Tag: Health Medical

I’m studying for my Nursing class and need an explanation.

Please apply nursing process when answering

Remediation 1

1. Arterial Blood Gases – Respiratory Acidosis/Alkalosis, Metabolic Acidosis/Alkalosis
2. Fluid Volume Deficit
3. Syndrome of Inappropriate Antidiuretic Hormone

Remediation 3

1. Patient education regarding use of inhalers (metered dose, spacers, etc)
2. Patient education regarding oral corticosteroid use
3. Care of client with chest tube

Please apply nursing process to each topic and briefly elaborate

Remediation 1

Assessment of infant injury especially history taking

Physical Assessment of heart sounds

Pediculosis capitis – diagnosis , sign & symptoms, treatment, nursing intervention

Remediation 2

Scoliosis

Red Reflex

Cystic Fibrosis

Remediation 3

Bronchiolitis

Cushing’s Syndrome

Hypothyroidism

INTRODUCTION

Healthcare organizations accredited by the Joint Commission are required to conduct a root cause analysis (RCA) in response to any sentinel event, such as the one described in the scenario attached below. Once the cause is identified and a plan of action established, it is useful to conduct a failure mode and effects analysis (FMEA) to reduce the likelihood that a process would fail. As a member of the healthcare team in the hospital described in this scenario, you have been selected as a member of the team investigating the incident.

SCENARIO

It is 3:30 p.m. on a Thursday and Mr. B, a 67-year-old patient, arrives at the six-room emergency department (ED) of a sixty-bed rural hospital. He has been brought to the hospital by his son and neighbor. At this time, Mr. B is moaning and complaining of severe pain to his (L) leg and hip area. He states he lost his balance and fell after tripping over his dog.

Mr. B was admitted to the triage room where his vital signs were B/P 120/80, HR-88 (regular), T-98.6, and R-32, and his weight was recorded at 175 pounds. Mr. B. states that he has no known allergies and no previous falls. He states, “My hip area and leg hurt really bad. I have never had anything like this before.” Patient rates pain at 10 out of 10 on the numerical verbal pain scale. He appears to be in moderate distress. His (L) leg appears shortened with swelling (edema in the calf), ecchymosis, and limited range of motion (ROM). Mr. B’s leg is stabilized and then is further evaluated and discharged from triage to the emergency department (ED) patient room. He is admitted by Nurse J. Nurse J finds that Mr. B has a history of impaired glucose tolerance and prostate cancer. At Mr. B’s last visit with his primary care physician, laboratory data revealed elevated cholesterol and lipids. Mr. B’s current medications are atorvastatin and oxycodone for chronic back pain. After Mr. B’s assessment is completed, Nurse J informs Dr. T, the ED physician, of admission findings, and Dr. T proceeds to examine Mr. B.

Staffing on this day consists of two nurses (one RN and one LPN), one secretary, and one emergency department physician. Respiratory therapy is in-house and available as needed. At the time of Mr. B’s arrival, the ED staff is caring for two other patients. One patient is a 43-year-old female complaining of a throbbing headache. The patient rates current pain at 4 out of 10 on numerical verbal pain scale. The patient states that she has a history of migraines. She received treatment, remains stable, and discharge is pending. The second patient is an eight-year-old boy being evaluated for possible appendicitis. Laboratory results are pending for this patient. Both of these patients were examined, evaluated, and cared for by Dr. T and are awaiting further treatment or orders.

After evaluation of Mr. B, Dr. T writes the order for Nurse J to administer diazepam 5 mg IVP to Mr. B. The medication diazepam is administered IVP at 4:05 p.m. After five minutes, the diazepam appears to have had no effect on Mr. B, and Dr. T instructs Nurse J to administer hydromorphone 2 mg IVP. The medication hydromorphone is administered IVP at 4:15 p.m. After five minutes, Dr. T is still not satisfied with the level of sedation Mr. B has achieved and instructs Nurse J to administer another 2 mg of hydromorphone IVP and an additional 5 mg of diazepam IVP. The physician’s goal is for the patient to achieve skeletal muscle relaxation from the diazepam, which will aid in the manual manipulation, relocation, and alignment of Mr. B’s hip. The hydromorphone IVP was administered to achieve pain control and sedation. After reviewing the patient’s medical history, Dr. T notes that the patient’s weight and current regular use of oxycodone appear to be making it more difficult to sedate Mr. B.

