QUESTION
Hazardous waste sites are numerous and common throughout the United States.  Use the links below and find a hazardous waste site near you to discuss.  If there are none within a reasonable distance, then report on one of your choice.  Go to the site to view it.  Do not go into the site unless it has been properly remediated and is no longer dangerous and you have permission to do so.  This is to familiarize yourself to the site and any apparent problems associated with it
ANSWER
1. Introduction
Hazardous waste sites comprise a broad, complex, and interdisciplinary array of physical, chemical, biological, and socioeconomic characteristics. Notwithstanding the wide variety among these sites, they share a common feature in the fact that they have been in some fundamental way altered, degraded, or made different by the introduction of hazardous wastes. Typically, these are sites that have been abandoned, declared inactive or closed, or have undergone partial remedial action in an effort to mitigate the ecological and public health impacts of the hazardous waste. However, active sites where ongoing hazardous waste treatment, storage, or disposal activities are occurring similarly pose risks to the environment and human health and are included in the definition of hazardous waste sites. Although the category of Superfund sites is a regulatory term used in the United States, these sites are considered to represent a specific type of hazardous waste site and are operationally similar to other types of hazardous waste sites. Therefore, it is important to consider Superfund sites within the broader context of hazardous waste sites.
1.1 Definition of Hazardous Waste Sites
A hazardous waste site is any location in the United States where hazardous waste (as defined in RCRA section 1004) has been deposited, stored, disposed or placed, or otherwise come to be located. Such sites include, but are not limited to, landfills, surface impoundments, land treatment units, waste piles, injection wells, tanks, and drums, or any locations where the release of hazardous waste constituents into the environment has resulted in the need for remedial action or corrective action as those terms are defined in the Superfund and RCRA programs. This definition is based on the Congressional Research Service’s Hazardous Waste Remediation. Primarily, we are concerned with NPL sites, though it should be mentioned that the NPL is only a small subset of the total hazardous waste sites in the United States. The RCRA program is concerned with hazardous waste sites which are not included on the NPL. Other governmental and non-governmental groups have developed lists of hazardous waste sites based on their own criteria, often quite different from that used to determine NPL inclusion. These other lists may include sites not thought to be as serious as NPL sites, or they may include types of sites not considered at all in NPL site selection. The definition used here can encompass all hazardous waste sites, regardless of the method they were identified. This inclusiveness is especially important given the high number of unregulated or informally regulated waste disposal sites. Considering this definition, the number of sites that could be considered hazardous waste sites is quite large. It has been estimated that by the year 2000 there were over 200,000 known and hundreds of thousands of unknown abandoned hazardous waste sites in the U.S. Today, that number is likely much larger.
1.2 Importance of Studying Hazardous Waste Sites
At this juncture it is important to be mindful that despite the hazardous effects of waste site pollutants, many hazardous waste sites are in fact remediated and converted to land that is safe for human utilization. Despite this fact, there are still many hazardous waste sites throughout the United States and the world, and some of these sites still remain to be the source of toxicological harm.
Now the reason that hazardous waste sites are out of the ordinary is that they are different in comparison to an everyday polluted site in a neighborhood backyard. Hazardous waste sites contain pollutants that have a higher probability of causing toxicological harm to humans. These sites are often the byproducts of industrial activity, agricultural chemicals, military weapons manufacturing or testing, mining, and other heavy duty operations. Often wastes produced by these activities are simply abandoned because of inadequate environmental control or understanding of the time. As a result, hazardous waste site pollutants can persist for many years above safe levels because the hazardous organic and inorganic compounds are resistant to microbial breakdown in the environment.
Studying hazardous waste sites is important for several reasons. However, before delving into the complexities of hazardous waste site research, we must first ask what makes something important to study. In general, things (such as hazardous waste sites) are studied because they are out of the ordinary or because they present complex problems to solve. This may not be true for all scientific research, but it is an appropriate starting point for understanding the importance of researching hazardous waste sites.
