Medicine and Health Sciences Commons^™

Chemotherapy Induced Painful Peripheral Neuropathy: A Treatment Option, Maria M. Acevedo

Cohort X

BACKGROUND: Cancer diagnosis and treatment are tragic issues for patients. Besides the psychological aspects associated with therapeutic interventions, chemotherapy-induced painful peripheral neuropathy (CIPPN) is one of the long-term side effects of intravenous chemotherapeutic agents used to treat cancers. This type of neuropathic pain has not effectively responded to medications for peripheral neuropathy treatment. Duloxetine is effective in decreasing CIPPN. This evidence-based research investigates the practice changes that can be implemented to reduce the pain ratings of survivors with CIPPN.

METHODS: In this practice improvement project, patients with CIPPN who reported a rating of ≥3 on the pain scale with the …

Introduction Of Semaglutide As An Effective Option For Obese Patients Motivated To Lose Weight, Crystal Garcia-Martinez

Cohort X

Obesity has become a global crisis with a tremendous impact on patients and costs reaching billions of dollars each year. Prevention and treatment of this condition will be crucial to ongoing efforts to prevent its long-term complications. Health care providers may have the opportunity to educate patients and address weight management issues before serious complications develop. The United States Centers for Disease Control and Prevention, the American Heart Association, and many publications in the medical literature focus on methods that might be used to target weight loss with diet and exercise. Unfortunately, many patients have had little to no success …

Thiazide-Like Diuretics As First-Line Treatment To Improve Blood Pressure Management, Raquel Okubo

Cohort X

Background: Thiazide diuretics are currently the first-line treatment for hypertension (HTN). This class of drugs includes hydrochlorothiazide (HCTZ) and the thiazide-like diuretic, chlorthalidone (CTDN). The quality improvement project began in the fall semester with a 10- day reflective practice log to assess my current practice. A review of the clinical practice log allowed me to evaluate my current practice and identify three opportunities to improve my practice. I developed three potential PICOT questions and selected one for the QI project with the guidance of my Doctor of Nursing Practice (DNP) chairperson. I performed a literature review to gather the best …

Screening For Tnf Response Prior To Initiation Of Biologic Therapy For Precise Targeted Therapy, Miguel A. Rodriguez

Cohort X

Objective: A quality improvement project to improve outcomes in rheumatoid arthritis (RA) patients who are anti-CCP positive by starting targeted biologic/targeted synthetic DMARDs (b/tsDMARDs) therapy after screening for tumor necrosis factor inhibitor (TNFi) response. Using a targeted therapy approach, patient’s disease activity was checked before and after intervention. The goal was to achieve a clinical disease activity index (CDAI) of <10, showing low disease activity. Methods: Quality improvement model used was the Plan-Do-Study-Act cycle to aid in implementing change to improve patient outcomes. Quality improvement project used Lewin’s change theory. The project allowed for change in provider behavior and organization by using a systemic approach and strategies to improve patient outcomes. Lewin’s change theory consists of three parts: unfreezing, changing, and refreezing. The project unfroze the traditional way of prescribing biologic therapy. The screening tool for TNFi response was the change used to find TNF inhibitor non-responders prior to or during biologic therapy. The refreezing part of the theory is to continue screening for TNFi response after the project to ensure the most proper biologic is chosen. Results: A total of 27 patients were screened with TNFi nonresponse prediction tool during a 6-week period. 10 patients were predicted non-responders to TNFi therapy. 15 patients had no prediction of non-response to TNF inhibitor therapy. Two patients were not resulted due sample quality issues. Test results information, the patient’s clinical picture, and therapies were adjusted accordingly. Conclusion: The use of the TNFi nonresponse prediction screening tool allowed for the 10 predicted non-responders to avoid TNFi that would be traditionally started on first line treatment. These 10 patients saved time, money, health, disability, and joint deterioration by starting or continuing proper treatment.

Implementing An Osteoporosis Screening And Treatment Protocol For Patients With Fragility Fractures, Lyndsey Slape

Cohort X

Osteoporosis is a global health concern that can be identified and treated with appropriate screening and medical management. The number of fragility fractures that occur will continue to rise with an aging population and is a key predictor of osteoporosis. However, many patients with fragility fractures do not receive the recommended post-fracture care. Poor bone health places patients at increased risk for secondary fracture and has serious emotional, physical, and financial consequences (Kanis et al., 2021). Understanding the benefit of identifying osteoporosis and preventing secondary fractures in an orthopedic clinic has proven advantageous in optimizing bone health and reducing fracture …

Empagliflozin And/Or Metformin: A Combination Approach For Uncontrolled Type 2 Diabetes, Maria Crespin

Cohort X

Background: Current guidelines recommend metformin as the first-line agent therapy for the

management of Type 2 Diabetes (T2D) when diet and exercise are insufficient. When

monotherapy with metformin is intolerant or contraindicated, or not sufficiently effective to

reach the glycated hemoglobin (HbA1c) target, a second anti-diabetic agent as an alternative or

add-therapy to metformin is recommended by all guidelines. The quality improvement project

was initiated in the fall semester with a 10-day reflective practice log to assess my current

practice. A review of the clinical practice log allowed for evaluation of my current practice and

identify three opportunities to improve …

Management Of Uncontrolled Type 2 Diabetes Mellitus With Combination Therapy With Metformin And/Or Glucagon-Like Peptide-1 Receptor Agonists/ Sodium-Glucose Cotransporter-2 Inhibitors, Bertha L. Contreras

