing speed in which technological changes in the last 25 years.  Information systems provide limitless possibilities for learning and exploring, connecting and bringing the world to within reach.  For nursing, the widening range of available technology enables the opportunities for research and reform unproven clinical practices to evidence-based practices.  Nursing informatics is synthesis of nursing science, information science, computer science, and cognitive science for the purpose of managing, disseminating, and enhancing healthcare data, information, knowledge, and wisdom to improve collaboration and decision making provide high quality patient care; and advance the profession of nursing.( McGonigle & Mastrian, 2017).

Nursing Informatics also needs to stay updated on policies and processes, so they know how to correctly build them in the systems. Technology in hospitals are ever growing, which means that nursing informatics is just scratching the surface and will continue to grow over the year.

Sweeny, 2017 define informatics as “the integration of healthcare sciences, computer science, information science and cognitive science to assist in the management of healthcare information” (p. 223). The future development of nursing capabilities in data science will essentially lead to an entirely new cadre of nursing informatics specialists whose work will focus on deriving new nursing knowledge from not only electronic health record data, but also the data from sensor and remote monitoring technologies, patient portals and mobile apps described above. The implications of omics data such as genomics, metabolomics, and proteomics, being included as part of the electronic health record in the near future, should be taken into account. Nurse informatics specialists will be pivotal in assisting to identify potential ethical and practice implications in the use of these data. The future development of nursing capabilities in data science will essentially lead to an entirely new cadre of nursing informatics specialists whose work will focus on deriving new nursing knowledge from not only electronic health record data, but also the data from sensor and remote monitoring technologies, patient portals and mobile apps described above. The implications of omics data such as genomics, metabolomics, and proteomics, being included as part of the electronic health record in the near future, should be taken into account.

According to Nagle et al,(2017) Nurse informatics specialists will be pivotal in assisting to identify potential ethical and practice implications in the use of these data. Using The future development of nursing capabilities in data science will essentially lead to an entirely new cadre of nursing informatics specialists whose work will focus on deriving new nursing knowledge from not only electronic health record data, but also the data from sensor and remote monitoring technologies, patient portals and mobile apps described above. The implications of omics data such as genomics, metabolomics, and proteomics, being included as part of the electronic health record in the near future, should be taken into account. Nurse informatics specialists will be pivotal in assisting to identify potential ethical and practice implications in the use of these data.

A clarified scenario is patient admission to the hospital, patients with a medical or surgical condition may not be identified as having a substance abuse problem. Nurses need to be able to recognize alcohol withdrawal syndrome and start appropriate interventions within the first 24 hours. Otherwise, such complications as seizures and substance withdrawal delirium may arise.  Most hospitals have implemented this practice by including it in initial nursing assessments by checking the vital signs every three hours. But because not all patients are identified on admission as having the potential for alcohol withdrawal, you must stay alert for signs and symptoms. These may arise 4 to 12 hours after the patient’s last drink and may emerge while the patient’s still intoxicated. Many patients with long-term alcohol dependence don’t allow their blood alcohol level (BAL) to drop below a comfortable level, so withdrawal may begin when BAL is still in the intoxication range.autonomic hyperactivity (such as sweating or a pulse faster than 100 beats/minute), increased hand tremor, insomnia, nausea or vomiting transient visual, tactile, or auditory hallucinations or illusions, psychomotor agitation, anxiety, grand mal seizures. Consider the rapid action on the patient, nurses relied on the immediate data and information that the patient as shown during the initial rapid assessment to deliver appropriate care to the patient. Message send to on call- doctors via telehealth. Using the technology like the pulse oximeter and blood pressure machine and breathalyzer with assist with the support of the delivery care.

References:

McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.

National Institute on Alcohol Abuse and Alcoholism; National Institutes of Health. Helping Patients Who Drink Too Much: A Clinician’s Guide and Related Professional Support Resources. www.niaaa.nih.gov/Publications/EducationTrainingMaterials/Pages/guide.aspx. Accessed May 15, 2012.

Nagle, L. M., Sermeus, W., & Junger, A. (2017). Evolving Role of the Nursing Informatics Specialist. Studies In Health Technology And Informatics, 232, 212–221. Retrieved from https://ezp.waldenulibrary.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=28106600&site=eds-live&scope=site

Sweeney, J. (2017). Healthcare informatics.(1)Online Journal of Nursing Informatics, 21

Resources:

McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.

  • Chapter 1, “Nursing Science and the Foundation of Knowledge” (pp. 7–19)
  • Chapter 2, “Introduction to Information, Information Science, and Information Systems” (pp. 21–33)
  • Chapter 3, “Computer Science and the Foundation of Knowledge Model” (pp. 35–62)

Sweeney, J. (2017). Healthcare informatics. Online Journal of Nursing Informatics, 21(1).

Note: You will access this article from the Walden Library databases.

Rubric:

 

Develop a 5- to 6-slide PowerPoint presentation that addresses the following:

·   Explain the concept of a knowledge worker.
·   Define and explain nursing informatics and highlight the role of a nurse leader as a knowledge worker.–

Levels of Achievement:Excellent 32 (32%) – 35 (35%) The presentation clearly and accurately explains the concept of a knowledge worker.

The presentation clearly and accurately defines and explains nursing informatics with a detailed explanation of the role of the nurse leader as a knowledge worker.

Includes: 3 or more peer-reviewed sources and 2 or more course resources.Good 28 (28%) – 31 (31%) The presentation explains the concept of a knowledge worker.

The presentation defines and explains nursing informatics with an explanation of the role of the nurse leader as a knowledge worker.

Includes: 2 peer-reviewed sources and 2 course resources.Fair 25 (25%) – 27 (27%) The presentation inaccurately or vaguely explains the concept of a knowledge worker.

The presentation inaccurately or vaguely defines and explains nursing informatics with an inaccurate or vague explanation of the role of the nurse leader as a knowledge worker.