2. Finding a Hazardous Waste Site near You
2.1 Researching Hazardous Waste Sites
2.2 Locating Hazardous Waste Sites
2.3 Choosing a Site for Discussion
3. Overview of the Chosen Hazardous Waste Site
3.1 Background Information
3.2 Site Location and Description
3.3 Historical Context
4. Environmental Issues Associated with the Site
4.1 Contamination Sources
4.2 Impact on Soil and Water Quality
4.3 Potential Health Risks
4.4 Ecological Consequences
5. Remediation Efforts at the Site
5.1 Cleanup Methods and Technologies Used
5.2 Successes and Challenges of Remediation
5.3 Monitoring and Long-Term Maintenance
6. Local Community Involvement and Concerns
6.1 Community Awareness and Activism
6.2 Health and Safety Concerns
6.3 Advocacy for Environmental Justice
7. Government Regulations and Policies
7.1 Federal Laws and Agencies
7.2 State and Local Regulations
7.3 Policy Implications and Reforms
8. Lessons Learned and Best Practices
8.1 Case Studies of Successful Remediation
8.2 Community Engagement Strategies
8.3 Improving Waste Management Practices

Question
 What is your definition of culture and why? Explain how experience shapes one’s attitude toward cultural diversity. Give examples. 

2.  
How can marketing principles be applied to the creation of a compelling resume and cover letter? Discuss the key elements that make these job application tools stand out to potential employers and provide examples of how you would market your skills and experiences effectively?

Answer
1. Definition of Culture
In trying to understand another culture, that is, learning its language, its folklore, and its institutions, we are to understand its people. If we truly want to understand ourselves, our own culture, and the culture of people who are different from us, we must make the effort to step out of our comfort zone and venture to the places and situations where we are exposed to something new. Only then will we break the barriers that are set amongst people of different cultural groups. Only then will we understand the feeling of alienation that a person of a different culture in our own society feels. Only then is it possible to understand the vast differences of cultural groups and the impact they have on our society.
A formal definition of culture is the sum total of the learned behavior of a group of people that is generally considered to be the tradition of that people and is transmitted from generation to generation. Culture is a total way of life and thinking patterns that are passed down from generation to generation. It also includes the beliefs, values, behavior, and material objects that constitute a people’s way of life. The importance of culture lies in its close association with the ways and living of a people. Culture is, in fact, a product of living experience and stands deeply rooted in man’s learned behavior.
1.1. Importance of Culture in Society
Culture provides the key to understanding who we are and why we behave as we do. Most human behavior is learned. Cultures differ greatly in the extent to which they rely on the collective learning process and in the domains in which the learning is most cumulative. Because culture is so ingrained in our behavior, culture is important in the understanding of consumer behavior, and it is important that business models adapt to consumer behaviors. Business models cannot change a culture but must adapt to the already existing culture of the consumer in mind. A true understanding of culture enables business to be culturally relative, adapting the product or service to the cultural expectations of the consumer. This is a great tool in making consumers feel comfortable and at ease with the product and, in turn, making the product a part of the person’s learned culture. This is the point where a product or brand can become so closely identified with a cultural way of life that it becomes part of a consumer’s routine and self-concept. This is the ideal state for a product as the marketing and product development costs are relatively low and the profit high.
It is well known that culture is a way of behaving that has been passed down from one generation to another. It is the shared patterns of behavior and interactions, cognitive constructs, and understanding that are learned by socialization. It can also be understood as information that has been stored in long-term memory. Culture is primarily learned from the family and is a macro influencer in an individual’s life. This can be seen when a person from one particular culture is greatly different from the social standards of another culture. This is usually due to the difference in socialization in the culture. This is important for marketing and market research as it is behavior and therefore can be altered. Understanding consumer culture is fundamental in the study of consumer behavior. It is pertinent that consumer research attempts to understand a consumer’s symbol system or the socially constructed associations between consumer products and lifestyle.
