For this discussion, you will Identify a situation in your current workplace where evidence based practice has been or could be applied. Is there a practice that seems out of date or "old fashioned?" Do you think there is a better approach, or has there been a recent change that was warranted? Dig into the literature and remember, this refers to decisions about patient care that are based on evidence that is produced by well designed research.  You will need to provide the research to support your decision. 

Planning is the key to successful completion of this course and your overall program of study. The Individual Success Plan (ISP) assignment requires early collaboration with the course faculty and your course mentor. You will need to establish a plan for successful completion of (1) deliverables associated with weekly course objectives, (2), required practice immersion hours, and (3) deliverables associated with your capstone project.Access the "Individual Success Plan" resource in the Topic Materials. Read the information in the resource, including student expectations and instructions for completing the ISP document.Use the "Individual Success Plan" to develop a personal plan for completing your practice hours and how topic objectives will be met. Include the number of hours you plan to set aside to meet your goals.A combination of 100 supervised clinical hours in community health and leadership areas will be obtained through the application of the objectives listed in the Guidelines for Undergraduate Field Experiences manual.Practicum immersion experiences are required in a community health setting. Community-based settings should encourage community integration and involvement; expand accessibility of services and supports; promote personal preference, strengths, dignity; and empower people to participate in the economic mainstream.According to HealthyPeople.gov, educational and community-based programs and strategies are designed to reach people outside of traditional health care settings. These settings may include schools, worksites, health care facilities, and communities. Community health and leadership practice immersion can occur in the same site and in conjunction with the evidence-based project in the NRS-490 course.If you are a registered nurse in Washington, your practicum experience must include a minimum of 50 hours in a community health setting.Students should apply concepts from prior courses to critically examine and improve their current practice. Students should also integrate scholarly readings to develop case reports that demonstrate increasingly complex and proficient practice.Consider the challenges you expect to encounter as you continue the practice hour and competency requirements throughout this course. How might you overcome these challenges?You can renegotiate these deliverables with your faculty and mentor throughout this course and update your ISP accordingly.Once your ISP has been developed and accepted by your course faculty, you will have your course mentor sign it at the beginning of, and upon completion of, each assignment that incorporates practice immersion hours. You will track all course practice immersion hours in the ISP.APA format is not required, but solid academic writing is expected.You are not required to submit this assignment to LopesWrite.

An obese patient, age 45, comes to your office. She recently moved from another state three weeks ago and told you that her FNP diagnosed her with type 2 diabetes mellitus. She is currently not on any medicine for her diabetes, and she wishes to avoid insulin, if possible. She is a non-smoker. Her blood pressure is 138/74 mmHg. Labs from 3-weeks ago was hemoglobin A1C = 8.4%; total cholesterol = 260 mg/dL, triglycerides = 290 mg/dL, HDL = 49 mg/dL, LDL = 170 mg/dL (calculated 10-year ASCVD risk = 6.2%). You discuss current treatment goal recommendations endorsed by the ADA regarding glycemic control, blood pressure control, and lipid management. She agrees to start any medications that you recommend with lifestyle modification and a DASH diet to treat hypertension.Q1. Which classes of diabetes medications are either weight neutral or cause weight loss? Please give one (1) example of a drug's generic and trade name in that class.Q2. Based on the current guidelines of the ADA, it would be appropriate to treat her with monotherapy since the patient is hesitant to take any injections. What agent would you recommend? Please provide the trade name, generic name, the dose you would start the patient with frequency, and route.Q3. What are the contraindications of your selected diabetic therapy?The patient returns to your office six months later complaining of fatigue for the past two months, constipation, and heavy, irregular menses. Upon examination, you note that her skin is dry, and her fingernails are brittle. You suspect she has hypothyroidism.Q4. What lab workup should you obtain? What sort of results will you see in patients who have hypothyroidism and hyperthyroidism? Q5. What is the treatment of choice for hypothyroidism? What is the mechanism of action? Please provide the initial dose, trade, and generic name of the drug, route, and frequency.Q6. What are the adverse effects, and what important teaching will you provide this patient on thyroid replacement therapy?