Assignment: Week 1 discussion

Assignment: Week 1 discussion
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Assignment: Week 1 discussion
Assignment: Week 1 discussion
Assignment: Week 1 discussion
Assignment: Week 1 discussion
Changes in Sites of Care
Since the culture and practices of care settings are inherently different, changes in sites of care are often difficult for geriatric patients. Efforts should be made to limit changes to only those necessary; however, sometimes a patient’s situation might require multiple changes in sites of care. When selecting sites of care, such as home, assisted living, rehabilitation facilities, and hospitals, many factors must be considered by patients, their families, and their health care providers. Health status, ability to perform self-care, financial limitations, and patient preferences are all factors that might influence a patient’s site placement. As an advanced practice nurse who recommends sites of care and facilitates changes, you must evaluate factors and consider sites that limit the impact of these changes on geriatric patients.
To prepare:
Review this week’s media presentation, as well as Chapters 4 and 7 of the Flaherty and Resnick text.
Reflect on your personal experiences, observations, and/or clinical practices from the last 5 years. Select a case from the last 5 years that involves an elderly patient who has been in two different sites of care such as home, assisted living, hospital, etc. Note: When referring to your patient, make sure to use a pseudonym or other false form of identification. This is to ensure the privacy and protection of the patient.
Reflect on issues that occurred because of the change in the patient’s sites of care. Think about the impact of differences in the settings themselves, inherent cultures of the settings, and ethical practices of these sites on the patient.
Consider whether the patient had an advanced directive in place at the time of the change in sites of care. Reflect on whether any difficult treatment decisions had to be made as a result.
Think about the impact of financial issues on site placement and treatment decisions.
Post on or before Day 3 a description of a case from your personal or clinical experiences in the last 5 years that involves an elderly patient who has been in at least two different sites of care. Explain the impact of differences in the settings themselves, inherent culture of the settings, and ethical practices of these sites on the patient. Then, explain whether the patient had an advanced directive in place at the time of the change in sites of care, and if so, whether any difficult treatment decisions had to be made as a result. Finally, explain the impact of financial issues on site placement and treatment decisions.
Read a selection of your colleagues’ responses.
Respond on or before Day 6 to at least two of your colleagues on two different days in one or more of the following ways:
Suggest community resources that may assist with related cases in the future.
Recommend appropriate alternative site placements for your colleagues’ patients based on your geographic location.
Provide insights on policy implications of your colleagues’ cases (i.e., Medicare, Medicaid, Veteran’s Affairs, etc.).
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Week 2 discussion
Assessment Tools
As geriatric patients age, their health and functional stability may decline resulting in the inability to perform basic activities of daily living. In your role as the advanced practice nurse, you must assess whether the needs of these aging patients are being met. Comprehensive geriatric assessments are used to determine whether these patients have developed or are at risk of developing age-related changes that interfere with their functional status. Since the health status and living situation of geriatric patients often differ, there are a variety of assessment tools that can be used to evaluate wellness and functional ability. For this Discussion, consider which assessment tools would be appropriate for the patients in the following three case studies:
Case Study 1:
Mr. Smith, age 77, reports for an annual physical examination. He says he is doing well. His only known problem is osteoarthritis. He also requests a flu shot. He takes no medications other than Tylenol for arthritis pain. When he walks into the exam room, you notice that he is using a straight cane in his right hand. When you ask about the cane, he says he began using the cane because the pain in his right hip had increased significantly over the past 6 months.
Case Study 2:
Mr. Jones, a 68-year-old man, was referred to your office for a hearing evaluation. He continues to work in a printing company, although he works only part-time. He has worked at the printing company for the past 35 years. He complains that he cannot hear much of the dialogue on the television. He is accompanied by his wife, who states that her husband cannot hear her at home. He has no history of dizziness, tinnitus, or vertigo. He has had cerumen impactions removed from both ears in the past. Overall, his medical history is quite benign. His only medications are aspirin 81 mg daily, a multivitamin daily, and occasional ibuprofen for back pain.