Culture is the way of life for an entire society. It includes codes of manners, dress, language, religion, rituals, norms of behavior, and systems of belief. Cultures have a deep impact on consumer behavior and play a key role in the marketing strategy of a business. The concept of culture is particularly important when attempting to understand buying habits and behavior in different consumers. Culture can be divided into subcultures such as nationality, religion, racial groups, and geographic regions.
1.2. Characteristics of Culture
Edward B. Tylor – an English anthropologist was the first to coin the term culture in the 19th century. He defined culture “as all complex whole which includes knowledge, belief, art, law, morals, custom, and any other capabilities and habits acquired by man as a member of society.” According to this definition, anything learned or shared can be a part of culture. This includes behavior which, while being acquired, is transmitted as well. Culture is shared: it is not something which an individual alone can possess. For example, the customs, traditions, beliefs, ideas, values, morals, etc. are not unique to one individual but are common to the group or society to which he belongs. These are the result of the interaction with others. But these customs and values keep on changing with time. This shows that culture is not rigid and can change to adapt to external or internal influences. A culture is a set of standards used to evaluate other cultures. This is known as ethnocentrism, i.e. the tendency to use one’s own culture as a yardstick against which to measure other cultures. A culture is a subsystem in the larger society and also a culture may have its own subcultures, e.g. there are various cultures which make up India or Pakistan.
Culture is a broad term which has been described by various anthropologists in diverse ways. It consists of customs, traditions, habits, values, beliefs, and the like which are acquired by individuals and help them to live a better life. Culture has been called “the way of life for an entire society.” As such, it includes codes of manners, dress, language, religion, rituals, norms of behavior, and systems of belief. It was a simple definition of culture some years ago. But today, culture is an umbrella which includes all the above-mentioned parameters.
1.3. Components of Culture
Music will be understood by everyone, but only further interested by several people. The United States of America is a home to various music, starting from native tribal music to modern music. Just like language, music is also a symbol. Learning from different genres of music is a sign of acceptance from a culture. This can happen because the rate of music understanding is quite high. It is usually much easier to understand music than learning a language. A high level understanding of music can also push someone to learn the culture behind the music. Music can be an environmental advantage for people migrating to another culture.
Symbols have an impact, apart from just being the pretty things seen from anywhere. They can be used for suggestions, message sending, and be the sign that an act has been done. Cultural diversity is possible because people can understand the message and the meaning of a symbol, then receive it in the same way as the sender. The United States of America, as we all know, does not have an official language. The government, communities, and schools are free to use other languages for people interested in using them. People are also free to choose which language they want their children to learn at school. This statement of freedom shows that the idea is to make a better understanding for everyone about the information that is delivered through some kind of suggestions, messages, or signs without reducing the quality of it.
2. Experience and Attitude Formation
2.1. Influence of Experience on Attitudes
2.2. Role of Exposure in Shaping Attitudes
2.3. Cultural Awareness and Sensitivity
3. Cultural Diversity and Attitude Formation
3.1. Understanding Cultural Diversity
3.2. Impact of Cultural Diversity on Attitudes
3.3. Benefits of Embracing Cultural Diversity
4. Examples of Experience Shaping Attitudes
4.1. Traveling and Exposure to Different Cultures
4.2. Interacting with People from Diverse Backgrounds
4.3. Education and Cultural Awareness Programs
5. Marketing Principles in Resume and Cover Letter
5.1. Applying Marketing Strategies to Job Applications
5.2. Highlighting Unique Selling Points
5.3. Crafting a Compelling Personal Brand
6. Key Elements of an Effective Resume
6.1. Clear and Concise Presentation
6.2. Relevant Skills and Experiences
6.3. Quantifiable Achievements
7. Key Elements of an Effective Cover Letter
7.1. Personalized Introduction and Salutation
7.2. Showcasing Fit with Company Culture
7.3. Expressing Enthusiasm and Motivation
8. Examples of Effective Job Application Marketing
8.1. Showcasing Transferable Skills
8.2. Demonstrating Results and Impact
8.3. Tailoring Application to Specific Job Requirements

Question
Discharge Resources for Chronic Cardiorespiratory Issues

Answer
1. Introduction
Perhaps the most compelling reason why patients with chronic medical conditions are frequently readmitted to the hospital is the lack of professional care available to them once they are discharged.