Finally, at 4:25 p.m., the patient appears to be sedated, and the successful reduction of his (L) hip takes place. The patient appears to have tolerated the procedure and remains sedated. He is not currently on any supplemental oxygen. The procedure concludes at 4:30 p.m.,and Mr. B is resting without indications of discomfort and distress. At this time, the ED receives an emergency dispatch call alerting the emergency department that the emergency rescue unit paramedics are enroute with a 75-year-old patient in acute respiratory distress. Nurse J places Mr. B on an automatic blood pressure machine programmed to monitor his B/P every five minutes and a pulse oximeter. At this time, Nurse J leaves Mr. B’s room. The nurse allows Mr. B’s son to sit with him as he is being monitored via the blood pressure monitor. At 4:35 p.m., Mr. B’s B/P is 110/62 and his O2 saturation is 92%. He remains without supplemental oxygen and his ECG and respirations are not monitored.

Nurse J and the LPN on duty have received the emergency transport patient. They are also in the process of discharging the other two patients. Meanwhile, the ED lobby has become congested with new incoming patients. At this time, Mr. B’s O2 saturation alarm is heard and shows “low O2 saturation” (currently showing a saturation of 85%). The LPN enters Mr. B’s room briefly, resets the alarm, and repeats the B/P reading.

Nurse J is now fully engaged with the emergency care of the respiratory distress patient, which includes assessments, evaluation, and the ordering of respiratory treatments, CXR, labs, etc.

At 4:43 p.m., Mr. B’s son comes out of the room and informs the nurse that the “monitor is alarming.” When Nurse J enters the room, the blood pressure machine shows Mr. B’s B/P reading is 58/30 and the O2 saturation is 79%. The patient is not breathing and no palpable pulse can be detected.

A STAT CODE is called and the son is escorted to the waiting room. The code team arrives and begins resuscitative efforts. When connected to the cardiac monitor, Mr. B is found to be in ventricular fibrillation. CPR begins immediately by the RN, and Mr. B is intubated. He is defibrillated and reversal agents, IV fluids, and vasopressors are administered. After 30 minutes of interventions, the ECG returns to a normal sinus rhythm with a pulse and a B/P of 110/70. The patient is not breathing on his own and is fully dependent on the ventilator. The patient’s pupils are fixed and dilated. He has no spontaneous movements and does not respond to noxious stimuli. Air transport is called, and upon the family’s wishes, the patient is transferred to a tertiary facility for advanced care.

Seven days later, the receiving hospital informed the rural hospital that EEG’s had determined brain death in Mr. B. The family had requested life-support be removed, and Mr. B subsequently died.

Additional information: The hospital where Mr. B. was originally seen and treated had a moderate sedation/analgesia (“conscious sedation”) policy that requires that the patient remains on continuous B/P, ECG, and pulse oximeter throughout the procedure and until the patient meets specific discharge criteria (i.e., fully awake, VSS, no N/V, and able to void). All practitioners who perform moderate sedation must first successfully complete the hospital’s moderate sedation training module. The training module includes drug selection as well as acceptable dose ranges. Additional (backup) staff was available on the day of the incident. Nurse J had completed the moderate sedation module. Nurse J had current ACLS certification and was an experienced critical care nurse. Nurse J’s prior annual clinical evaluations by the manager demonstrated that the nurse was “meeting requirements.” Nurse J did not have a history of negligent patient care. Sufficient equipment was available and in working order in the ED on this day.

REQUIREMENTS

Your submission must be your original work. No more than a combined total of 30% of the submission and no more than a 10% match to any one individual source can be directly quoted or closely paraphrased from sources, even if cited correctly. An originality report is provided when you submit your task that can be used as a guide.