Includes: 1 peer-reviewed sources and 1 course resources.Poor 0 (0%) – 24 (24%) The presentation inaccurately and vaguely explains the concept of a knowledge worker or is missing.

The presentation inaccurately and vaguely defines and explains nursing informatics with an inaccurate and vague explanation of the role of the nurse leader as a knowledge worker or is missing.

Includes:  1 or fewer resources.Feedback:

·   Develop a simple infographic to help explain these concepts.–

Levels of Achievement:Excellent 14 (14%) – 15 (15%) The presentation provides an accurate and detailed infographic that helps explain the concepts related to the presentation.Good 12 (12%) – 13 (13%) The presentation provides an infographic that helps explain the concepts related to the presentation.Fair 11 (11%) – 11 (11%) The presentation provides an infographic related to the concepts of the presentation that is inaccurate or vague.Poor 0 (0%) – 10 (10%) The infographic provided in the presentation related to the concepts of the presentation is inaccurate and vague, or is missing.Feedback:

·   Present the hypothetical scenario you originally shared in the Discussion Forum. Include your examination of the data you could use, how the data might be accessed/collected, and what knowledge might be derived from the data. Be sure to incorporate feedback received from your colleagues’ replies.–

Levels of Achievement:Excellent 32 (32%) – 35 (35%) The presentation clearly and thoroughly includes the hypothetical scenario originally shared in the Discussion Forum, including a detailed and accurate examination of the data used, how the data might be accessed/collected, and the knowledge that could be derived from the data.Good 28 (28%) – 31 (31%) The presentation includes the hypothetical scenario originally shared in the Discussion Forum, including an accurate examination of the data used, how the data might be accessed/collected, and the knowledge that could be derived from the data.Fair 25 (25%) – 27 (27%) The presentation includes the hypothetical scenario originally shared in the Discussion Forum, including an examination of the data used, how the data might be accessed/collected, and the knowledge that could be derived from the data that is vague or inaccurate.Poor 0 (0%) – 24 (24%) The presentation includes the hypothetical scenario originally shared in the Discussion Forum, including an examination of the data used, how the data might be accessed/collected, and the knowledge that could be derived from the data that is vague and inaccurate, or is missing.Feedback:

Written Expression and Formatting – Paragraph Development and Organization:

Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance.–

Levels of Achievement:Excellent 5 (5%) – 5 (5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity.Good 4 (4%) – 4 (4%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.Fair 3.5 (3.5%) – 3.5 (3.5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%- 79% of the time.Poor 0 (0%) – 3 (3%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time.Feedback:

Written Expression and Formatting – English writing standards:

Correct grammar, mechanics, and proper punctuation–

Levels of Achievement:Excellent 5 (5%) – 5 (5%) Uses correct grammar, spelling, and punctuation with no errors.Good 4 (4%) – 4 (4%) Contains a few (1-2) grammar, spelling, and punctuation errors.Fair 3.5 (3.5%) – 3.5 (3.5%) Contains several (3-4) grammar, spelling, and punctuation errors.Poor 0 (0%) – 3 (3%) Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.Feedback:

Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.–

Levels of Achievement:Excellent 5 (5%) – 5 (5%) Uses correct APA format with no errors.Good 4 (4%) – 4 (4%) Contains a few (1-2) APA format errors.Fair 3.5 (3.5%) – 3.5 (3.5%) Contains several (3-4) APA format errors.Poor 0 (0%) – 3 (3%) Contains many (≥ 5) APA format errors.Feedback: Total Points: 100

Reflect on how emerging technologies such as artificial intelligence may help fortify nursing informatics as a specialty by leading to increased impact on patient outcomes or patient care efficiencies.

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To Prepare:

Review the concepts of technology application
Reflect on how emerging technologies such as artificial intelligence may help fortify nursing informatics as a specialty by leading to increased impact on patient outcomes or patient care efficiencies.
The Assignment: (4-5 pages)

In a 4- to 5-page project proposal written to the leadership of your healthcare organization, propose a nursing informatics project for your organization that you advocate to improve patient outcomes or patient-care efficiency. Your project proposal should include the following:

Describe the project you propose.
Identify the stakeholders impacted by this project.
Explain the patient outcome(s) or patient-care efficiencies this project is aimed at improving and explain how this improvement would occur. Be specific and provide examples.
Identify the technologies required to implement this project and explain why.
Identify the project team (by roles) and explain how you would incorporate the nurse informaticist in the project team.