One study found that there was a mismatch between what patients and physicians said about what level of functionality the patient should be at before discharge. Phase I of the study showed that the physician thought 63% of patients could be independent in taking care of their illness, while only 37% of the patients said they could. This disparity in perception of the patient’s ability to take care of his/her illness mostly results in premature discharge of the patient.
One reason for readmission is that chronic medical illnesses are often not resolved at hospital discharge. This is evident because one-third of patients have a recurrence of the same illness within 2 weeks of hospital discharge. The reasons for patients leaving the hospital before their illness is adequately resolved are manifold. Usually, the patient and the doctor feel that they can take care of the remaining illness at home.
Chronic medical illnesses account for a greater percentage of patient conditions and diseases that contribute to hospital readmission. Although the acute treatment received by the patient in the hospital is often excellent, chronic medical conditions are often not resolved and the patients are frequently left without proper care. They often must fend for themselves in managing their chronic medical conditions, and their illnesses often become exacerbated, leading to a resumption of acute treatment.
1.1. Definition of chronic cardiorespiratory issues
According to the Respiratory Resource Centre in Ottawa, chronic illness is defined as the presence of an illness that is prolonged, does not often resolve, and is rarely cured completely. Cardio-respiratory diseases are chronic illnesses and are considered to be the leading health problem in Canada. They affect the heart and lungs and can greatly impact the patient’s quality of life. Some examples of cardio-respiratory diseases are hypertension, heart disease, stroke, asthma, and diabetes. The management of these diseases is vital to the patient’s overall health and well-being. Although chronic cardio-respiratory diseases are often managed in the community setting, there are also a significant number of patients who require care in the acute care setting. The burden of health care utilization in Canada continues to grow, as there are increasing numbers of patients being admitted to the hospital with acute exacerbations of their chronic diseases. This is particularly true for respiratory diseases. With the burden of health care utilization comes an increasing demand for efficient resource utilization as well as an increased focus on health system outcomes. The fluctuating nature of chronic diseases means that coping with these illnesses can be difficult for patients. A common problem for patients dealing with an exacerbation of their cardio-respiratory disease is the inability to return to their baseline level of function. This is often due to muscle deconditioning and/or a decrease in dyspnea tolerance. These patients often require additional support and resources to help them regain their independence and previous level of functioning. Failure to do so can greatly impact a patient’s quality of life. With an aging population and an increasing emphasis on keeping patients out of hospitals, it is important to help patients learn self-management skills and be as independent as possible. The ultimate goal is to prevent further exacerbations of their diseases and to help them maintain their highest level of function.
1.2. Importance of discharge resources for patient independence
Success in reducing acute healthcare usage occurs when the patient is able to comfortably and confidently manage their health condition using the recommended treatment and symptom management techniques, without the need for unscheduled visits to a healthcare facility. This is commonly referred to as self-management. High-quality self-management has positive outcomes for the patient and reduces cost to the healthcare system. In order for self-management to occur, a patient must understand their condition and the actions which must be taken to manage it, the patient must have confidence in their ability to take these actions, and the patient must have the necessary resources to carry the actions out.
The importance of discharge resources for patient independence cannot be underestimated. In the context of chronic cardiorespiratory issues, it has been shown that far more attention needs to be focused on the patient’s discharge planning in an effort to impede the reoccurrence of symptoms and decrease the likelihood of hospital readmission. A strong, consistent factor in the literature is the profound effect that the implementation of effective discharge planning can have on the patient’s quality of life without increasing the economic burden on the already strained healthcare system. The goal of discharge planning is to reduce the time the patient spends being acutely ill (that is, time spent in hospital or with a doctor visit) and to help the patient manage his or her own health effectively. The means in which this is achieved is varied but the implications of its success are profound and far-reaching.