You must use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate your work. Each requirement below may be evaluated by more than one rubric aspect. The rubric aspect titles may contain hyperlinks to relevant portions of the course.

A. Explain the general purpose of conducting a root cause analysis (RCA).

1. Explain each of the six steps used to conduct an RCA, as defined by IHI.

2. Apply the RCA process to the scenario to describe the causative and contributing factors that led to the sentinel event outcome.

B. Propose a process improvement plan that would decrease the likelihood of a reoccurrence of the scenario outcome.

1. Discuss how each phase of Lewin’s change theory on the human side of change could be applied to the proposed improvement plan.

C. Explain the general purpose of the failure mode and effects analysis (FMEA) process.

1. Describe the steps of the FMEA process as defined by IHI.

2. Complete the attached FMEA table by appropriately applying the scales of severity, occurrence, and detection to the process improvement plan proposed in part B. 

Note: You are not expected to carry out the full FMEA.

D. Explain how you would test the interventions from the process improvement plan from part B to improve care.

E. Explain how a professional nurse can competently demonstrate leadership in each of the following areas:

• promoting quality care
• improving patient outcomes
• influencing quality improvement activities

1. Discuss how the involvement of the professional nurse in the RCA and FMEA processes demonstrates leadership qualities.

F. Acknowledge sources, using in-text citations and references, for content that is quoted, paraphrased, or summarized.

G. Demonstrate professional communication in the content and presentation of your submission.

Review “An Integrated Ethical Decision-Making Model for Nurses”

Apply the ethical decision-making model in the article to access to care or an ethical issue of your choice.

Note: If you have questions about your chosen topic, contact your instructor faculty member to ensure it is appropriate.

Follow the steps provided in the model, including the following:

• State the ethical issue and its relevance for nursing practice.
• Collect and analyze additional information:
  • What populations does this serve?
  • Who are the key stakeholders?
  • What information is needed to overcome the problem?
  • After looking at additional information, decide whether or not the initial problem was correctly stated.
• Develop alternatives and compare them:
  • What alternative programs address the issues?
• Justify the decision:
  • Explain why this is important, needed, or beneficial for vulnerable populations.
• Find strategies to implement the plan:
  • What ethical arguments could you use to dissuade someone who disagrees with the program?

  Cite at least 3 evidence-based, peer-reviewed sources published within the last 5 years to support your position(s) and include a reference sheet.

Q1. Describe an organizational change model that can be used in a dynamic health care environment. Based on this model, how is organizational change is managed? What role do stakeholders play during organizational change?

Q2.You have been selected to serve on a community outreach committee within your state’s nursing organization. The committee includes registered nurses of different specialties. At your first meeting, it becomes evident that not everyone is in agreement with a recent position statement about the role of spiritual care, with some members arguing they will no longer support the committee if the position statement is not revised or reversed. As a nurse leader and change agent, how would you approach the committee? How could you draw from change theory to address these concerns and encourage collaboration on the committee?

Q3.Evidence-based practice and translational research are both linked to the integration of the best research evidence with clinical expertise and clinical values to improve patient outcomes. Research is completed by highly trained and educated professionals and evidence-based practice applies the relevant research and includes the expertise of the practitioner as well as the patient preferences and values. Using an evidence-driven model for change serves to provide focus and organization of change initiatives. Can you explain a time when you were involved in organizational change within your current or past facilities?

I’m working on a health & medical writing question and need an explanation and answer to help me learn.

Instructions:

Concept to Consider:

Imagine that you are a social worker at a local hospital. You have been asked to explain the issues involved in coordinating patients’ continued post-acute care (PAC), and  safely transitioning them out of the acute-care hospital. This Assignment examines PAC to patients with healthcare services for their recuperation and rehabilitation after an illness or jury and emphasizes the ethics in coding. Your responses are to address the best practices for assuring continuum of care.