Rubric
Name: NURS_6051_Module02_Week03_Assignment_Rubric
Grid View
List View
ExcellentGoodFairPoorIn a 4- to 5-page project proposal written to the leadership of your healthcare organization, propose a nursing informatics project for your organization that you advocate to improve patient outcomes or patient care efficiency. Your project proposal should include the following:
· Describe the project you propose.
· Identify the stakeholders impacted by this project.
· Explain the patient outcome(s) or patient-care efficiencies this project is aimed at improving, and explain how this improvement would occur. Be specific and provide examples.
· Identify the technologies required to implement this project and explain why.
· Identify the project team (by roles) and explain how you would incorporate the nurse informaticist in the project team.77 (77%) – 85 (85%)The response accurately and thoroughly describes in detail the project proposed.
The response accurately and clearly identifies the stakeholders impacted by the project proposed.
The response accurately and thoroughly explains in detail the patient outcome(s) or patient-care efficiencies that the project proposed is aimed at improving, including an accurate and detailed explanation, with sufficient supporting evidence of how this improvement would occur.
The response accurately and clearly identifies the technologies required to implement the project proposed with a detailed explanation why.
The response accurately and clearly identifies the project team (by roles) and thoroughly explains in detail how to incorporate the nurse informaticist in the project team.68 (68%) – 76 (76%)The response describes the project proposed.
The response identifies the stakeholders impacted by the project proposed.
The response explains the patient outcome(s) or patient-care efficiencies that the project proposed is aimed at improving, including an explanation, with some supporting evidence of how this improvement would occur.
The response identifies the technologies required to implement the project proposed with an explanation why.
The response identifies the project team (by roles) and explains how to incorporate the nurse informaticist in the project team.60 (60%) – 67 (67%)The response describing the project proposed is vague or inaccurate.
The response identifying the stakeholders impacted by the project proposed is vague or inaccurate.
The response explaining the patient outcome(s) or patient-care efficiencies the project proposed is aimed at improving, including an explanation of how this improvement would occur, is vague or inaccurate, or includes little to no supporting evidence.
The response identifying the technologies required to implement the project proposed with an explanation why is vague or inaccurate.
The response identifying the project team (by roles) and an explanation of how to incorporate the nurse informaticist in the project team is vague or inaccurate.0 (0%) – 59 (59%)The response describing the project proposed is vague and inaccurate, or is missing.
The response identifying the stakeholders impacted by the project proposed is vague and inaccurate, or is missing.
The response explaining the patient outcome(s) or patient-care efficiencies the project proposed is aimed at improving, including an explanation of how this improvement would occur, is vague and inaccurate, includes no supporting evidence, or is missing.
The response identifying the technologies required to implement the project proposed with an explanation why is vague and inaccurate, or is missing.
The response identifying the project team (by roles) and an explanation of how to incorporate the nurse informaticist in the project team is vague and inaccurate, or is missing.Written Expression and Formatting – Paragraph Development and Organization:
Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance.5 (5%) – 5 (5%)Paragraphs and sentences follow writing standards for flow, continuity, and clarity.4 (4%) – 4 (4%)Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.3.5 (3.5%) – 3.5 (3.5%)Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%- 79% of the time.0 (0%) – 3 (3%)Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time.Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation5 (5%) – 5 (5%)Uses correct grammar, spelling, and punctuation with no errors.4 (4%) – 4 (4%)Contains a few (1-2) grammar, spelling, and punctuation errors.3.5 (3.5%) – 3.5 (3.5%)Contains several (3-4) grammar, spelling, and punctuation errors.0 (0%) – 3 (3%)Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.5 (5%) – 5 (5%)Uses correct APA format with no errors.4 (4%) – 4 (4%)Contains a few (1-2) APA format errors.3.5 (3.5%) – 3.5 (3.5%)Contains several (3-4) APA format errors.0 (0%) – 3 (3%)Contains many (≥ 5) APA format errors.Total Points: 100

Name: NURS_6051_Module02_Week03_Assignment_Rubric

Discussion replies

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I NEED A POSITIVE COMMENT BASED IN THIS ARGUMENT..BETWEEN 100-120 WORDS

After discussion with your mentor, name one financial aspect, one quality aspect, and one clinical aspect that need to be taken into account in developing the evidence-based practice project. Explain how your proposal will, directly and indirectly, impact each of the aspects.

Speaking with the mentor, the financial aspect of the project would be hours spent trying to get nurses educated on the proposed guidelines for late preterm infants. Hours will be needed as well to get the basic checklist implemented into the computer in this particular area, which requires going to different committees and getting approvals needed. This takes more than one nurse or person to get this done. This requires more hours of pay, and that would be the financial aspect of the proposed project.

Now, the clinical aspect that has to be taken into account with developing the project would be how the nurses will accept the project. As lifelong learners, staff nurses continually encounter new knowledge of relevance to their patients. The conscientious nurse remains alert to clinical problems and encourages investigation into ways to improve patient outcomes(Di Lenoardi, 2014). The nurses need to be given research and data that proves this could help readmission of late preterm infants. If given this data, they would be involved in the process of implementing as well,

In 2001, the Institute of Medicine (IOM) recommended evidenced based practice to improve healthcare outcomes(Stephens, 2013). This project is to improve the quality outcome of late preterm infants and prevent their readmission to hospital.

All the aspects brought together will make a good impact on the project the author believes with the research and data given to the nurses, implementation and then follow up of results will show this is a great solution to help alleviate many readmissions nationwide as well. If this hospital shows that the guidelines are helping there, then they can show other colleagues in the nation that this helps and also will cut costs by preventing readmissions.

 

References

Di Lenoardi, B. C. (2014). Bringing evidence-based practice to life. Retrieved from https://lms.rn.com/getpdf.php/2145.pdf

Stephens, K. R. (2013, May 13). The impact of evidence-based practice in nursing and the next big ideas. The Online Journal of Issues in Nursing., 18. https://doi.org/10.3912/OJIN.Vol18No02Man04

Question 1 A nurse educator who coordinates the staff education on an oncology unit is conducting an inservice on targeted therapies. What potential benefit of targeted therapies should the nurse highlight in this education session?

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Question 1 A nurse educator who coordinates the staff education on an oncology unit is conducting an inservice on targeted therapies. What potential benefit of targeted therapies should the nurse highlight in this education session?

A) Targeted therapies achieve the therapeutic benefits of traditional chemotherapy with no risk of adverse effects.
B) Targeted therapies have the potential to provide prophylactic protection against neoplasia in high-risk individuals.
C) Targeted therapies are significantly more cost-effective than traditional chemotherapeutic drugs.
D) Targeted therapies have the potential to damage cancerous cells while leaving normal body cells less affected.

Question 2 An oncology nurse is aware of the risks for injury that exist around the preparation, transportation, and administration of chemotherapeutic agents. In order to reduce these risks of injury, the nurse should take which of the following actions?

A) Dispose of intravenous lines used for chemotherapy administration in a covered trash can in the patient’s room.
B) Use an IV system for administration that includes needles to reduce the risk of accidental spills.
C) Prime the IV tubing with an approved IV solution rather than with the drug itself.
D) Encourage patients who have been receiving chemotherapy to use a bedside commode rather than a toilet.