1.3. Impact of readmission on reimbursement and hospitals
An important factor that drives the push for quality improvement is the Medicare perspective payment system, where hospitals that treat a higher proportion of low-income patients with multiple chronic conditions will be expected to lose a significant amount of their Medicare payment. It is estimated that payment reductions can be up to 3% of the reimbursement value in 2015 and 2017 (Haveman, 2013). This can create financial strain on already resource-poor safety-net hospitals. Readmission can result in financial penalization of the hospital. In 2012, 2,200 hospitals received penalties ranging from 1% to discharge 1.5 billion in total (Martin & Lassman, 2013), and in 2013, this increased to 2,600 hospitals (Health policy, 2013). This extra money can be crucial for a hospital already struggling with poor reimbursement to put into patient services, and in the current day and age, in a very money-driven healthcare environment, financial penalties due to increased readmission rates may act as an incentive for hospitals to improve the care they provide to reduce readmission rates. On the contrary to reduced reimbursement, for a patient who is readmitted, Medicare will pay for readmission services with an additional DRG payment for the readmission if it takes place within the same DRG window. This may sound like a benefit for the hospital; however, any additional payment will not offset the amount that was lost due to the initial admission.
1.4. Implications of readmission on patients
Soon after discharge from a hospital, the average chronically ill patient has a 20% chance of being readmitted to the hospital within 30 days and a 57% chance within 1 year. These rates have changed little in the past 30 years and readmission remains a common and expensive occurrence. Factors associated with readmission to the hospital include those related to the nature of the illness, the quality of patient care, characteristics of the patient, and the structure of the health care system. Although many readmissions are for medical issues similar to the previous admission, some patients are readmitted for conditions that are complications of medical treatments and some are readmitted for unrelated new medical issues. Given the nature of chronic illnesses and the link between patient functional status and hospital readmission, it is important to consider the effect of readmission on patients’ ability to live in the community and gain independence. High rates of hospital readmission can prevent a patient from leaving the cycle of frequent hospitalization and institutionalization, leading to worsening functional status and increased morbidity. Although this phenomenon has been recognized anecdotally, it is difficult to measure the impact of hospital readmission on patient independence and the ability to live in the community. Improved understanding of the factors that lead to hospital readmission, changes in the care of patients at risk of readmission, and development of interventions to prevent readmission are essential steps to reducing the high rates of hospital readmission and improving the health of chronically ill patients.
2. Discharge Resources for Patient Independence
2.1. Home healthcare services
2.2. Medical equipment and supplies
2.3. Rehabilitation and therapy programs
2.4. Education and self-management resources
3. Preventing Readmission
3.1. Care coordination and transitional care programs
3.2. Medication management and adherence support
3.3. Telehealth and remote monitoring solutions
3.4. Follow-up appointments and outpatient services
4. Impact of Readmission on Reimbursement
4.1. Medicare’s Hospital Readmissions Reduction Program
4.2. Financial penalties for excessive readmissions
4.3. Importance of quality improvement initiatives
4.4. Strategies for reducing readmission rates
5. Implications of Readmission on Hospitals
5.1. Increased healthcare costs
5.2. Overburdened healthcare resources
5.3. Negative impact on hospital reputation
5.4. Importance of patient satisfaction and outcomes
6. Implications of Readmission on Patients
6.1. Physical and emotional toll on patients
6.2. Financial burden of additional healthcare expenses
6.3. Disruption of daily life and routines
6.4. Importance of patient education and empowerment
7. Conclusion
7.1. Recap of discharge resources and their impact
7.2. Importance of preventing readmission for patient well-being and healthcare system sustainability

Questions
Application?of?Course?Knowledge: Answer all questions/criteria with explanations and detail.
·   
a.  Describe one source of big data that you are likely to use in your future advanced practice nursing role.  
b.  Identify the types of information that can be obtained from this source.  
c.  Examine three ways data from this source can be used to impact client care. 
d.  Discuss the role of the advanced practice nurse in data stewardship. 