Cohort X

The management of chronic medical conditions in a primary care practice requires knowledge and commitment, particularly when providing services for the underserved. Type 2 diabetes mellitus (T2DM) is a complex and difficult condition that can result in complications that affect multiple organ systems. Numerous studies have described GLP-1RAs and SGLT-2is as complementary agents that can be used to prevent the multi-organ complications associated with T2DM. The purpose of this Quality Improvement (QI) Project is to introduce combination therapy with metformin and GLP-1RAs or SGLT-2is as part of an overall effort to address hyperglycemia in patients with uncontrolled T2DM. The foundations …

Implementation Of An Evidence-Based Screening And Treatment Algorithm For Chronic Constipation In A Skilled Nursing Facility, Lucia Belleza De La Paz

Cohort X

This quality improvement (QI) project was an evidence-based screening and treatment algorithm for chronic constipation at a skilled nursing facility. The project aimed to decrease the occurrence of constipation using an evidence-based screening tool, Rome IV criteria for chronic constipation, and a modified algorithm for managing chronic constipation in a skilled nursing facility population setting. The project will provide skilled nursing facilities with a practical and straightforward management algorithm for patients with chronic constipation as described by Rome IV criteria.

Background During a review of bowel movement records from a 129-bed capacity nursing home with post-acute care subspecialty hospital, the …

The Use Of Valium In Alcohol Withdrawal, Holly Powers

Cohort X

Background: Benzodiazepines are the primary medical intervention used in the hospital for inpatients suspected of acute alcohol withdrawal during their admission. Per Shu et al. (2015) a study completed in the 1960 compared Librium with placebo as well as other drugs which showed the therapeutic efficacy of benzodiazepines in alcohol withdrawal. “Alcoholism has been reported in 20% to 50% of hospitalized medical patients” (Maldonado, 2012), moreover, the data indicate that 39% of ICU admission are alcohol-related (Muzyk et al., 2011). This is noted in an inpatient unit where alcohol withdrawal is common, Ativan is the benzodiazepine of choice along with …

Impact Of Expedited Partner Therapy, Sutha M. Fernando

Cohort X

Sexually transmitted infections (STIs), including Chlamydia trachomatis and Neisseria gonorrhoeae, have reached record high rates in the United States. Sexually transmitted infections disproportionately affect reproductive-aged males and females 15–44 years of age, who account for 65% and 42% of the total reported C. trachomatis and N. gonorrhoeae cases, respectively. These infections are the most common treatable sexually transmitted infections in the United States. The purpose of this evidence-based practice project was to decrease the rates of recurrence of STIs in males and females older than 17 years at a private family practice clinic in Carrollton, Texas, in the Dallas metropolitan …

Silver Alloy-Coated Urinary Catheters: Preventing Urinary Tract Infection, Assumpta I. Iwe

Cohort X

Background: A urinary tract infection (UTI) involves any part of the urinary system, including the urethra, ureter, kidney, and bladder. Urinary tract infections are the most common healthcare-associated infection reported to National Healthcare Safety Network (NHSN). A UTI is also the second most frequent infection in long-term care (LTAC) facilities, making it the most common cause of bacterial infection or sepsis and hospitalization. Patients with urinary catheters are at an increased risk of infection, and standard catheters reduce the body’s natural ability to cleanse the urinary tract of microorganisms. Bacteria can colonize into biofilms that attach themselves to the catheter …

Use Of A Structured Clinical Interview To Eliminate Unspecified Psychiatric Diagnoses, Gabriela Mimbela

Cohort X

Background: A definitive psychiatric diagnosis can provide significant direction to patient treatment strategies and will facilitate the identification of potential risks and qualification for supportive resources. Psychiatric research programs that were initiated in the 1950s led to the classification framework known as the Diagnostic and Statistical Manual (DSM) of Mental Disorders. These guidelines provide physicians with the information that they need for the appropriate diagnosis of major psychiatric conditions. While the DSM has had a large impact on the practice of psychiatry, there are still no biological markers of these diseases. This has led to the development of diverse assessment …

Prophylactic Bioimpedance Spectroscopy For Breast Cancer-Related Lymphedema, Maria M. Marquez

Cohort X

The purpose of this quality improvement project was to implement the standardized use of Bioimpedance Spectroscopy (BIS) for the early detection and management of breast cancerrelated lymphedema (BCRL). BCRL is a common complication of breast cancer treatments resulting from damage to the lymphatic system. While three of every four patients that develop lymphedema typically do so within the first three years after treatment, this complication can develop at any time during or after therapeutic intervention. The National Comprehensive Cancer Network® Clinical Practice Guidelines and others suggest that bilateral baseline limb measurements should be performed on patients at high risk for …