Question 3 A patient has just received her first dose of imatinib and the nurse on the oncology unit is amending the patient’s care plan accordingly. What nursing diagnosis is most appropriate in light of this addition to the patient’s drug regimen?

A) Risk for Infection related to bone marrow suppression
B) Risk for Acute Confusion related to adverse neurological effects of imatinib
C) Risk for Impaired Skin Integrity related to exaggerated inflammatory response
D) Risk for Deficient Fluid Volume related to changes in osmotic pressure

Question 4 A nurse has administered filgrastim to a diverse group of patients in recent months. Which of the following patients should the nurse observe for extremely elevated white blood cell counts following administration of the drug?

A) A 19-year-old male receiving radiotherapy
B) A 25-year-old female with a diagnosis of congenital neutropenia
C) A 39-year-old female with a nonmyeloid malignancy
D) A 47-year-old male with aplastic anemia

Question 5 A patient with chronic lymphocytic leukemia (CLL) will imminently begin a course of treatment with rituximab. In order to minimize the risk of adverse effects, what strategy for administration will be adopted?

A) Admitting the patient to the intensive care unit in anticipation of the initial bolus of the drug
B) Administering diphenhydramine 30 minutes prior to the initial dose of rituximab
C) Administering the drug by slow infusion to two peripheral IV sites simultaneously
D) Administering the initial doses by slow infusion while observing for adverse reactions

Question 6 A 45-year-old woman with acute leukemia is going to begin chemotherapy with vincristine. The nurse is aware that vincristine must always be administered

A) at a rapid infusion rate.
B) at a slow infusion rate.
C) through an IV line primed with vincristine.
D) through a central line.

Question 7 Mr. Singh is a 66-year-old man who is receiving chemotherapy for the treatment of lung cancer that has metastasized to his liver. In an effort to prevent infection, Mr. Singh has been prescribed filgrastim (Neupogen). Which of the nurse’s following assessment questions most directly addresses a common adverse effect of filgrastim?

A) “Have you noticed any bleeding in your gums or cheeks?”
B) “Do you feel like you’re having any pain in your bones?”
C) “Are you experiencing any waves of cool, clammy skin?”
D) “Have you had any shortness of breath lately?”

Question 8 A 67-year-old man who is being treated for prostate cancer is taking epoetin alfa. The nurse will instruct the patient to

A) stop taking the drug after a 2-week period.
B) schedule an appointment to measure hemoglobin twice a week for at least 2 to 6 weeks.
C) schedule an appointment to check if the patient has a high WBC count.
D) begin taking a calcium channel blocker to treat hypertension, which usually develops as an adverse effect of epoetin alfa therapy.

Question 9 A male patient is receiving heparin by continuous intravenous infusion. The nurse will instruct the patient and family members to report which of the following should it occur?

A) A skin rash
B) Sudden occurrence of sleepiness and drowsiness
C) Dizziness
D) Presence of blood in urine or stools

abcd

Question 10 A nurse is caring for a 64-year-old female patient who is receiving IV heparin and reports bleeding from her gums. The nurse checks the patient’s laboratory test results and finds that she has a very high aPTT. The nurse anticipates that which of the following drugs may be ordered?

A) Coumadin
B) Alteplase
C) Ticlopidine
D) Protamine sulfate

Question 11 A nurse has been assigned to a 55-year-old woman who has a malignant brain tumor. The patient is receiving her first dose of carmustine. It will be critical for the nurse to observe for which of the following?

A) Nausea and vomiting
B) Respiratory difficulty
C) Inability to drink fluids for 6 hours
D) Reddish urine

Question 12 A nurse is assessing a patient who has chronic lymphoblastic myelogenous leukemia. The treatment plan includes hydroxyurea (Hydrea). The nurse will assess the patient for which of the following?

A) Diabetes mellitus
B) Hypertension
C) Leukopenia
D) Hypoglycemia

Question 13 A patient’s current course of cancer treatment involves the administration of a conjugated monoclonal antibody. What characteristic of the drug is specified by the fact that it is classified as a conjugated drug?

A) The drug is derived from nonhuman sources.
B) The targeted therapy is combined with another substance that causes cell death.
C) The targeted therapy is combination of a monoclonal antibody, a kinase inhibitor, and an inorganic cytotoxin.
D) The drug is able to adapt its pharmacokinetics to the etiology of the patient’s cancer.

Question 14 An oncology nurse is reviewing the pathophysiology of cancer and is discussing with a colleague the factors that contribute to the success or failure of a patient’s chemotherapy. Which of the following cancerous cells is most susceptible to the effects of chemotherapeutic drugs?

A) Cells with a long generation time
B) Cells that lack contact inhibition
C) Cells that have a rapid mitotic rate
D) Cells that lack a blood supply

Question 15 A patient receiving high-dose cisplatin therapy exhibits symptoms of hypomagnesemia. Which of the following should the nurse suggest to help offset the magnesium losses from the cisplatin therapy?

A) Consuming dairy products
B) Consuming chocolates
C) Drinking 2 to 3 liters of fluid a day
D) Consuming potassium-rich foods

Question 16 An older adult woman has been diagnosed with acute lymphoblastic leukemia (ALL) and her care team has identified potential benefits of imatinib. Which of the following characteristics of this patient’s current health status may preclude the use of imatinib?

A) The patient has type 2 diabetes mellitus that is controlled using diet and oral antihyperglycemics.
B) The patient has chronic heart failure resulting in significant peripheral edema.
C) The patient experienced a mild ischemic stroke several years ago and had transient ischemic attacks last year.
D) The patient had a total knee arthroplasty several months earlier.

Question 17 A female patient is prescribed oprelvekin therapy to treat thrombocytopenia. Which of the following should the nurse continuously monitor to determine the efficacy and duration of the oprelvekin therapy?

A) Weight gain
B) Platelet count
C) Red and white blood cell count
D) Cardiac arrhythmias

Question 18 During ongoing assessment of a patient receiving 5-FU therapy, the nurse finds the patient’s platelet count to be 92,000 cells/mm3. The nurse should do which of the following?