Answer
1. Source of Big Data in Advanced Practice Nursing
The last source is the data collected from wearable devices. Wearable devices are electronic tools that can be worn on the body. Often, these devices have sensors attached to them and can be connected to the internet to transfer data. The big data source that comes out from wearable devices is very broad and varies from device to device, but it includes all information about a person’s health, from lifestyle to vital signs and even location. The purpose of this data collection is to make the user self-aware about their own health, and the data can be shared with healthcare providers to constantly keep track of the patient’s condition. The use of these devices is increasing mainly due to the evolution of smartphones and the simplicity to make the devices compact and user-friendly. APN can use this data to constantly monitor the patient’s condition from home, and in the long term, can assess if by using the device, the patient’s health outcome increases.
Another source is Clinical Decision Support Systems (CDSS), which is a computer program designed to help clinical decision making. It accomplishes this by taking data from the patient, combining it with available knowledge, and providing possible courses of action. CDSS is designed to help clinical decisions in which arriving at a single well-accepted answer is difficult. It usually aids in patient assessment, forming a diagnosis, and selecting therapy. These systems are usually based on a knowledge base that can be created from various sources, including medical journals, expert opinions, etc., and it also uses an inference engine method to provide the user with a solution. CDSS has shown high potential in improving healthcare quality and reducing costs. It can also be used in managing chronic diseases and reducing adverse events that usually occur in the medication process. APN can use the big data from CDSS to correlate the clinical decisions made and the patient’s outcome to show if CDSS really improves patient care and to improve the CDSS itself.
There are three sources of data which are the EHR, CDSS, and wearable devices that serve as a new method of APN to collect various data in formulating a clinical decision. Big data in Electronic Health Records (EHR) refers to the vast data on patients that includes demographic information, medical history, medication, etc. that can be managed and reviewed systematically. It also provides a tool for clinical quality and performance measures to improve healthcare. APN can use EHR data to measure and report healthcare quality and outcomes, to analyze patient safety, to compare the effectiveness of different treatments, etc. and it can also help in developing a clinical practice guideline that will lead to evidence-based practice to improve patient outcomes. In the long term, the guideline will be assessed and refined in a continuous cycle. EHR assists in the progression toward improved care, improvement in the health of the population, and lower healthcare costs.
1.1 Electronic Health Records (EHR)
The source of data when relating EHRs to nursing comes from the information that is put into EHRs by the patient or the family of the patient. Data also comes from the patient’s visits to healthcare facilities. EHRs help improve patient care because they can contain the information that was collected in multiple care settings, assisting the coordination of care provided by nurses and other healthcare professionals. For example, if a patient has visited the emergency room multiple times for one issue, all the information from these visits will be contained in one place in the EHR. This will prevent the patient from receiving the same treatment multiple times and increase the probability of diagnosing the problem.
An electronic health record (EHR) is defined as the “systematized collection of a patient’s health information in a digital format.” This includes a variety of types of data, including demographic, medical history, medication and allergies, immunization status, laboratory test results, radiology images, and vital signs. They are real-time, patient-centered records that make information available instantly and securely to authorized users. EHRs have the potential to access the record simultaneously and independently, increasing accuracy of diagnoses. This, in turn, increases patient safety and the overall quality of care. EHRs help with diagnoses and treatments made by healthcare providers. With the patient’s overall information available, providers are able to determine, based on statistical data, what the best diagnosis or treatment plan should be. This has the potential to increase the cost-effectiveness of the treatment, enhancing the healthcare that patients receive. With the large amount of information available in EHRs, they encourage better management of chronic diseases by detecting the warning signs and ensuring patients receive the appropriate treatments.