Perform a search on healthcare issues and review the textbook for completing the seven questions listed below the discussion. Prepare 2–3 paragraphs for each question. Paper should include the following:

Document:

As patients continue their recovery, post-acute care (PAC) safely transitions them out of the acute-care hospital. There are four PAC settings: skilled nursing facilities (SNF), long-term care hospitals (LTCHs), inpatient rehabilitation facilities (IRFs), and home health agencies (HHAs).

Patients in these settings have similar conditions, such as strokes and hip replacements. However, Medicare pays different prices depending upon the setting

(Medicare Payment Advisory Commission 2014, 171). For a patient’s continued recovery and optimal outcome, does the choice of PAC setting matter? Two sets of researchers investigated this question. One set investigated the functional recovery for patients who had had a stroke (Chan et al. 2013). Another set investigated the functional recovery for patients who had had a hip fracture repaired (Mallinson et al. 2014).

Chan and colleagues performed a long-term study on 222 patients who had a stroke. The patients had received care from four different acute-care hospitals in one integrated delivery system (IDS). The patients also received their post-acute care from settings in the IDS. The IDS offered three types of PAC settings: SNF, IRF, and HHA. In addition, patients could receive outpatient care in the IDS. The researchers used a standardized instrument, the Activity Measure for Post-Acute Care (AM-PAC), to determine the patients’ functional status. The researchers scored the patients’ functional status twice: first immediately upon discharge from the acute care hospital and second 6 months after discharge and after receiving post-acute care. The researchers’ results showed:

Patients who received their post-acute care in an IRF had at least eight-point higher improvements in mobility, self-care, and cognition than patients who received their post-acute care in an SNF.

Patients who received their post-acute care in an IRF also had statistically significant improvements in applied cognition compared to those patients who only received home health combined with outpatient services.

Chan and colleagues concluded that “patients with a stroke may make more functional gains if they receive some of their post-acute care in an IRF compared to other sites” (Chan et al., 2013, 629).

Deutsch’s commentary on the research of Chan and colleagues noted that comparing outcomes across post-acute care is difficult because the PAC sites use different data sets (2013, 631–632).

Mallinson and colleagues investigated the outcomes of patients after hip fracture repair. Facilities from three types of PAC settings participated in the research. Eventually, the researchers reviewed the care of 181 patients at 18 PAC providers. These PAC providers were four IRFs, six SNFs, and eight HHAs. After being trained on the data collection instrument, nurses at each site collected data using the IF functional independence measure (FIM). The researchers’ results showed, controlling for patients’ characteristics, severity, comorbidities, and services:

• IRF and HHA patients had lower self-care function at discharge relative to SNF patients
• HHA patients had, on average, a 2-week longer length of stay than SNF patients

SNF patients had, on average, a 9-day longer length of stay than IRF patients

Mallinson and colleagues concluded that outcomes varied among settings “depending upon whether self-care or mobility was the outcome of focus” (Mallinson et al., 2014, 209).

DeJong’s commentary on the research of Mallinson and colleagues noted that the absence of a common PAC patient assessment instrument requires workarounds (DeJong, 2014). Researchers can use a site-neutral instrument, such as the AM-PAC, or they can use an existing PAC site-specific instrument. Both workarounds require training on the instrument for all or some of the data collectors and require special data collection outside of routine procedures.

Question:

• Prepare 2–3 paragraphs for each question.  
• Review the chapter in your textbook. List the data collection instrument for PAC settings discussed in the case.
• What PAC setting is missing from the previously described research investigations? What is that setting’s data collection instrument?

Both Deutsch and DeJong note problems caused by the lack of a common data set across PAC settings. How has Congress addressed this problem?

Workarounds require special training and special data collection outside routine procedures. Why are these workarounds a problem for researchers? Does Congress’s solution address this problem?

How could you or your family benefit from a common data collection instrument across PAC settings?

What are the various methods that a healthcare facility employ to monitor medical documentation for approving stay.

How are per diem rates for SNF PPS patients determined for various cases. 

Your submission should:

Create a bibliography citing a minimum of three references according to APA format.