A) Consult the prescriber for an increase in dosage
B) Consult the prescriber for a decrease in dosage
C) Consult the prescriber for discontinuation of the drug
D) Continue the therapy as prescribed

Question 19 A nurse has been assigned to a female patient who is to begin chemotherapy. The nurse will initiate the prescribed oprelvekin therapy

A) 6 to 24 hours after chemotherapy.
B) 2 days after chemotherapy.
C) 6 days after chemotherapy.
D) 10 days after chemotherapy.

Question 20 A patient with a recent diagnosis of chronic myelogenous leukemia (CML) is discussing treatment options with his care team.What aspect of the patient’s condition would contraindicate the use of cyclophosphamide for the treatment of leukemia?

A) The patient has a diagnosis of type 2 diabetes and takes oral antihyperglycemics.
B) The patient has had a history of nonadherence to medical treatment.
C) The patient’s bone marrow function is significantly depressed.
D) The patient has decreased renal function.

Question 21 A female patient has follicular non-Hodgkin’s lymphoma and is receiving thalidomide (Thalomid). It will be most important for the nurse to monitor this patient for which of the following?

A) Angina
B) Fever
C) Chills and rigors
D) Bleeding

Question 22 When planning care for a patient who is receiving filgrastim (Neupogen) for a nonmyeloid malignancy, the nurse should formulate which of the following patient outcomes? (Select all that apply.)

A) The patient will not develop an infection.
B) The patient will not experience bone pain.
C) The patient will be able to self-administer filgrastim at home.
D) The patient will not develop febrile neutropenia.
E) The patient will not retain fluid.

Question 23 A nurse is to use a single-dose 1 mL vial to administer 0.5 mL of epoetin alfa to a 39-year-old woman who is being treated for chemotherapy-induced anemia. Which of the following will the nurse do with the unused portion of the drug?

A) Refrigerate the medication for a future use.
B) Discard the unused portion of the drug.
C) Store the medication in the drug cart for the next dose.
D) Put the medication in the freezer compartment of the refrigerator.

Question 24 nurse is discussing oprelvekin therapy with a male patient. Which of the following will the nurse tell the patient is the most common adverse effect of the drug?

A) Medullary bone pain
B) Papilledema
C) Fluid retention/weight gain
D) Atrial arrhythmia

Question 25 A patient with chronic heart failure has begun treatment with epoetin alfa, which she will receive in her own home from a home health nurse. The nurse should teach the patient to supplement this treatment with a diet that is high in

A) iron-rich foods such as beans and leafy green vegetables.
B) complex carbohydrates and vegetable-source proteins.
C) calcium, such as dairy products, fish and vegetables.
D) protein and low in carbohydrates.

Question 26 A nurse is administering rituximab to a patient via the IV route. The nurse will set the IV pump at 50 mg/hour for the first half hour of the initial infusion. If there are not apparent reactions after 30 minutes of the infusion, the nurse will increase the dosage every 30 minutes by 50 mg/hour until the maximum infusion rate reaches which of the following?

A) 250 mg/hour
B) 300 mg/hour
C) 400 mg/hour
D) 500 mg/hour

Question 27 A 62-year-old patient taking tamoxifen exhibits increased bone and tumor pain along with a local disease flare. The nurse interprets this as an indication of which of the following?

A) A hypersensitivity reaction
B) The tumor responding to treatment
C) Nephrotoxic effects of tamoxifen
D) Cardiomyopathy

Question 28 A male patient is receiving rituximab therapy for non-Hodgkin’s lymphoma. Which of the following would be a priority nursing intervention to reduce the risk for cytotoxicity and tumor lysis syndrome?

A) Ensure that the patient maintains a normal breathing pattern.
B) Ensure that the patient maintains a normal fluid and electrolyte balance.
C) Protect the patient from exposure to infections.
D) Monitor the patient for deterioration in renal function.

Question 29 A patient with a diagnosis of chronic myeloid leukemia has met with her oncologist, who has recommended treatment with the kinase inhibitor imatinib. What route of administration should the nurse explain to the patient?

A) Daily intramuscular injections throughout the course of treatment
B) Peripheral IV administration three times a day for 7 to 10 days
C) Weekly IV infusions over 6 to 8 hours through a central line
D) Oral administration of imatinib in a home setting

Question 30 A 60-year-old patient experienced a sudden onset of chest pain and shortness of breath and was subsequently diagnosed with a pulmonary embolism in the emergency department. The patient has been started on an intravenous heparin infusion. How does this drug achieve therapeutic effect?

A) By promoting the rapid excretion of vitamin K by the gastrointestinal mucosa
B) By inhibiting the action of vitamin K at its sites of action
C) By inhibiting platelet aggregation on vessel walls and promoting fibrinolysis
D) By inactivating clotting factors and thus stopping the coagulation cascade

Question 31 A male patient has been on long-term bicalutamide (Casodex) therapy. In order to assess adverse effects of the drug therapy, the nurse will closely monitor which of the following?

A) Visual function
B) Blood counts
C) Pap test results
D) Liver function

Question 32 Intravenous carmustine has been prescribed for a patient with cancer. The nurse should help relieve the discomfort of pain and burning during the infusion by

A) slowing the infusion.
B) decreasing the volume used for dilution.
C) decreasing the total volume of the primary IV infusion.
D) administering a dose of 2 units of bleomycin before carmustine.

Question 33 A middle-aged patient has received a diagnosis of GI stromal tumor following an extensive diagnostic workup. Imatinib has been recommended as a component of the patient’s drug regimen. What patient education should the nurse provide to this patient?

A) “It’s important that you let us know if you develop any significant swelling or puffiness.”
B) “Try to keep your PICC line dressing as dry as possible at all times.”
C) “You’ll likely experience a lot of dry mouth while you’re taking this drug, so it’s helpful to chew ice chips.”
D) “If you experience significant nausea after taking a dose, stop taking the drug and schedule an appointment at the clinic.”