1.1 Electronic Health Records (EHR)
1.2 Clinical Decision Support Systems (CDSS)
Clinical decision support systems have been in use for more than 30 years (Kawamoto et al., 2005). However, they are only now beginning to take hold in healthcare. CDSS can take the form of “active”, meaning the system solicits the user with inferences and recommendations, or “passive”, meaning the system waits for the user to access it for support (Delpierre et al., 2004). Most are integrated into EHR systems and provide assistance in making clinical decisions by filtering knowledge and patient information to offer the best possible assessment and plan (Kawamoto et al., 2005). Data mining with CDSS makes use of algorithms to search databases and form patterns, generating information which was not previously known (Greene et al., 2014). At present, the most widely used CDSS applications are for preventive care and chronic disease management. However, they are underutilized in medical oncology compared to other fields and have been shown to improve adherence to guidelines and potential outcomes (Tolbert et al., 2013). CDSS align with the nursing process and best practices by providing assessment of the patient, diagnoses, identification of outcomes, planning, and implementation. The WHO has described this as the key to quality care and the gold standard within the information age. This attribute to evidence-based practice should enable greater use of structured data collection techniques and documentation at the point of care, thereby enhancing the quality of big data from said encounters.
1.3 Wearable Devices
Health informatics professionals have been especially successful in developing wearable devices which monitor health status and health behaviors continuously in real time in an efficient and non-invasive manner. Wearable devices have been categorized into two types: those which are worn on the body, which has been further subcategorized according to the body part, and smart accessories (smartphones). They are designed to measure certain health parameters and behaviors valuable to the maintenance of health and management of chronic conditions. Examples of these health parameters and behaviors include heart rate, blood pressure, body temperature, physical activity, eating, and sleep patterns. The data collected from wearable devices has been referred to as quantified self data, defined as self-knowledge through self-tracking with technology. The term was coined by scholars from the Quantified Self community, an international collaboration of users and makers of self-tracking tools who share an interest in self-knowledge through self-tracking. Wearable devices provide multiple forms of big data using both structured and unstructured data, thus offering vast potential to improve patient outcomes through health data analysis, enhanced clinical decision-making, and improved patient engagement.
2. Types of Information Obtained from the Source
2.1 Patient Demographics
2.2 Medical History
2.3 Vital Signs
2.4 Laboratory Results
2.5 Medication Records
3. Impact of Data on Client Care
3.1 Personalized Treatment Plans
3.2 Early Detection of Health Issues
3.3 Improved Clinical Decision Making
3.4 Enhanced Patient Safety
3.5 Efficient Resource Allocation
4. Role of Advanced Practice Nurse in Data Stewardship
4.1 Ensuring Data Privacy and Security
4.2 Data Collection and Analysis
4.3 Collaborating with Interdisciplinary Teams
4.4 Implementing Evidence-Based Practice
4.5 Continuous Quality Improvement

Questions
Identify a cardiac or respiratory dysfunction and its cause. Outline the key steps necessary to prevent the dysfunction and improve health status.
Answer
1. Introduction
The heart and lungs are two vital organs in the body that work together to sustain life. The heart pumps blood, which carries oxygen, to all parts of the body. The blood then returns to the heart, so it can be pumped to the lungs to receive oxygen. Finally, the oxygen-rich blood is pumped back to all parts of the body. The heart is made up of specialized cardiac muscle, which does not become tired. The lungs are responsible for providing the oxygen and removing carbon dioxide. When the heart or lungs malfunction, it causes a decreased quality of life and can be life-threatening. Cardiac and respiratory dysfunctions lead to a decreased quality of life where a person may have difficulty completing everyday activities, such as climbing stairs, cleaning, grocery shopping, and taking care of their family. During severe dysfunction, a person may not be able to care for themselves and they may need to spend a lot of time and money on healthcare. Some dysfunctions can be life-threatening, for example, congestive heart failure or acute respiratory distress syndrome. Any therapy or lifestyle changes that can prevent or improve these dysfunctions can greatly increase the quality of life for that person and even be life-saving. Cardiac and respiratory disease is the leading cause of death in the United States. According to the American Heart Association, 8,100,000 people have a heart attack or angina. There are almost 650,000 cases of heart failure diagnosed each year, and it is the only cardiovascular disease that is increasing in incidence. The AHA estimated that the cost for heart failure in 2008 was 34.8 billion dollars, and by 2030 this will increase to 98.1 billion. With the statistics so high, it is important to further develop techniques to prevent and improve cardiac and respiratory dysfunctions.