Assignment: Week 1 discussion
Assignment: Week 1 discussion
Assignment: Week 1 discussion
Assignment: Week 1 discussion
Case Study 3:
Mrs. Roberts, an 83-year-old widow, is brought to the office by her daughter. The daughter claims that her mother seems to be depressed. There is a history of depression approximately five years ago, shortly after Mrs. Roberts’ husband died. At that time, she was successfully treated with antidepressants. Currently, the daughter states that her mother’s memory for appointments and events has declined severely, and she can no longer drive because she does not remember the route to the store or other familiar places. The daughter also noted that her mother’s house seemed very disorganized and dirty, there was a limited amount of food in the kitchen, and the checkbook had not been balanced for several months. Mrs. Roberts appears slightly disheveled, she has a flat affect, and she does not maintain eye contact during your interview.
To prepare:
Review the Rosen and Reuben article in this week’s Learning Resources. Consider how assessment tools are used to evaluate patients.
Select one of the three case studies. Based on the provided information, think about a possible patient evaluation plan. As part of your evaluation planning, consider where the evaluation would take place, whether any other professionals or family members should be present, appropriate assessment tools and guidelines, and any other relevant information you may wish to address.
Consider whether the assessment tool you identified was validated for use with this specific patient population and if this poses issues. Think about additional factors that might present issues when performing assessments, such as language, education, prosthetics, missing limbs, etc.
Post on or before Day 3 an explanation of your evaluation plan for the patient in the case study you selected and explain which type of assessment tool you might use for the patient. Explain whether the assessment tool was validated for use with this patient’s specific patient population and whether this poses issues. Include additional factors that might present issues when performing assessments, such as language, education, prosthetics, missing limbs, etc.
Read a selection of your colleagues’ responses.
Respond on or before Day 6 to at least two of your colleagues on two different days in one or more of the ways listed below. Respond to colleagues who selected different case studies than you did.
Suggest alternative assessment tools and explain why these tools might be appropriate for your colleagues’ patients.
Recommend strategies for mitigating issues related to use of the assessment tools your colleagues discussed.
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Week 3 discussion
Models of Interdisciplinary Geriatric Care Teams
With the growing population of frail elders, there is an increase of geriatric patients requiring ongoing care for multiple medical conditions. This creates the need for interdisciplinary geriatric care teams. Often, the dynamics and culture of these teams differ across various sites of care, such as assisted living, home care, hospitals, long-term care, and rehabilitation facilities. As an advanced practice nurse, it is important to understand your role in the care team as well as your potential impact on patient care. In this Discussion, you explore models of interdisciplinary geriatric care teams for different sites of care and the varying roles of the advanced practice nurse. Consider the following three case studies:
Case Study 1:
Mrs. Martinez is an 83-year-old Mexican American widow who lives in her own home and is cared for by her adult daughter. Mrs. Martinez owns the home, and her daughter lives with her and provides the care. Her daughter brought her mother to the clinic today to ask to speak to the social worker. She requests that her mother be placed in a nursing home. The daughter states that her mother has nothing to do during the day. The television is on The Weather Channel most of the day because Mrs. Martinez has limited English capability and is unable to read closed-captioning. Mrs. Martinez also has two sons who do not live in the local area, but they do call regularly and check in with their mother and sister. The two sons are opposed to moving their mother to a nursing home because they had promised her that they would “never put her away.”
Case Study 2:
Mr. Williams, a 79-year-old African American widower, resides in a foster care home. He has lived there for 4 years since his wife died. He is a former minister. His medical history includes long-term diabetes, high blood pressure, and benign prostatic hypertrophy. The home care provider has requested a home visit to evaluate Mr. Williams’s ability to remain in the home. The provider states that because Mr. Williams’s vision is seriously compromised (he is nearly blind), and because he has been unable to get to the toilet as quickly as necessary (he is very unsteady on his feet), his care is becoming burdensome. According to the home care provider, for safety reasons, Mr. Williams may not fit the criteria for remaining in the foster care home.
Case Study 3:
Mrs. Randall is a 77-year-old female who resides in a long-term care facility. She has a history of frequent falls and is severely cognitively impaired. The nursing staff at the long-term care facility called the nurse practitioner at the medical home office to report the recent development of productive cough and high fever. There have been cases of flu in the facility; however, Mrs. Randall has had a flu shot. The nurse practitioner in the office requests a chest x-ray in the long-term care facility. The nurse on duty in the facility states that there is no portable chest x-ray equipment available. She further requests that Mrs. Randall be transferred to the emergency room of the local hospital. Mrs. Randall’s daughter has durable power of attorney for health care decisions for her mother. The long-term care facility has notified the daughter of the change in her mother’s condition. The daughter says whatever the nursing home wants is fine with her.