Question 34 A nurse has completed a medication reconciliation of a patient who has been admitted following a motor vehicle accident. Among the many drugs that the patient has received in the previous year is rituximab. The nurse would be justified in suspecting the patient may have received treatment for which of the following diseases?

A) Non-Hodgkin’s lymphoma
B) Malignant melanoma
C) Nonsmall cell lung cancer
D) Renal cell carcinoma

Question 35 Mr. Lepp is a 63-year-old man who was diagnosed with colon cancer several weeks ago and who is scheduled to begin chemotherapy.He reports to the nurse that he read about the need for erythropoietin in an online forum for cancer patients and wants to explore the use of epoetin alfa with his oncologist. Which of the following facts should underlie the nurse’s response to Mr. Lepp?

A) Epoetin alfa is normally contraindicated in patients who are receiving radiotherapy or chemotherapy.
B) Treatment with epoetin alfa will likely begin 4 to 6 days before Mr. Lepp’s first round of chemotherapy and continue indefinitely.
C) The potential benefits of epoetin alfa must be weighed carefully against the potential adverse effects in cancer patients.
D) Mr. Lepp’s oncologist should have begun treatment with epoetin alfa immediately after he was diagnosed.

Explain how using EDI facilitates electronic transactions. Explain how HIPAA has changed how health care information is transmitted in EDI.  Describe the relationship between Electronic Health Records, reimbursement, HIPAA, and EDI transactions.

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I have uploaded an example. Please use the example provided as a reference only

 

Imagine you are the office manager at a small doctor’s office. As the office manager, you are in charge of educating new hires.

Write a 700- to 1,050-word reference guide describing electronic data interchange (EDI).

Include the following in your summary:

  • Define EDI.
  • Explain how using EDI facilitates electronic transactions.
  • Explain how HIPAA has changed how health care information is transmitted in EDI.
  • Describe the relationship between Electronic Health Records, reimbursement, HIPAA, and EDI transactions.

Cite a minimum of two outside sources. For additional information on how to properly cite your sources, log on to the Reference and Citation Generator in the Center for Writing Excellence.

Format your assignment according to APA guidelines.

Students will develop a 1,250-1,500 word (word count does not include references)  paper that includes the following information as it applies to the  problem, issue, suggestion, initiative, or educational need profiled in  the capstone change proposal:

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Benchmark Capstone Change Proposal

In  this assignment, students will pull together the change proposal project  components they have been working on throughout the course to create a  proposal inclusive of sections for each content focus area in the  course. At the conclusion of this project, the student will be able to  apply evidence-based research steps and processes required as the  foundation to address a clinically oriented problem or issue in future  practice.

Students will develop a 1,250-1,500 word (word count does not include references)  paper that includes the following information as it applies to the  problem, issue, suggestion, initiative, or educational need profiled in  the capstone change proposal:

  1. Background
  2. Problem statement
  3. Purpose of the change proposal
  4. PICOT
  5. Literature search strategy employed
  6. Evaluation of the literature
  7. Applicable change or nursing theory utilized
  8. Proposed implementation plan with outcome measures
  9. Identification of potential barriers to plan implementation, and a discussion of how these could be overcome
  10. Appendix section, if tables, graphs, surveys, educational materials, etc. are created (I am not sure what an appendix section is but if you know please add something. I do know it should come AFTER the references)

All reference resources are attached. Please use the Literature Review paper as just a REFERENCE.

Prepare this assignment according to APA Style Guidelines. An abstract is not required.

This assignment uses a rubric (ATTACHED). Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

ELIMINATION COMPLEXITIES

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Health History

Mr. C., a 32-year-old single male, is seeking information at the outpatient center regarding possible bariatric surgery for his obesity. He currently works at a catalog telephone center. He reports that he has always been heavy, even as a small child, gaining approximately 100 pounds in the last 2-3 years. Previous medical evaluations have not indicated any metabolic diseases, but he says he has sleep apnea and high blood pressure, which he tries to control by restricting dietary sodium. Mr. C. reports increasing shortness of breath with activity, swollen ankles, and pruritus over the last 6 months.

Objective Data:

1. Height: 68 inches; weight 134.5 kg

2. BP: 172/98, HR 88, RR 26

3. 3+ pitting edema bilateral feet and ankles

4. Fasting blood glucose: 146 mg/dL

5. Total cholesterol: 250 mg/dL

6. Triglycerides: 312 mg/dL

7. HDL: 30 mg/dL

8. Serum creatinine 1.8 mg/dL

9. BUN 32 mg/dl

Critical Thinking Essay

In 900-words, critically evaluate Mr. C.’s potential diagnosis and intervention(s). Include the following:

1. Describe the clinical manifestations present in Mr. C.

2. Describe the potential health risks for obesity that are of concern for Mr. C. Discuss whether bariatric surgery is an appropriate intervention.

3. Assess each of Mr. C.’s functional health patterns using the information given. Discuss at least five actual or potential problems can you identify from the functional health patterns and provide the rationale for each. (Functional health patterns include health-perception, health-management, nutritional, metabolic, elimination, activity-exercise, sleep-rest, cognitive-perceptual, self-perception/self-concept, role-relationship, sexuality/reproductive, coping-stress tolerance.)

4. Explain the staging of end-stage renal disease (ESRD) and contributing factors to consider.

5. Consider ESRD prevention and health promotion opportunities. Describe what type of patient education should be provided to Mr. C. for prevention of future events, health restoration, and avoidance of deterioration of renal status.

6. Explain the type of resources available for ESRD patients for nonacute care and the type of multidisciplinary approach that would be beneficial for these patients. Consider aspects such as devices, transportation, living conditions, return-to-employment issues.

You are required to cite to three sources to complete this assignment. Sources must be published within the last 5 years. Also, you must have an abstract and a conclusion with a minimum of 5 sentences to wrap up this case study.