The first paper will outline important aspects of the person/s’ physical, cognitive, behavioral, social, and moral/ethical background that might be considered when teaching the student. THE RUBRIC DEFINES THE DIMENSIONS TO BE DISCUSSSED AND STATES THAT YOU MUST RELATE THE RESPONSES TO A THEORY/FRAMEWORK. If you are reviewing a teacher, you can assess that person’s attention to these developmental factors.

You may use a book character or a character from a movie/tv show that you will use to do all four papers

A QUICK EXAMPLE for part of the paper:

The character that I would like to work with is Kylo Ren (aka Ben Skywalker). I believe that I can assist him with what is an overly aggressive reaction to people

In my first assessment, I see that Kylo Ren is in good physical shape. He can run faster than his peers, his eye-hand coordination with a light saber is excellent in that he wins all of his battles even if he faces multiple combatants alone. He can manage dual light sabers and light sabers with dual capacity. He seems to have worked hard on these motor skills and may be operating very close to his genetic capacity (the reaction range or development identified by his genetic capacity has been met at the higher end). He is descended from people who were also very physically active and have similar midochlorian levels in the blood as does Kylo (Midochlorian loads or levels are genetic markers for having more energy or force, according to Lucas, 1977) so there is a genetic explanation for Kylo’s behavior. The aggressiveness of Kylo’s behavior may also be genetic in origin. His maternal grandfather was known to be highly aggressive. His mother pursued a military career doing active duty in war zones. Kylo’s uncle was also in the military where he caused the death of other people and is alleged to have almost murdered Kylo. Hare (1977) has found that the fewer than normal connections between the executive cognitive and emotional cortex in some people is associated with higher aggression rates. This explanation is a tentative in that brain scans of the family have not been done.

EXAMPLE OF HOW SOCIAL ANALYSIS MIGHT LOOK

Kylo comes from a family with multiple disruptions. His mother and brother were separated at birth due to their mother’s wish to hide the births from their father. The mother grew up in a military/governmental family. Her brother was raised to be a farmer in the place where the “center of the universe is farthest from”. The siblings met as they united to fight off a force they saw as unbalanced. The person both eventually come to fight against is their father, unbeknownst to all parties. The uncle has a reconciliation with the father at the end of his life. The siblings come to be reunited and it is to the uncle that Kylo goes to be trained to continue in the family military tradition. During this training, it is alleged that the uncle attempts to kill Kylo. Sensing this betrayal, Kylo renounces his mother and father and joins the group to which his grandfather belonged. Kylo’s father is a mercenary, a scoundrel, and is separated from the mother.

The values of the family, being a warrior or fighting others is held to be important. Some of Kylo’s behavior may thus be behavior that was a value or norm to which he was taught to adhere. “Disrupted families may also result in parenting styles (authoritarian or neglectful) that lead to problems in attachment, including the tendency to be aggressive. Trust vs Mistrust (Erik Erikson cited in Santrock) issues abound in this family and may be connected to the shifting of values Kylo shows and his desire to harm his family and former allies. Kylo should probably be evaluated for the effects of trauma like hypervigilance or reactivity as this is a likely source of some of the aggressiveness he shows.

Ethics/morals

The family members all seem to be deeply involved in thinking about right and wrong. I believe Kylo may be at the higher levels, where his beliefs are based in adherence to principle rather than to “what other folks think” or what the punishers are (Kohlberg). Certainly, he discusses his beliefs with others and attempts to work with them in ways that are not as “extreme” as either group, The Jedi or the Sith. He goes away/against both groups to forge a way that seems based in his evolved sense of the correct sense of action. (this response is big, so this one is written to give you the general idea, you may wish to use more detail)

Cognitive/Behavioral

Kylo is at the level of formal operations. He can think about “solutions not seen before” as he outlines for Rae a way to bring an end to the Jedi/Sith dispute. He has hypothetical deductive reason, a hallmark of Piagetian theory for the attainment of formal operational thought. What is out of balance is his integration of the cognitive and emotional executive functioning aspects of cognition. Kylo comes up with plans such as trapping the “Resistance” in a cave where he will be able to destroy them. As he is moving forward with this well-constructed plan”, part of which is motivated by his hate for his uncle, he lets himself become deterred from completing his plan because he allows his under-regulated emotions to govern his actions. Emotional regulation training as well as retraining his cognitive-emotional regulating system is needed. Kylo’s tendency to “break things when angry” is also a sign that this regulation system is in need of retraining.