To prepare:
Review this week’s media presentation, as well as the American Geriatrics Society and Arbaje et al. articles in the Learning Resources.
Research models of interdisciplinary geriatric care teams that are used at various sites, such as assisted living, home care, hospitals, long-term care, and rehabilitation facilities.
Consider the model used for the interdisciplinary geriatric care teams at your current practicum site. Compare this model to models used at other sites.
Reflect on how the role of the advanced practice nurse differs according to the site of care.
Select one of the three case studies. Consider how care should be facilitated for the patient in the case you selected based on the model used for the interdisciplinary geriatric care teams at your practicum site.
Post on or before Day 3 a comparison of the model used for the interdisciplinary geriatric teams at your current practicum site to models used at other sites. Then, explain how the role of the advanced practice nurse differs according to the site of care. Finally, explain how care should be facilitated for the patient in the case you selected based on the model used for the interdisciplinary geriatric teams at your practicum site.
Read a selection of your colleagues’ responses.
Respond on or before Day 6 to at least two of your colleagues on two different days in one or more of the ways listed below. Respond to colleagues who selected different case studies than you did.
Offer and support an alternative perspective based on your own experience and additional literature search.
Validate an idea with your own experience and additional literature search.
Click on the Reply button below to reveal the textbox for entering your message. Then click on the Submit button to post your message.
Week 4 discussion
Over-the-Counter Drugs
Pharmacokinetic and pharmacodynamic processes differ among patients across their life spans. For geriatric patients, alterations due to aging make them especially prone to adverse drug reactions. The various health issues that affect many geriatric patients further complicate this, as the need to treat these multiple health issues often results in polypharmacy. Although treatments are frequently drugs prescribed by the health care provider, many geriatric patients also take over-the-counter (OTC) drugs. While the provider sometimes recommends these OTC drugs, patients often select the drugs on their own. This makes patient education on pharmacology key when caring for geriatric patients. Many patients assume that if drugs are available over the counter, then they are safe to take. However, due to issues related to polypharmacy and how their aging bodies process drugs, OTC drugs may have serious implications for patients.
To prepare:
Review the American Geriatrics Society article and interactive media piece in this week’s Learning Resources.
Select one of the following over-the-counter drugs commonly used by geriatric patients:
Antacids or acid suppressants
Antidiarrheal
Antihistamines
Antimicrobial ointments
Antispasmodics for the bladder
Cough suppressants
Laxatives
Neutraceuticals (choose one; e.g., ginseng, St. John’s wart, etc.)
Pain medications (choose one; e.g., acetaminophen, ibuprofen, rub-on pain ointments/patches, etc.)
Supplements (choose one; e.g., calcium, iron, etc.)
Vaginal creams
Research the over-the-counter drug you selected. Visit a local pharmacy and explore the types/varieties of the drug that are available. Reflect on the ingredients in each type/variety, including additional active ingredients.
Consult with the pharmacist about the ingredients in each type/variety, including how to make safe and effective clinical decisions in relation to this drug. Discuss potential interactions in frail elders and precautions related to the drug based on Beers Criteria. If one is available, you may consult with a pharmacist at your practicum site as an alternative to visiting a pharmacy.
Consider ways to educate elders about the OTC drug you selected.
Post on or before Day 5 a PowerPoint presentation that addresses the following:
Describe the over-the-counter drug that you selected.
Identify the types/varieties of the drug that are available. Describe the ingredients in each type/variety including additional active ingredients.
Explain the key information that you need to know about this OTC drug to make safe and effective clinical decisions. Include potential interactions in frail elders and describe any precautions related to the drug based on Beers Criteria.
Explain how you would educate elders about the OTC drug you selected.
Read a selection of your colleagues’ responses.
Respond on or before Day 7 to at least two of your colleagues on two different days in one or more of the ways listed below. Respond to colleagues who selected a different drug than you did.
Suggest additional interactions in frail elders that may be caused by the ingredients in your colleagues’ drugs.