1.1. Overview of Cardiac and Respiratory Dysfunctions
Cardiac dysfunction usually refers to the heart’s inability to maintain adequate blood circulation to meet the body’s needs. In an ideal situation, this would occur during both rest and activity. There are many different types of cardiac dysfunction including heart failure, cardiac ischemia, and arrhythmias. Respiratory dysfunction refers to inadequate gas exchange, and can be due to either inadequate ventilation or perfusion. Respiratory failure occurs when gas exchange is so poor that it does not meet the body’s metabolic demands, whereas respiratory insufficiency is a state in which there is a significant decrease in gas exchange that does not meet the body’s metabolic demands. Similar to cardiac dysfunction, respiratory dysfunction can occur during rest or during activity.
Cardiac and respiratory dysfunctions occur for a variety of reasons and in response to numerous stimuli. In order to understand how and why dysfunction occurs, it is useful to first understand the normal process of cardiac and respiratory function. Dysfunction of one system often leads to dysfunction of the other, and in fact it is hard to isolate one system from the other.
1.2. Importance of Prevention and Improvement
Prevention of the initial development of heart and lung diseases through treating the risks and underlying pathophysiological processes is obviously an effective strategy. Most cardiac and lung diseases are caused or made worse by modifiable lifestyle and environmental factors. Hypertension, dyslipidemia, and diabetes have a multiplicative effect on the risks of cardiac failure and stroke, and due to their high prevalence in the population, effective treatment of these conditions would prevent a large number of cardiac events. Randomized controlled trials have shown that management of cardiovascular risk factors in hypertensive and diabetic patients can be effective in terms of reducing cardiac events, with and even without reduction in blood pressure or glucose levels.
The idea of prevention and improvement is something that is not only important, but imperative in the context of cardiac and respiratory dysfunction as it is exactly the strategies that are needed to take the pressure off ailing health systems worldwide. Acute care for decompensated major chronic or acute cardiac and respiratory disease is consuming large amounts of healthcare expenditure in western countries. In Australia alone, heart disease costs $5.9 billion per year, and lung diseases cost $2.5 billion. By focusing on prevention and quality improvement, hospital care could be reduced substantially, freeing up funds for other resources, as well as achieving further benefits to patients. Primary and secondary prevention are integral parts of improving patient outcomes and are necessary to reduce the growing prevalence of cardiac and respiratory diseases.
2. Understanding the Dysfunctions
2.1. Causes of Cardiac Dysfunction
2.1.1. Coronary Artery Disease
2.1.2. Hypertension
2.1.3. Heart Valve Disorders
2.2. Causes of Respiratory Dysfunction
2.2.1. Chronic Obstructive Pulmonary Disease (COPD)
2.2.2. Asthma
2.2.3. Lung Infections
3. Preventive Measures for Cardiac Dysfunction
3.1. Regular Exercise
3.2. Balanced Diet
3.3. Stress Management
3.4. Smoking Cessation
4. Preventive Measures for Respiratory Dysfunction
4.1. Avoiding Environmental Triggers
4.2. Proper Ventilation
4.3. Vaccinations
4.4. Avoiding Smoking and Secondhand Smoke
5. Improving Cardiac Health
5.1. Medications and Treatment Options
5.2. Lifestyle Modifications
5.2.1. Healthy Eating Habits
5.2.2. Regular Physical Activity
5.2.3. Stress Reduction Techniques
5.3. Cardiac Rehabilitation Programs
6. Improving Respiratory Health
6.1. Medications and Treatment Options
6.2. Pulmonary Rehabilitation Programs
6.3. Breathing Exercises
6.4. Airway Clearance Techniques
7. Conclusion