Ouch: Overcoming Uncontrolled Chronic Migraine Headaches, Angel Pineda

Cohort X

Migraines are a common type of primary headache that affects over 36 million people in the United States and one billion people worldwide. While oral preventative treatments have been considered first-line therapy for chronic migraines, anti-calcitonin gene-related peptide monoclonal antibodies have recently emerged as an effective treatment option. The purpose of this quality improvement project was to improve the therapy adherence and quality of life outcomes for patients with chronic migraines by facilitating a transition from oral migraine prevention therapy to treatment with an anti-calcitonin gene-related peptide monoclonal antibody agent. This project was developed utilizing the Focus, Analyze, Develop, and …

Type 2 Diabetes: Motivational Interviewing Improving Clients’ Dieting And Exercise, Azeb Lema

Cohort X

Background: Type 2 diabetes continues to be a prevalent chronic disease in the world, leading to increased rates of mortality and morbidity. In context of type 2 diabetes (T2D) management, patient empowerment is broadly investigated in the medical literature to date. This concept emphasizes patient autonomy and an individual approach to patient care. In turn, motivational interviewing (MI) is a patient-centered approach that aims to modify patients’ behaviors. The effectiveness of MI in modifying patients’ behaviors diagnosed with T2D has been documented in many sources. MI aims to reduce patients’ internal resistance to change health and lifestyle habits and provide …

Utilizing Motivational Interviewing Intervention To Improve Compliance With Self-Care Among Hispanic Adults With Obesity, Type 2 Diabetes Mellitus, And Hypertension, Mariagorety O. Nwiloh

Cohort X

Obesity, hypertension, and type 2 diabetes mellitus (type 2 DM) have continued to plague the healthcare system and the economy of the United States of America. They are most common among African Americans and Hispanic Americans. The objective of this quality improvement project was to improve compliance to self-care regarding self-monitoring of blood glucose, blood pressure, and exercise to achieve target fasting blood glucose (FBG) ≤ 120 mg/dL, blood pressure (BP) ≤ 130/80mm Hg and a weight loss of ≥5 pounds among adult Hispanics aged 18- 65 years old. A weekly motivational interviewing (MI) session was conducted for 6 weeks …

Basal-Plus Insulin Regimen: Helping Patients With Diabetes Mellitus Type 2 To Maintain Blood Glucose Levels During Hospitalization, Marcia Watts Hammons

Cohort X

Diabetes mellitus type 2 (DM2) patients are at risk of episodes of fluctuating blood glucose levels when in the hospital. On admission at the target practice site, the home dose of oral hypoglycemic medication is typically stopped and replaced with sliding-scale insulin therapy. Hyperglycemia among the hospital population of DM2 patients is common, causing delayed healing times, increased length of stay, increased costs, and other medical detrimental factors. A doctor of nursing practice project was based on the findings from a randomized controlled trial of a basal-plus insulin protocol that lowered the mean blood glucose level for noncritically ill hospitalized …

Implementation Of Itraconazole To Reduce Reoccurrence Of Tinea Corporis In A Correctional Facility, Desiree A. Medina

Cohort X

Tinea corporis is a superficial fungal infection that involves a circular pruritic rash on different parts of the body. Many individuals recognize this type of fungal infection as “ringworm.” Tinea corporis thrives in areas of the body that experience humidity and friction and can be spread from person to person. Vulnerable populations such as those in detention centers are more susceptible due to the environment and close quarters. During 10 days of reflective practice, more than half of the patients cared for developed reoccurring tinea corporis after treatment with fluconazole. After conducting a literature review, a variety of medications were …

“I Can’T Catch My Breath’...The Use Of Noninvasive Ventilation As Adjunct Therapy To Reduce The Need For Intubation., Erika Meza Rodriguez

Cohort X

Noninvasive ventilation (NIV) is currently used as an adjunct therapy for treatment of respiratory failure with or without hypoxia. NIV is use a support for patients with severe is used acute respiratory failure) associated with Coronavirus-19, exacerbations of chronic obstructive pulmonary disease, acute cardiopulmonary edema and hypercapnia as well as to avoid reintubation of patients who were recently extubated. Published evidence that supports the use of noninvasive ventilation was collected from a comprehensive search of MEDLINE, EMBASE, PubMed, Cumulative Index Nursing and Allied Health Literature (CINAHL) and Cochrane databases. The purpose of the quality improvement (QI) project was to implement …

The Bipolar Crash: Treating Bipolar Depression, Juan E. Anzures

Cohort X

Bipolar Disorder (BD), in the depressive phase is among the most common mental disorder diagnosed in patient’s I treated based on the insight gained after completing a 10-day reflective practice log at Emergence Health Network, outpatient services. In my clinical practice, I noticed that when patients with bipolar depression were on certain antipsychotics, i.e., Aripiprazole, their bipolar disorder, depressive phase symptoms were not improving. Bipolar depression is a debilitating mental disorder and if effective treatment is not implemented, the disease can provoke a suicide death. After an intensive literature review, I found the following guidelines for the effective treatment of …