Provide insights to drug-drug interactions between the drug you selected and the drugs your colleagues selected.
Validate an idea with your own clinical experiences and additional literature search.
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Week 5 discussion
Fall-Risk Assessment
Fall risks are very high for the geriatric population. According to the Centers for Disease Control and Prevention (2013), one out of every three adults aged 65 years and older falls each year. This can be attributed to factors such as changes in aging, other health issues, environment, and effects of prescribed drugs. When caring for geriatric patients, it is important to screen them for risks and perform fall-risk assessments. These assessment tools help to determine the level of risk for patients so that preventive measures can be taken. The implications of falls are very serious and range from fractures to mental health disorders and even death. In this Discussion, you explore risk assessment tools for use with patients at your practicum site.
To prepare:
Review the Kanis article in this week’s Learning Resources.
Consider a geriatric patient at your practicum site who is at risk for falls. Coordinate an opportunity to assess this patient with your Preceptor. Note: When referring to your patient, make sure to use a pseudonym or other false form of identification. This is to ensure the privacy and protection of the patient.
In addition to the Fracture Risk Assessment Tool (FRAX), select one of the following tools to assess this patient for falls:
Tinetti Performance Oriented Mobility Assessment (POMA)
Systems Approach
Berg Balance Scale
Elderly Mobility Scale
Timed Unsupported Stead Stand (TUSS)
Six-Minute Walk Test (6MWT)
Hendrich II Fall Risk Model
Consider why you selected the assessment tool for this particular patient.
Assess the patient using the tool you selected under Preceptor guidance. Reflect on the assessment, including any issues with the patient and/or the effectiveness of the tool.
Think about strategies and interventions to reduce the risk of falls for frail elders.
Post on or before Day 3 a case study description of a geriatric patient from your practicum site who is at risk for falls. Describe this patient’s FRAX assessment. Then, describe the other assessment tool you used in the fall-risk assessment and explain why you selected the tool for this particular patient. Explain the patient assessment, including any issues with the patient and/or the effectiveness of the tool. Finally, explain strategies to reduce the risk of falls for your patient.
Read a selection of your colleagues’ responses.
Respond on or before Day 6 to at least two of your colleagues on two different days in one or more of the ways listed below. Respond to colleagues who selected a different assessment tool than you did.
Suggest alternative tools for assessing your colleagues’ patients.
Recommend additional strategies to reduce the risk of falls for your colleagues’ patients.
Share insights based on your own experience and additional literature search.
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Week 6 discussion
Patient Presentation of Dementia, Delirium, and Depression
With the prevalence of dementia, delirium, and depression in the growing geriatric population, you will likely care for elderly patients with these disorders. While many symptoms of dementia, delirium, and depression are similar, it is important that you are able to identify those that are different and properly diagnose patients. A diagnosis of one of these disorders is often difficult for patients and their families. In your role as the advanced practice nurse, you must help patients and their families manage the disorder by facilitating necessary treatments, assessments, and follow-up care. Consider the patient presentations in the following case studies. What distinct symptoms or factors would lead you to a diagnosis of dementia, delirium, or depression?
Case Study 1:
HPI: Mrs. Mayfield is a 75-year-old woman who is brought to the emergency room by the police at 11 p.m. She was found wandering and confused in a local neighborhood. The police were called when Mrs. Mayfield tried to use her key on a neighbor’s door. When confronted by the police she became abusive, confused, and frightened and looked very pale and agitated. The police could not establish her correct address and they subsequently brought her to the emergency room.
Review of Symptoms (ROS): Unable to obtain at this time.
Objective Data:
PE:
VS: Pulse 96 and regular; B/P 150/90; Axillary temperature 99°F.
General: She appears clean and well nourished, with no signs of injury, trauma, or neglect.
Her physical exam is unremarkable except –
Neuro: No gross focal neurological signs, but she is only intermittently cooperative. Her mental status fluctuates and a full neurological evaluation is not possible at this time.
Psych: A & O x 1 to person only. She has episodes of agitation and alternating withdrawal/somnolence. During the examination, it takes several attempts to gain Mrs. Mayfield’s attention to answer questions, but once focused, she rambles on in a disorganized and incoherent way.