 

Health Policy And Legal Aspect (Assignment)

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Overview: Peer Review

In the Module 3 Reflection Assignment, you will reflect upon what you have learned about Peer Review Committee processes and Texas Board of Nursing rules as you consider the actions of fictitious nurses and committee members in scenarios. REMEMBER, YOU ARE USING THE TEXAS BOARD OF NURSING RULES, NOT THE STATE YOU LIVE IN. Please use the link provided in the assignment for the Texas BON Rule 217.16.

ALSO, THERE ARE 2 PARTS TO THIS ASSIGNMENT. PLEASE MAKE SURE YOU COMPLETE BOTH PARTS.

Refer to your course readings and lectures as you complete the assignment.

Performance Objectives:

· Apply the Minor Incident Rule to specific incidents.

· Describe the due process protections for a nurse who is peer-reviewed.

Rubric

Use this rubric to guide your work on the assignment, “Peer Review.”

 

Task

Accomplished

Proficient

Needs Improvement

 

Part 1 (a)

Applying Rule 217.16

(Total 50 points)

Lists all the correct 5 criteria, accurately explains application of   criteria clearly. (25 points)

Lists 3 or 4 of the   correct criteria, accurately explains application of these criteria

(15 points)

Lists 2 applications of criteria.

10 points)

Incorrectly lists criteria (0   point)

 

Part   1 (b)

Reflects upon applications

of Rule 217.16

(Total 25 points)

Correctly states if nurse should be reported or not reported with 3 substantial sentences. (25 points)

Correctly states if nurse should be reported or not reported with 2 sentences.

(15 point)

Writes 1 sentence.

(10 points)

Incorrectly judges whether violations occurred (0 point)

 

Part   2

Violation of IBPR Rule 217.19 (Total   25 points)

Correctly listed the 4 violations and provides correct explanations (25 points)

Correctly lists 2-3 violations and explanations (15 points)

Lists 1 violation and explanation (10 points)

Incorrectly lists criteria (0 point)

 

All 5 questions correct (25 points)

4 questions correct (20 points)

3 questions correct (15 points)

2 questions correct (10 points)

1 question correct (5 points)

0 questions correct (0 point)

 

Part 1: (a) Applying Rule 217.16(h) Minor Incidents

Read the following scenario and then answer the questions that follow:

You are on your hospital’s Peer Review Committee (PRC). You are reviewing Nurse A’s practice. She works on the pediatric unit. In the past, Nurse A has practiced safely without incidents. However, four months ago, Nurse A gave immunizations to five pediatric patients (3 months, 9 months, 2 years, 4 years, and 5 years of age). She used a vial of Hepatitis B vaccine that had been expired for 30 days but still was being stored in the unit refrigerator. She gave the five immunizations within a few minutes of each other, and she got the vial from the refrigerator only once (i.e., She did not take it out and replace it five times). She took responsibility for the errors when she was informed by her unit manager.

Should Nurse A be reported to the BON?

 

Let’s review what deems a minor vs. a reportable (NOT minor) incident-

A minor incident is- 217.16(a)-  as defined under the Texas Nursing Practice Act, Texas Occupations Code §301.401(2), means conduct by a nurse that may be a violation of the Texas Nursing Practice Act or a Board rule but does not indicate the nurse’s continued practice poses a risk of harm to a patient or another person.

A reportable incident is- 217.16(h)- conduct that falls outside of the definition of a minor incident and must be reported to a PRC or BON.

Apply the Minor Incident Rule to reach and support your decision. This Rule 217.16 can be found at http://www.bon.texas.gov/rr_current/217-16.asp

Use this specific link only- it is the official updated Texas Board of Nursing information. Click on the link and scroll down to the bottom to find the letter (h), where criteria are listed that describes actions that must be reported to the Peer Review Committee or BON.

Criteria. In the first column of the table, list the 5 criteria as it appears in the rule that are essential in determining if an incident is a reportable action. All 5 must be listed for full credit. Then, in the second column, record your explanation as to why or why not the nurse’s actions deem it reportable and therefore harmful to a patient.

 

Criteria that determine an incident is reportable

Rule 217.16(h)

Explanation of whether or not Nurse A’s actions are minor vs. reportable

Criteria :

1.

 

2.

 

3.

 

4.

 

5.

Part 1: (b) Report vs. Not Report

Based on the Rule 217.16(h) criteria you listed above, would you report Nurse A to the Board? Please explain why or why not. At least 3 substantial sentences are needed for full credit.:       (Explain below)

 

 

 

Part 2: Applying Rule 217.19 Incident-Based Peer Review

Read the following scenario and then reflect upon the actions it portrays.:

Last month, the chairperson of your hospital’s Peer Review Committee (PRC) passed you in the hallway and said, “I’m glad I ran into you. You’re going to be peer-reviewed.” The chairperson continued, saying, “Your manager found out that you called the Texas Department of State Health Services two months ago and reported that LVNs were being allowed to do the complete initial assessment on patients. Also, you made some medication errors over the past couple of months. I’ll let you know when the meeting is to occur.”

You heard nothing more about the PRC meeting. Today, the chairperson came to you and told you that you had been reported to the Texas Board of Nursing. She said, “It was just felt by the work group that you are a troublemaker and lack the skills to practice due to your med errors. I’m also giving you a ‘heads up’ that you are going to be put on suspension for at least three days by your unit manager.”

Applying Rule 217.19, what violations of the rule occurred in the above scenario?

First, review your learning about incident-based peer review. In the first column of the table, list any 4 criteria from Rule 217.19 that were violated (there are more than 4 to choose from).

1-

2-

3-

4-

In the second column, explain how each criterion was violated. All 4 boxes must be completed for full credit. Please use the link provided at http://www.bon.texas.gov/rr_current/217-19.asp

 

Which part of the rule was violated?