Activity 5

Background Analysis – Part IV 

Students will discuss a background analysis of the capstone project topic. The background discussion will synthesize the relevant information identifying why the topic is important for both the student’s personal practice as well as the profession of nursing.

Play Video

Additional Instructions:

• All submissions should have a title page and reference page.
• Utilize a minimum of two scholarly resources.
• Adhere to grammar, spelling and punctuation criteria.
• Adhere to APA compliance guidelines.
• Adhere to the chosen Submission Option for Delivery of Activity guidelines.

Submission Options:

Choose One:

Instructions:

Paper

• 4 to 6-page paper. Include title and reference pages.

Capstone Project Background Analysis-Part IV

Description: The baccalaureate graduate will participate in quality initiatives, recognizing that

these are complex system issues, involving other members of the healthcare team.

Course Competencies: 1) Demonstrate accountability and responsibility of professional

judgment and actions by integrating professional values and role behaviors by examining the

problems of contemporary health and illness. 4) Demonstrate the role of the global citizen by

designing care for individuals, groups, and communities by incorporating methods of health

promotion and education.

QSEN Competencies: 3) Evidence-Based Practice 4) Quality Improvement

BSN Essential X

Area Gold

Mastery

Silver

Proficient

Bronze

Acceptable

Acceptable

Mastery not

Demonstrated

Synthesizes the

background

analysis of the

capstone project

Explains why the

project topic is

important to the

student’s personal

practice and the

nursing profession

Discusses why the

project topic is

important to the

student’s personal

practice and the

nursing profession

States why the

project topic is

important to the

student’s personal

practice and the

nursing profession

Does not address

section

Identifies and

discusses in-depth

a minimum of

three areas of focus

in which the

capstone project

can impact the

student’s personal

practice

Identifies and

discusses in-depth

a minimum of

three areas of focus

in which the

capstone project

can impact the

student’s personal

practice

Identifies and

discusses in-depth

a minimum of two

areas of focus in

which the capstone

project can impact

the student’s

personal practice

Identifies and

discusses in-depth

a minimum of one

areas of focus in

which the capstone

project can impact

the student’s

personal practice

Does not address

section

Identifies and

discusses in-depth

a minimum of

three areas of focus

in which the

capstone project

can impact the

overall profession

of nursing

Identifies and

discusses in-depth

a minimum of

three areas of focus

in which the

capstone project

can impact the

overall profession

of nursing

Identifies and

discusses in-depth

a of two areas of

focus in which the

capstone project

can impact the

overall profession

of nursing

Identifies and

discusses in-depth

a of one areas of

focus in which the

capstone project

can impact the

overall profession

of nursing

Does not address

section

Students will present the capstone project objectives and discuss how they will improve the problem or issue being presented. Students will discuss strategies of the capstone project and how the strategies will help reach the objectives

Reading and Resources

Dickerson, P. (2010).  Continuing nursing education:  Enhancing professional development. Journal of Continuing Education in Nursing, 41(3), 100-101. 

Watson, J. (2008). Social Justice and human caring: A model of caring science as a hopeful paradigm for moral justice. Creative Nursing, 14(2), 54-61. 

The selected topic of the project proposal is the management and prevention of diabetes. Today, diabetes has become one of the deadliest diseases globally, which has had several impacts on the social and economic aspects. Therefore, based on the fact that there is no effective research which has been carried out concerning the internationally agreed management and prevention of Diabetes, the paper completely provides an in-depth explanation and discussion of the selected capstone project in detail and fully explains the importance and main purpose of the project proposal. Alongside that, the proposal identifies several ways on how the project will impact my own personal profession and also provides a number of ways on how the project will impact the nursing profession as a whole.