Case Study 2:
CC: “irritable and forgetful”
HPI: Mrs. White, a 78-year-old married woman, is brought to the office of her primary care provider by her husband because of increasing forgetfulness and irritability over the past 3 months. Mr. White claims that his wife has had problems for several years now, but has just gotten “worse in her memory” in the past few months. She recently misplaced her purse and accused her son of stealing it.
On three occasions, she left the stove on and boiled a pot dry, nearly causing a fire. She recently put a container of ice cream into the washing machine instead of into the freezer and her husband did not discover it for more than a week. Mrs. White claims her family wants to take her money and leave her with nothing. “No matter what they say, there is nothing wrong with me,” she states.
Past Medical History (PMH) includes: hypothyroidism, treated with Synthroid, and successful treatment of breast cancer approximately 15 years prior. She also takes over-the-counter ibuprofen for chronic lower back pain and occasional Benadryl to help her sleep at night.
Objective data: Her physical examination is within normal limits.
Case Study 3:
HPI: Mr. George is a 72-year-old male who has lived alone since his wife died approximately 1 year ago. He has lived in the same house for 45 years. He is brought in by his son who is concerned that his father has lost more than 35 pounds over the past year. Mr. George admits to not eating well because “I don’t know how to cook for myself.”
PMH: He has been in good health with the exception of hypertension, which is well controlled.
Social history: He spends most of his time watching sports on television. He occasionally drinks one or two cans of beer when he is watching TV. He does go to his son’s house to visit with his grandchildren about once a week, and he says he enjoys that. He does not receive any social services, he still drives but only in the daytime, and he does not participate in any other leisure activities.
Objective data: His physical examination is normal. He responds correctly to questions, although he appears to have a flat affect.
To prepare:
Review Chapters 6–8 of the Holroyd-Leduc and Reddy text.
Select one of the three case studies. Reflect on the way the patient presented in the case study you selected, including whether the patient might be presenting with dementia, delirium, or depression.
Think about how you would further evaluate the patient based on medical history, current drug treatments, and the patient’s presentation. Consider whether you would modify drug treatments, use additional assessment tools, and/or refer the patient to a specialist.
Post on or before Day 3 an explanation of whether you suspect the patient in the case study you selected is presenting with dementia, delirium, or depression and why. Then, explain how you would further evaluate the patient in the case study based on medical history, current drug treatments, and the way the patient presented. Include whether you would modify drug treatments, use additional assessment tools, and/or refer the patient to a specialist.
Read a selection of your colleagues’ responses.
Respond on or before Day 6 to at least two of your colleagues on two different days in one or more of the ways listed below. Respond to colleagues who selected a different case study than you did.
Suggest additional tools for assessing the patients in the case studies your colleagues’ selected.
Offer and support an alternative perspective based on your own experience and additional research.
Validate an idea with your own experience and additional literature search.
Click on the Reply button below to reveal the textbox for entering your message. Then click on the Submit button to post your message.
Week 7 discussion
Nutrition and Hydration
Geriatric patients have many nutritional and hydration concerns that impact their health and ability to acquire sufficient nutrients. Advanced practice nurses evaluating these patients must be able to account for all barriers that prevent elders from obtaining adequate nutrition, including medical conditions, transportation, finances, physiologic changes, and functional abilities. When evaluating patients, it is important to consider how they eat, what their diet consists of, and whether they have any special dietary needs that are not being met. Assessment tools, such as the Lawton Instrumental Activities of Daily Living (IADL) Scale, are an integral part of this evaluation process as they help providers identify potential obstacles for patients. In this Discussion, you assess a patient at your current practicum site and consider strategies for improving any nutrition or hydration issues.
Assignment: Week 1 discussion
Assignment: Week 1 discussion
Assignment: Week 1 discussion
Assignment: Week 1 discussion
Assignment: Week 1 discussion
Assignment: Week 1 discussion
To prepare:
Review this week’s media presentation, as well as Chapters 28 and 29 of the Flaherty and Resnick text.
Assess a patient using tools for inpatient and long-term patient care, such as the Lawton IADL Scale. Note: You should coordinate this opportunity with the Preceptor at your practicum site.
Consider whether nutrition and/or hydration might be impacted by the patient’s functional abilities. Reflect on whether the patient is able to go out and get food to eat, cook meals, safely use the stove, etc.