(Subsection number and letter OR descriptive phrase)

(Rule 217.19)

Explanation of violation ( from the 4 criteria above):

 

1.

 

2.

 

3.

 

4.

Case Study On Death And Dying

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The practice of health care providers at all levels brings you into contact with people from a variety of faiths. This calls for knowledge and understanding of a diversity of faith expressions; for the purpose of this course, the focus will be on the Christian worldview.

Based on “Case Study: End of Life Decisions,” the Christian worldview, and the worldview questions presented in the required topic study materials you will complete an ethical analysis of George’s situation and his decision from the perspective of the Christian worldview.

Provide a 1,500-2,000-word ethical analysis while answering the following questions:

How would George interpret his suffering in light of the Christian narrative, with an emphasis on the fallenness of the world?
How would George interpret his suffering in light of the Christian narrative, with an emphasis on the hope of resurrection?
As George contemplates life with amyotrophic lateral sclerosis (ALS), how would the Christian worldview inform his view about the value of his life as a person?
What sorts of values and considerations would the Christian worldview focus on in deliberating about whether or not George should opt for euthanasia?
Given the above, what options would be morally justified in the Christian worldview for George and why?
Based on your worldview, what decision would you make if you were in George’s situation?
Remember to support your responses with the topic study materials.

Prepare this assignment according to the guidelines found in the APA Style Guide. An abstract is required.

This assignment uses a rubric.You are required to submit this assignment to LopesWrite.

1. Bioethics: A Primer for Christians

Read Chapters 6 and 12 in Bioethics: A Primer for Christians.

http://gcumedia.com/digital-resources/wm-b-eerdmans-publishing-co/2013/bioethics_a-primer-for-christians_ebook_3e.php
2. Called to Care: A Christian Worldview for Nursing

Read Chapters 10-12 in Called to Care: A Christian Worldview for Nursing.

http://gcumedia.com/digital-resources/intervarsity-press/2006/called-to-care_a-christian-worldview-for-nursing_ebook_2e.php

3. Defining Death: Medical, Legal and Ethical Issues in the Determination of Death

Read the Introduction and Chapters 1-3 of “Defining Death: Medical, Legal and Ethical Issues in the Determination of Death” by the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (1984).

https://repository.library.georgetown.edu/bitstream/handle/10822/559345/defining_death.pdf?sequence=1

Rubric

Analysis of how the man would interpret his suffering in light of the Christian narrative and the fallenness of the world is clear and demonstrates a deep understanding that is skillfully supported by topic study materials. 12%
Analysis of how the man would interpret his suffering in light of the Christian narrative and the hope of resurrection is clear and demonstrates a deep understanding that is skillfully supported by topic study materials. 12%
Analysis of how the Christian worldview of the man might inform his view about the value of his life as a person with ALS is clear and demonstrates a deep understanding that is skillfully supported by topic study materials.12%
Evaluation of which values and considerations the Christian worldview focuses on when deliberating the option of euthanasia for the man is clear and demonstrates a deep understanding that is skillfully supported by topic study materials. 12%
Evaluation of which options would be justified in the Christian worldview for the man is clear and demonstrates a deep understanding that is skillfully supported by topic study materials. 12%
Reflection hypothesis of which personal choices would be make if faced with ALS based on personal worldview is clear, relevant, and insightful. 10%
Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear. 7%
Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative. 8%
Writer is clearly in command of standard, written, academic English. 5%
All format elements are correct.5%
Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error. 5%

Assessing Client Family Progress

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                           Practicum – Assessing Client Family Progress

Learning Objectives

Students will:

· Create progress notes

· Create privileged notes

· Justify the inclusion or exclusion of information in progress and privileged notes (SEE ATTACHED SAMPLE OF PROGRESS AND PRIVILIGED NOTE)

· Evaluate preceptor notes

To prepare:

· Reflect on the client family you selected for the Week 3 Practicum Assignment (SEE ATTACHED WEEK 3 NOTE),

                                                             The Assignment

                 Part 1: Progress Note

Using the client family from your Week 3 Practicum Assignment address in a progress note (without violating HIPAA regulations) the following:

· Treatment modality used and efficacy of approach

· Progress and/or lack of progress toward the mutually agreed-upon client goals

(reference the treatment plan for progress toward goals)

· Modification(s) of the treatment plan that were made based on progress/lack of

progress

· Clinical impressions regarding diagnosis and or symptoms

· Relevant psychosocial information or changes from original assessment (e.g.,

marriage, separation/divorce, new relationships, move to a new

house/apartment, change of job)

· Safety issues

· Clinical emergencies/actions taken

· Medications used by the patient, even if the nurse psychotherapist was not the

one prescribing them

· Treatment compliance/lack of compliance

· Clinical consultations

· Collaboration with other professionals (e.g., phone consultations with physicians,

psychiatrists, marriage/family therapists)

· The therapist’s recommendations, including whether the client agreed to the

recommendations

· Referrals made/reasons for making referrals

· Termination/issues that are relevant to the termination process (e.g., client

informed of loss of insurance or refusal of insurance company to pay for

continued sessions)

· Issues related to consent and/or informed consent for treatment

· Information concerning child abuse and/or elder or dependent adult abuse,

including documentation as to where the abuse was reported

· Information reflecting the therapist’s exercise of clinical judgment

Note: Be sure to exclude any information that should not be found in a discoverable progress note.

                       Part 2: Privileged Note

· Based on this week’s readings, prepare a privileged psychotherapy note that you would use to document your impressions of therapeutic progress/therapy sessions for your client family from the Week 3 Practicum Assignment. (SEE ATTACHED WEEK 3 NOTE),

In your progress note, address the following:

· Include items that you would not typically include in a note as part of the clinical record.

· Explain why the items you included in the privileged note would not be included in the client family’s progress note.

· Explain whether your preceptor uses privileged notes. If so, describe the type of information he or she might include. If not, explain why.