Consider the patient’s diet and whether they have any special dietary needs due to medical conditions, such as congestive heart failure, end-stage kidney disease, diabetes, oral health issues, etc. Reflect on whether or not the patient is attempting to compensate for a medical issue and thus creating a deficiency or excess in his or her diet.
Based on your patient assessment, think about strategies for improving any nutrition issues that might have presented (e.g., nutritional supplements, community resources such as Meals on Wheels, referral to a nutritionist or dietician, etc.).
Post on or before Day 3 a description of the patient assessment you performed using a tool for inpatient and long-term patient care, such as the Lawton IADL Scale. Explain whether nutrition and/or hydration might be impacted by the patient’s functional abilities. Then, describe the patient’s diet and whether he or she has any special dietary needs due to medical conditions. Address whether or not the patient is attempting to compensate for a medical issue and thus creating a deficiency or excess in his or her diet. Finally, explain strategies for improving any nutrition issues that might present during the patient assessment.
Read a selection of your colleagues’ responses.
Respond on or before Day 6 to at least two of your colleagues on two different days in one or more of the following ways:
Suggest additional strategies for improving nutrition issues for your colleagues’ patients.
Offer and support an alternative perspective based on your own experience and additional literature search.
Validate an idea with your own experience and additional literature search.
Click on the Reply button below to reveal the textbox for entering your message. Then click on the Submit button to post your message.
Week 4 assignment part 1
Assignment 1: Practicum – Week 3 SOAP Note
In addition to journal entries, SOAP Note submissions are a way to reflect on your practicum experiences and connect these experiences to your classroom experience. SOAP Notes, such as the ones required in this course, are often used in clinical settings to document patient care. Refer to this week’s Learning Resources for guidance on writing SOAP Notes.
Select a geriatric patient that you examined during the last 3 weeks. The patient you select should be currently taking at least five prescription and/or over-the-counter drugs. With this patient in mind, address the following in a SOAP Note:
Subjective: What was the patient’s subjective complaint? What details did the patient provide regarding his or her personal and medical history? Include a list of prescription and over-the-counter drugs the patient is currently taking. Compare this list with the Beers Criteria and consider alternative drugs if appropriate.
Objective: What observations did you make during the physical assessment? What functional assessments were used?
Assessment: What were your differential diagnoses? Provide a minimum of three possible diagnoses. List them from top priority to least priority.
Plan: What was your plan for diagnostics and primary diagnosis? What was your plan for treatment and management including alternative therapies? What is your care plan for the patient? How would you offer caregiver support?
Reflection notes: What would you do differently in a similar patient evaluation? How might you improve your assessment, diagnosis, and/or plan through interprofessional collaboration?
Refer to this week’s Learning Resources for guidance on writing SOAP Notes.
By Day 7 of Week 4
This Assignment is due. You will submit this Week 3 SOAP Note along with your Journal Entries (from Weeks 1, 2, and 4). Practicum Time Log is Due in Week 3
Week 4 assignment part 2
Assignment 2: Practicum – Week 3 Time Log
By Day 7 of Week 3
Submit your Practicum Time Log. The Practicum Time Log template is located in the Week 1 Learning Resources. Contact the Instructor with any questions.
Note: For the Practicum Time Logs—which are assessed with a Satisfactory (S) or Unsatisfactory (U) score—the numerical grade will show as 0 points and the “S” or “U” will be posted in the Feedback area by your Instructor. These scores of 0 points do not affect your grade; they simply allow for a placeholder to place the “S” or “U” scoring. This concept also applies to Weeks 7 and 11.
Submission
To submit your completed Assignment for review and grading, do the following:
Please save your Assignment using the following naming convention: “WK3Assgn2+lastname+first initial”.
Click the Week 3 Assignment 2 link.
Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK3Assgn2+last name+first initial.(extension)” and click Open. If you are submitting multiple files, repeat until all files are attached.
Click on the Submit button to complete your submission.
Assignment: Practicum – Week 4 Journal Entry
Reflect on medication adherence issues you have encountered with geriatric patients in your practicum setting. Explain implications of these issues on patient health, as well as strategies to improve medication adherence for geriatric patients. If you did not have an opportunity to evaluate a patient with this background during the last 4 weeks, you can select a related case study or reflect on previous clini

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